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Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy
Andreas V Alexopoulos1, Prakash Kotagal, Tobias Loddenkemper
1Department of Neurology, The Cleveland Clinic Foundation, Epilepsy Center, Desk S-51, Cleveland, OH 44195, USA. alexopa@ccf.org
Insights
Vagus nerve stimulation (VNS) effectively reduced seizure frequency in pediatric epilepsy patients, with better outcomes observed in younger children. Discontinuation was mainly due to lack of response or infection.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Pharmacoresistant epilepsy affects children, necessitating alternative treatments.
- Vagus nerve stimulation (VNS) is an established therapy for refractory epilepsy.
Purpose of the Study:
- To evaluate the efficacy and safety of VNS in pediatric patients with pharmacoresistant epilepsy.
- To compare seizure-frequency reduction and discontinuation rates between adolescent and pre-adolescent children.
Main Methods:
- Retrospective review of 46 pediatric patients with pharmacoresistant epilepsy who underwent VNS implantation.
- Analysis of seizure frequency, adverse events, and discontinuation rates pre- and post-VNS.
- Comparison of outcomes between children under 12 and those 12 years or older at implantation.
Main Results:
- VNS demonstrated significant seizure-frequency reduction, with a median reduction of 56% at 3 months, peaking at 83% at 24 months.
- Over 43% of patients achieved >75% seizure-frequency reduction; 10% were seizure-free long-term.
- The overall long-term discontinuation rate was 21.7%, primarily due to lack of efficacy or infection.
Conclusions:
- VNS is a well-tolerated and effective add-on therapy for refractory seizures in children across all age groups.
- Younger children (<12 years) showed a more favorable response to VNS therapy.
- Infection and insufficient clinical response were the main reasons for VNS discontinuation in this pediatric cohort.
Purpose:
To retrospectively review our experience with VNS in pediatric patients with pharmacoresistant epilepsy and examine the seizure-frequency outcome and rates of discontinuation in two age groups: adolescent and pre-adolescent children.
Results:
Complete pre- and post-VNS data were available for 46/49 patients. Median age at implantation was 12.1 (range 2.3-17.9) and median duration of epilepsy 8.0 (1.9-16.9) years. Twenty-one patients (45.6%) were under 12 years at the time of surgery. Median follow-up was 2 years; follow-up exceeded 4 years in 9/46 patients. As compared to baseline, median seizure-frequency reduction in the setting of declining numbers was 56% at 3 months, 50% at 6, 63% at 12, 83% at 24 and 74% at 36 months. When a last observation carried forward analysis was employed median seizure-frequency reduction in the range of 60% was observed at 1, 2 and 3 years post-VNS. Twenty patients (43.5%) had >75% seizure-frequency reduction. No response (increase or <50% reduction) was observed in 19/46 (41.3%). Five patients (10.1%) were seizure-free for more than 6 months by their last follow-up. There was no difference in the number of AEDs used before and after VNS. The long-term discontinuation rate was 21.7% and reflected a lack of clinical response or infection.
Conclusions:
In this series VNS was well-tolerated and effective as add-on therapy for refractory seizures in children of all ages. Response was even more favorable in the younger group (<12 years at implantation). Infection and lack of efficacy were the most common reasons for discontinuation of long-term VNS therapy in this group.
