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Vagus Nerve Stimulation in children: A focus on intellectual disability
Jo Sourbron1, Sylvia Klinkenberg2, Alfons Kessels3
1Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
Insights
Vagus Nerve Stimulation (VNS) shows less efficacy in pediatric epilepsy patients with intellectual disability (ID) compared to those without ID. However, VNS may still be considered for this subgroup, with reported quality of life improvements and well-tolerated side effects.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Intellectual Disability
Background:
- Vagus Nerve Stimulation (VNS) is an established add-on therapy for drug-resistant epilepsy in non-surgical candidates.
- Limited evidence exists regarding VNS efficacy in pediatric patients with intellectual disability (ID).
Purpose of the Study:
- To review VNS data in pediatric epilepsy patients (≤18 years).
- To specifically analyze VNS outcomes in the challenging subpopulation with ID.
Main Methods:
- A comprehensive literature search was conducted across Cochrane, EMBASE, PubMed, and MEDLINE.
- A meta-analysis included seven studies that reported separate outcomes for patients with and without ID.
Main Results:
- VNS was found to be less effective in pediatric epilepsy patients with ID compared to those without ID (p=0.028, OR 0.18).
- No prospective controlled studies were identified.
- Quality of life improvements were reported in the ID subpopulation, with generally transient and well-tolerated adverse events; no cognitive or behavioral side effects were noted.
Conclusions:
- VNS may warrant consideration in the early treatment of pediatric epilepsy with ID, despite reduced efficacy compared to non-ID peers.
- Current data, primarily from retrospective studies with limitations in follow-up and control groups, should be interpreted cautiously.
- VNS remains a viable option for children with drug-resistant epilepsy and ID, but further high-quality research is needed.
Introduction:
Vagus Nerve Stimulation (VNS) can be an efficacious add-on treatment in patients with drug-resistant epilepsy, who are not eligible for surgery. Evidence of VNS efficacy in children with intellectual disability (ID) is scarce.
Objectives:
The purpose of this study was to review all available VNS data in the pediatric population (≤18 years old) and focus on the subpopulation with ID since appropriate treatment of these children is often challenging and complex.
Methods:
Cochrane, EMBASE, PubMed and MEDLINE were used to collect all research associated to VNS and ID (or synonyms) leading to a total of 37 studies. Seven studies showed the results of patients with ID and those without separately; thereby only these studies were included in the VNS meta-analysis.
Results:
Our meta-analysis showed that VNS was less effective in pediatric epilepsy patients with ID compared to those without ID (Mantel-Haenszel meta-analysis; p = 0.028, OR 0.18 (CI 95% 0.039-0.84)). However, there were no prospective controlled studies. Numerous studies reported quality of life (QoL) improvements in this subpopulation. The most common adverse events were transient and well tolerated. Side effects on cognition and behavior were not reported.
Discussion:
These results might be a reason to consider VNS early on in the treatment of this subgroup. The significantly greater amount of retrospective studies, differences in follow-up (FU), lack of control data, heterogeneous series and limited number of patients could have biased the outcome measurements. Hence, current data do not exclude VNS for children with drug-resistant epilepsy and ID but should be interpreted with caution.
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