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Vagus nerve stimulation in pediatric patients: Is it really worthwhile?
Vera C Terra1, Luciano L Furlanetti2, Altacílio Aparecido Nunes3
1Centro de Cirurgia de Epilepsia (CIREP), Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, SP, Brazil.
Insights
Vagus nerve stimulation (VNS) effectively reduces seizures in children with drug-resistant epilepsy. This treatment also decreased associated traumas, hospitalizations, and improved patient mood and alertness.
Area of Science:
- Neurology
- Pediatric Epilepsy Management
Background:
- Pharmacoresistant epilepsy poses significant challenges in pediatric patients.
- Vagal nerve stimulation (VNS) is an emerging treatment option for refractory epilepsy.
Purpose of the Study:
- To evaluate the efficacy and outcomes of VNS in pediatric patients with drug-resistant epilepsy.
- To compare VNS therapy with conventional antiepileptic drug treatment in a case-control study.
Main Methods:
- A prospective case-control study comparing children with refractory epilepsy treated with VNS implantation versus an age-matched control group on antiepileptic drugs.
- Data collected included age at epilepsy onset, neurological examination findings, prior epilepsy surgery history, and seizure frequency.
- Long-term follow-up assessed seizure reduction, associated morbidities, and subjective patient well-being.
Main Results:
- VNS group showed significantly earlier epilepsy onset (p=0.0001) and higher rates of abnormal neurological exams and prior ineffective epilepsy surgery.
- 55.4% of VNS patients experienced ≥50% seizure reduction, with 11.1% achieving ≥95% reduction.
- VNS treatment led to decreased traumas, hospitalizations, and improved mood and alertness, unlike the control group.
Conclusions:
- Vagus nerve stimulation is an effective therapeutic alternative for pediatric patients with drug-resistant epilepsy.
- VNS offers significant seizure reduction, decreased morbidity, and improved quality of life in this population.
- The study supports VNS as a valuable option for managing refractory pediatric epilepsy, aligning with existing literature.
Abstract:
Vagus nerve stimulation (VNS) seems to be effective in the management of selected cases of pharmacoresistant epilepsy in children. This was a case-control prospective study of children with refractory epilepsy submitted to vagal nerve stimulator implantation and a control group with epilepsy treated with antiepileptic drugs. Patients under 18years of age who underwent clinical or surgical treatment because of pharmacoresistant epilepsy from January 2009 to January 2012 were followed and compared with an age-matched control group at final evaluation. Statistically significant differences were observed considering age at epilepsy onset (VNS group - 1.33±1.45years; controls - 3.23±3.11; p=0.0001), abnormal findings in neurological examination (p=0.01), history of previous ineffective epilepsy surgery (p=0.03), and baseline seizure frequency (p=0.0001). At long-term follow-up, 55.4% of the patients in the VNS group had at least 50% reduction of seizure frequency, with 11.1% of the patients presenting 95% reduction on seizure frequency. Also, a decrease in traumas and hospitalization due to seizures and a subjective improvement in mood and alertness were observed. The control group did not show a significant modification in seizure frequency during the study. In this series, VNS patients evolved with a statistically significant reduction of the number of seizures, a decreased morbidity of the seizures, and the number of days in inpatient care. In accordance with the current literature, VNS has been proven to be an effective alternative in the treatment of pediatric patients with drug-resistant epilepsy.
