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Published on: January 7, 2019
Beneficial effects on sleep of vagus nerve stimulation in children with therapy resistant epilepsy
Tove Hallböök1, Johan Lundgren, Sven Köhler
1Department of Paediatrics, University Hospital, SE-221 85 Lund, Sweden. tove.hallbook@skane.se
Insights
Vagus Nerve Stimulation (VNS) improved sleep structure in children with epilepsy, increasing slow wave sleep and reducing sleep latency. These positive sleep changes correlated with reduced seizures and improved quality of life.
Area of Science:
- Neurology
- Sleep Medicine
- Pediatric Epilepsy
Background:
- Epilepsy negatively impacts sleep structure in children.
- Therapy-resistant epilepsy presents significant challenges in management.
- Vagus Nerve Stimulation (VNS) is an established treatment for refractory epilepsy.
Purpose of the Study:
- To evaluate sleep structure changes after Vagus Nerve Stimulation (VNS) in children with therapy-resistant epilepsy.
- To correlate VNS-induced sleep alterations with changes in epileptiform activity and clinical outcomes.
- To assess the impact of VNS on seizure severity, quality of life, and behavior.
Main Methods:
- Ambulatory polysomnography was used to assess sleep parameters in 15 children before and during VNS treatment (3 and 9 months).
- Sleep parameters, delta power, and movement times (MTs) for arousal estimation were analyzed.
- Epileptiform activity, seizure frequency, seizure severity (NHS3), quality of life (QOL), and behavior (CBCL) were quantified.
Main Results:
- VNS significantly increased slow wave sleep (SWS) and decreased sleep latency and stage 1 sleep.
- A significant increase in movement times (MTs) during sleep was observed, potentially related to VNS stimulation.
- Improvements in National Hospital Seizure Severity Scale (NHS3), quality of life (QOL), and behavior were noted, correlating with increased SWS and MTs.
Conclusions:
- Vagus Nerve Stimulation (VNS) positively modulates sleep architecture in children with therapy-resistant epilepsy, counteracting adverse effects of the condition.
- Increased slow wave sleep (SWS) following VNS may contribute to improvements in well-being and behavior.
- Observed increases in movement times (MTs) appear to be of minor clinical importance for quality of life and may be linked to VNS's antiepileptic mechanisms.
Abstract:
The study purpose was to evaluate sleep structure following Vagus Nerve Stimulation (VNS) in 15 children with therapy resistant epilepsy and to correlate possible alterations with changes in epileptiform activity and clinical effects. Fifteen children were examined with ambulatory polysomnographic recordings initially, and after 3 and 9 months of VNS-treatment. Sleep parameters, all-night delta power activity and movement times (MTs), used to account for arousals were estimated. Epileptiform activity was evaluated by spike detection. Seizure frequency was recorded in a diary. The severity of the seizures was scored with the National Hospital Seizure Severity Scale (NHS3). Quality of life (QOL) was assessed by a visual analogue scale. Behaviour problems were quantified by using the total score of the Child Behaviour Checklist (CBCL). VNS induces a significant increase in slow wave sleep (SWS) and a decrease in sleep latency and in stage 1 sleep. The number and density of MTs during total night sleep were significantly increased. There was also a significant increase in the number of MTs immediately related to the VNS stimulation periods. Of the 14 children with increased MTs, 10 had a reduction in epileptiform activity, and in clinical seizures, all had an improvement in NHS3, and 11 in QOL. Of the 10 children with increased SWS, eight also improved in QOL and eight in behaviour. Our findings indicate that VNS counteracts known adverse effects of epilepsy on sleep and increases slow wave sleep. This possibly contributes to the reported improvement in well-being. We also see an increase in MTs. This arousal effect seems to be of minor importance for QOL and could possibly be related to the antiepileptic mechanisms in VNS.
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