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Improvement in alertness and behavior in children treated with combination topiramate and vagus nerve stimulation
Eric H Kossoff1, Paula L Pyzik
1Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. ekossoff@jhmi.edu
Insights
Vagus nerve stimulation (VNS) combined with topiramate significantly improved behavior and reduced seizures in three boys with refractory epilepsy. This combination therapy showed benefits beyond seizure reduction alone.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurostimulation
Background:
- Vagus nerve stimulation (VNS) is known to improve behavior in children.
- Topiramate's effect on behavior in pediatric epilepsy is less defined.
- Refractory epilepsy in children presents significant behavioral challenges.
Observation:
- Three boys (aged 5-12) with generalized slow spike-wave discharges and refractory epilepsy were treated.
- Combination therapy included topiramate and VNS.
- Significant seizure reduction was observed in all three patients.
Findings:
- Dramatic improvements in aggression, social interaction, and ambulation were noted.
- A Cyberonics Patient Outcome Registry query revealed behavioral benefits beyond VNS and other anticonvulsants.
- These behavioral improvements were not solely attributable to seizure reduction, which was differential at 12 months.
Implications:
- Combination therapy of VNS and topiramate may offer significant behavioral benefits for children with refractory epilepsy.
- Further research is warranted to explore the mechanisms behind these behavioral improvements.
- This approach could represent a novel therapeutic strategy for managing complex pediatric epilepsy cases.
Abstract:
It has been reported that vagus nerve stimulation (VNS) improves behavior in children, whereas topiramate has a less clear effect. Three boys, aged 5-12 years, with generalized slow spike-wave discharges and refractory epilepsy, were treated with combination therapy of topiramate and VNS. All three had a significant reduction in seizures, but even more dramatic improvement in aggression, social interaction, and ambulation. The Cyberonics Patient Outcome Registry was subsequently queried and a beneficial effect of this combination therapy on behavior (specifically alertness) beyond that of VNS and other anticonvulsants was noted. This did not appear to be due solely to seizure reduction, which was observed only differentially at 12 months.
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