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Vagus nerve stimulation: clinical experience in drug-resistant pediatric epileptic patients
Franco Rychlicki1, Nelia Zamponi, Roberto Trignani
1Department of Neurosurgery, University of Ancona School of Medicine, Università di Ancona, Azienda Ospedaliera Umberto I, Torrette, Via Conca, 60100 Ancona, Italy. f.ryc@ao-umbertoprimo.marche.it
Insights
Vagus nerve stimulation (VNS) effectively reduces seizures in children with drug-resistant epilepsy, particularly partial epilepsy. This treatment is safe and well-tolerated, offering a valuable option when surgery is not feasible.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Vagus nerve stimulation (VNS) is an established treatment for refractory epilepsy in adults.
- Limited data exists on the efficacy and safety of VNS in pediatric populations.
- Drug-resistant epilepsy in children poses significant management challenges.
Purpose of the Study:
- To evaluate the clinical efficacy, safety, and neuropsychological effects of VNS in children with drug-resistant epilepsy.
- To assess the long-term outcomes of VNS in different pediatric epilepsy syndromes.
- To determine VNS as a potential add-on therapy for pediatric epilepsy.
Main Methods:
- Prospective study of 34 children (mean age 11.5 years) with drug-resistant epilepsy.
- Inclusion of patients with Lennox-Gastaut Syndrome, severe partial epilepsy with bisynchronous EEG, and partial epilepsy without bisynchronous EEG.
- Data collection included seizure frequency, quality of life, neuropsychological assessment, and adverse events over a mean follow-up of 30.8 months.
Main Results:
- Significant seizure reduction observed: 71% at 36 months.
- Better outcomes in partial epilepsy (with/without drop attacks) compared to Lennox-Gastaut Syndrome; 3 patients became seizure-free.
- Adverse events were minor and transient (e.g., voice alteration, coughing); no operative morbidity. Electrode breakage occurred in 2 patients.
Conclusions:
- Vagus nerve stimulation is an appropriate add-on treatment for children with drug-resistant partial epilepsy.
- VNS offers a viable alternative for pediatric patients ineligible for resective epilepsy surgery.
- The study supports the safety and efficacy of VNS in managing pediatric refractory epilepsy.
Introduction:
Vagus nerve stimulation (VNS) is an effective alternative treatment for patients with partial refractory epilepsy. Nevertheless, information regarding VNS in children is still limited.
Materials And Methods:
The clinical efficacy, safety and neuropsychological effects of VNS in 34 children (mean age 11.5 years) with drug-resistant epilepsy were studied. Mean follow-up was 30.8 months. Nine patients have been diagnosed with Lennox-Gastaut Syndrome, nine patients were affected by severe partial epilepsy with bisynchronous EEG and drop attacks, and 16 patients suffered from partial epilepsy without bisynchronous EEG and fall seizures. Forms were designed for prospective data collection on each patient's history, seizures, implants, device settings, quality of life (QOL), neuropsychological assessment and adverse events. Surgical technique was performed both by standard two incisions and single neck incision.
Results:
Mean reduction in total seizures was 39% at 3 months, 38% at 6 months, 49% at 12 months, 61% at 24 months and 71% at 36 months. Significant better results were obtained in partial epilepsy, with and without drop attacks, than in Lennox-Gastaut syndrome--three patients being seizure-free. No operative morbidity was reported. Side-effects were minor and transient--the most common were voice alteration and coughing during stimulation. In two patients, electrode breakage occurred 3 years after surgical procedure; in both cases, a new device was implanted after removing the vagal electrode coils and generator.
Conclusion:
VNS can be considered an appropriate strategy as an add-on treatment in children affected by drug-resistant partial epilepsy and ineligible for resective epilepsy surgery.
