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Remote programming: A convenient and cost-effective measure of vagus nerve stimulation for children with epilepsy
Han Xie1, Taoyun Ji1, Jiayi Ma1
1Department of Pediatrics, Peking University First Hospital, 100034, China; Pediatric Epilepsy Center, Peking University First Hospital, 100034, China.
Insights
Remote programming for vagus nerve stimulation (VNS) in children with epilepsy is as effective and safe as outpatient programming. This method offers significant cost savings, particularly for families living far from specialized epilepsy centers.
Area of Science:
- Pediatric Neurology
- Epilepsy Management
- Medical Technology
Background:
- Vagus nerve stimulation (VNS) is a treatment for drug-resistant epilepsy in children.
- Programming VNS typically requires in-person outpatient visits.
- Remote programming offers a potential alternative to reduce patient burden.
Purpose of the Study:
- To compare the efficacy, adverse events, and cost-effectiveness of outpatient versus remote programming for VNS in pediatric epilepsy patients.
- To evaluate the impact of programming method on patient outcomes and healthcare expenses.
Main Methods:
- A non-randomized study of 46 children with drug-resistant epilepsy undergoing VNS.
- Patients were assigned to either outpatient or remote programming groups.
- Comparison of responder rates, seizure freedom, adverse events, and programming costs.
Main Results:
- Both groups showed comparable efficacy: 62.5% responders (outpatient) vs. 72.7% (remote), and 16.6% seizure-free (outpatient) vs. 17.4% (remote).
- Adverse events like cough and hoarseness were similar between groups.
- Remote programming was significantly more cost-effective ($75.8 vs. $192.4 per visit), especially for distant patients.
Conclusions:
- Remote VNS programming is a viable and cost-effective alternative to outpatient programming for pediatric epilepsy.
- The efficacy and safety profiles are comparable, with significant financial benefits for remote care.
- This approach is particularly advantageous for patients residing far from epilepsy centers.
Abstract:
This study aimed to evaluate the efficacy, adverse events and expense burden of outpatient versus remote programming for vagus nerve stimulation (VNS) in children with epilepsy. A total of 46 children with drug-resistant epilepsy, who underwent VNS at the Pediatric Epilepsy Center, Peking University First Hospital between March 2017 and June 2018, were enrolled into the study. Participants were assigned (non-randomized) into an outpatient programming group or remote programming group (where VNS parameters were adjusted through the internet) by parental choice. The responder rate, expenditure for VNS programming and adverse events were compared between the two groups. The median age at VNS implantation was 5.17 years (3.83-6.71), with the median epileptic course being 3.79 years (2.65-4.90). Twenty-four patients were assigned to the outpatient programming group and 22 were assigned to the remote programming group. Baseline data were comparable between the two groups, with the exception of the remote group having a longer distance between their place of residence and the hospital. The median time from VNS implantation to last follow-up was 1.33 years (1.25-1.75) and 1.46 years (1.17-1.58) in the outpatient and remote groups, respectively. In the outpatient programming group, 15 patients (62.5 %,) were VNS responders and four patients (16.6 %) became seizure-free. In the remote programming group, 16 patients (72.7 %) were VNS responders and four (17.4 %) became seizure-free. Cough and hoarseness were common adverse events in both the outpatient and remote groups (33.3 % vs. 18.2 %). There were no significant differences between the two groups in terms of adverse events. The median cost of each follow-up visit per patient in the outpatient group was 192.4 US dollars ($120.0-$376.5), of which travelling expenses were the major component, followed by accommodation fees, outpatient service fees and indirect costs. Whereas, patients in the remote programming group only needed to pay for the remote programming expense, which totaled 75.8 US dollars per person each time. The efficacy and adverse events were both comparable between the outpatient and remote programming patients. Remote programming was found to be a more cost-effective treatment, especially for patients living further away from centers specializing in epilepsy.
