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Long term effect of vagus nerve stimulation in pediatric intractable epilepsy: an extended follow-up
Ayse Serdaroglu1, Ebru Arhan2, Gökhan Kurt3
1Pediatric Neurology Department, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey.
Insights
Vagus nerve stimulation (VNS) offers sustained seizure reduction in children with intractable epilepsy, with over 60% experiencing significant improvement long-term. This epilepsy treatment is well-tolerated, demonstrating its efficacy beyond five years.
Area of Science:
- Pediatric Neurology
- Epilepsy Management
- Neurostimulation
Background:
- Vagus nerve stimulation (VNS) is an established treatment for intractable epilepsy in children and adults.
- Previous studies focused on short-term VNS outcomes (up to 5 years) in pediatric populations.
- Extended long-term seizure outcomes in children treated with VNS remain underreported.
Purpose of the Study:
- To evaluate the long-term seizure outcomes of vagus nerve stimulation (VNS) in children with intractable epilepsy.
- To assess the efficacy and tolerability of VNS for periods exceeding five years.
- To identify factors influencing treatment response in pediatric epilepsy patients.
Main Methods:
- Retrospective analysis of 56 pediatric patients (4-17 years) who underwent VNS implantation for intractable epilepsy between 2000 and 2015.
- Data collected included demographics, epilepsy onset, VNS implantation details, antiepilepsy drug (AED) usage, and seizure frequency.
- Long-term follow-up included clinic visits and phone surveys for patients with extended observation periods.
Main Results:
- 62.5% of patients achieved >50% seizure reduction at long-term follow-up (mean duration >5 years).
- Eleven patients (19.6%) achieved complete seizure freedom.
- Seizure reduction efficacy was maintained or improved over time; age at seizure onset was a significant predictor of response.
- Common adverse events included hoarseness and cough; VNS was generally well-tolerated.
Conclusions:
- This study provides the first pediatric evidence of sustained VNS efficacy for over 5 years in intractable epilepsy.
- VNS demonstrates favorable long-term seizure control, with significant reduction in seizure frequency for a majority of patients.
- VNS is a safe and effective extended treatment option for pediatric intractable epilepsy.
Purpose:
Over the past two decades, vagus nerve stimulation (VNS) has become an accepted and viable treatment modality for intractable epilepsy both in children and adults. Earlier studies have demonstrated short-term seizure outcomes, usually for up to 5 years; so far, none have reported an extended outcome in children. We aimed to assess long term seizure outcome in children with intractable epilepsy for more than 5 years.
Methods:
We identified patients who had VNS implantation for treatment of intractable epilepsy from March 2000 to March 2015 at our Epilepsy Center and collected data including demographic, age at epilepsy onset and VNS implantation, duration of epilepsy, seizure type, number of antiepilepsy drugs (AEDs), and monthly seizure frequency before VNS implantation and at the last clinic visit. Phone surveys were conducted with patients without recent clinic follow-up.
Results:
Fifty-six patients (aged 4-17 at the time of implant) are the subjects of the study. Seizure reduction of >50 % was achieved in 9.8 % (6th month), 24 % (2nd year), 46.4 % (3rd year), and 54 %(5th year), and overall 35 (62.5 %) of the 56 subjects had a greater than 50 % reduction in seizure frequency at the last follow-up. Eleven patients became seizure free. The results, once obtained, were maintained steadily or even improved over time without any loss of efficacy during the follow-up. The only parameter, significantly related with clinical response, was age at seizure onset. The most frequent adverse events were hoarseness, cough, sore throat, and anorexia, experienced by 13 patients. Two patients had local wound infections and lead to the removal of the stimulator. An improvement in alertness, attention, and psychomotor activity, independent of the efficacy of vagal nerve stimulation, was observed in 8 patients.
Conclusion:
To our knowledge, this is the first pediatric study evaluating seizure outcome over more than 5 years of follow-up, and demonstrates a favorable seizure outcome of >50 % seizure frequency in 62.5 % of patients and seizure freedom in 11 patients. It is well tolerated over an extended period of time.
