Vagus nerve stimulation for control of intractable seizures in childhood

Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for children with intractable epilepsy. VNS offers several advantages over extant treatments. Its efficacy is maintained during prolonged stimulation, and seizure control actually improves with time. There is no associated cognitive impairment and no adverse drug interactions. Unlike cerebral surgery, VNS is a potentially reversible form of therapy. The computer-controlled characteristic of the device permits complete and involuntary treatment compliance. VNS is safe and well-tolerated. Its side effects are generally transient and mild, and no physiologic perturbations have been reported despite extensive monitoring. Serious adverse events are rare, and no deaths have been attributed to VNS therapy itself or to the technique of surgical insertion. In this article, we discuss the theoretical background behind VNS and review the clinical studies that substantiate its long-term safety, feasibility, tolerability and potential efficacy in children with refractory epilepsy.