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Efficacy of vagal nerve stimulation in children with medically refractory epilepsy
R V Patwardhan1, B Stong, E M Bebin
1Division of Neurosurgery, University of Alabama at Birmingham, USA.
Insights
Vagal nerve stimulation (VNS) effectively reduced seizure frequency in most children with difficult-to-treat epilepsy. This treatment also significantly improved their quality of life, making it a valuable option.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurosurgery
Background:
- Medically refractory epilepsy in children presents significant management challenges.
- Vagal nerve stimulation (VNS) is an established treatment for refractory epilepsy.
- Assessing VNS efficacy on seizure control and quality of life in pediatric populations is crucial.
Purpose of the Study:
- To retrospectively analyze the impact of VNS on seizure frequency in children with medically refractory epilepsy.
- To evaluate the effect of VNS on the quality of life (QOL) for pediatric patients.
- To identify factors influencing VNS outcomes in children.
Main Methods:
- Retrospective analysis of 38 children (11 months to 16 years) who underwent VNS implantation.
- Preoperative and postoperative seizure frequency, type, and duration were recorded.
- Quality of life was assessed using a caretaker-reported visual analog scale (-1 to +1).
Main Results:
- A significant reduction in seizure frequency was observed in the majority of children (68% had ≥50% reduction).
- Seizure reduction varied by type: atonic (80%), absence (65%), complex partial (48%), generalized tonic-clonic (45%).
- Eighty-six percent of children experienced improved quality of life (QOL score ≥0.5), with a mean QOL change of 0.61.
Conclusions:
- VNS is an effective treatment for reducing seizure frequency in children with medically refractory epilepsy.
- VNS significantly improves the quality of life for the majority of pediatric patients.
- VNS should be considered for children with refractory epilepsy lacking a surgically resectable focus.
Objective:
The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy.
Methods:
Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of -1 (much worse) to +1 (much improved).
Results:
The median follow-up period was 12 months (range, 10-18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P < 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P < 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction.
Conclusion:
VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.