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Therapeutic effects of children with refractory epilepsy after vagus nerve stimulation in Taiwan
Sung-Tse Li1, Nan-Chang Chiu2, Kun-Long Hung3
1Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
Insights
Vagus nerve stimulation (VNS) effectively reduces seizures in children with refractory epilepsy (RE). Higher initial seizure frequency predicts greater seizure reduction after VNS treatment.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Medical Devices
Background:
- Refractory epilepsy (RE) in children poses significant treatment challenges.
- Vagus nerve stimulation (VNS) is an established add-on therapy for drug-resistant epilepsy.
- Taiwanese nationwide registry data provides a valuable resource for analyzing VNS effectiveness.
Purpose of the Study:
- To evaluate the therapeutic effects of VNS in pediatric patients with refractory epilepsy.
- To identify predictive factors for successful VNS treatment outcomes in children.
- To analyze seizure frequency reduction rates at different time points post-VNS implantation.
Main Methods:
- Retrospective analysis of 80 children with refractory epilepsy from December 2007 to December 2014.
- Categorization of patients into three groups based on baseline seizure frequency (high, moderate, low).
- Multivariate regression analysis to identify predictors of seizure frequency reduction.
Main Results:
- Significant decrease in seizure frequency observed at 12 and 24 months post-VNS treatment (44.6% and 50.1% reduction, respectively).
- Higher baseline seizure frequency (Group I) was a significant positive predictor of seizure reduction (p < 0.001).
- Coughing was the most common complication (10%), with no early treatment withdrawals due to adverse events.
Conclusions:
- Vagus nerve stimulation (VNS) demonstrates effectiveness as a palliative treatment for various seizure types in children with refractory epilepsy.
- Longer-term VNS treatment (24 months) shows improved seizure reduction compared to shorter-term (12 months).
- High baseline seizure frequency is a key positive predictor for VNS treatment success in pediatric refractory epilepsy.
Background:
Vagus nerve stimulation (VNS) is used as an add-on treatment for epilepsy. This study aimed to use Taiwanese nationwide registry data to analyze the therapeutic effects of VNS in children with refractory epilepsy (RE) and try to explore predictive factors of VNS treatment effectiveness.
Methods:
This retrospective study collected data from December 2007 to December 2014. Patient variables included gender, age, VNS implantation date, epilepsy duration, seizure frequency, seizure type, etiology, and antiepileptic drug (AED) history. We divided patients into three groups: Group I as seizure frequency >80 times per month, Group II as seizure frequency 24-80 times per month, and Group III as seizure frequency <24 times per month. Multivariate regression analysis was performed to determine predictors of seizure frequency reduction after VNS treatment.
Results:
A total of 80 patients were included in this study. Three or more AED types were prescribed for 61 (77.1%) patients. Seizure frequency decreased significantly at 12 and 24 months after VNS treatment. The mean seizure reduction rates were 44.6% and 50.1% at 12 and 24 months after VNS treatment, with the difference between them reaching statistical significance (p = 0.001). In multivariate linear regression, high seizure frequency (Group I) was a positive predictor of seizure frequency reduction (p < 0.001). The most common complication was coughing (eight patients, 10%) and no patient had early withdrawal or premature termination of VNS use due to complications.
Conclusion:
VNS is an effective palliative treatment for children with RE for different seizure types. Seizure reduction rate at 24 months after VNS was better than at 12 months after VNS. High seizure frequency can be regarded as a positive predictor for seizure frequency reduction in children with RE treated with VNS.
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