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Early Implantation as a Main Predictor of Response to Vagus Nerve Stimulation in Childhood-Onset Refractory Epilepsy
Angelo Russo1, Ann Hyslop2, Valentina Gentile3
1419170IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy.
Insights
Early vagus nerve stimulator implantation in children with epilepsy improves quality of life. Performing the procedure within 5 years of seizure onset is key for favorable outcomes in drug-resistant epilepsy.
Area of Science:
- Neurology
- Pediatric Epilepsy Surgery
Background:
- Drug-resistant epilepsy affects pediatric patients often unsuitable for surgical resection.
- Vagus nerve stimulation (VNS) is an alternative neuromodulation therapy.
Purpose of the Study:
- To evaluate the efficacy of vagus nerve stimulator (VNS) implantation in pediatric patients with drug-resistant epilepsy.
- To identify predictors of favorable outcomes following VNS therapy.
Main Methods:
- Retrospective multicenter study of 89 pediatric patients (≤18 years) with drug-resistant epilepsy.
- Outcomes assessed at 1, 2, 3, and 5 years post-VNS implantation, defining favorable outcome as >50% seizure reduction.
- Statistical analysis included Fisher exact test and logistic regression.
Main Results:
- At last follow-up, 31.5% of patients achieved >50% seizure reduction, with 5.2% seizure-free.
- VNS implantation within 3 years of epilepsy onset predicted favorable outcomes.
- Improved quality of life was reported by 65.2% of patients; 12.4% experienced mild adverse events.
Conclusions:
- Early VNS implantation (within 5 years of seizure onset) is the sole predictor of favorable clinical outcomes in pediatric epilepsy.
- Vagus nerve stimulation therapy offers improved quality of life with a low incidence of significant adverse events in this population.
Objective:
We describe a multicenter experience with vagus nerve stimulator implantation in pediatric patients with drug-resistant epilepsy. Our goal was to assess vagus nerve stimulation efficacy and identify potential predictors of favorable outcome.
Methods:
This is a retrospective study. Inclusion criteria: ≤18 years at time of vagus nerve stimulator implantation, at least 1 year of follow-up. All patients were previously found to be unsuitable for an excisional procedure. Favorable clinical outcome and effective vagus nerve stimulation therapy were defined as seizure reduction >50%. Outcome data were reviewed at 1, 2, 3, and 5 years after vagus nerve stimulator implantation. Fisher exact test and multiple logistic regression analysis were employed.
Results:
Eighty-nine patients met inclusion criteria. Responder rate (seizure frequency reduction >50%) at 1-year follow-up was 25.8% (4.5% seizure-free). At last follow-up, 31.5% had a favorable outcome and 5.2% were seizure free. The only factor significantly predicting favorable outcome was time to vagus nerve stimulator implantation, with the best outcome achieved when vagus nerve stimulator implantation was performed within 3 years of seizure onset. Implantation between 3 and 5 years after epilepsy onset correlated with better long-term seizure freedom (13.3% at T5). Overall, 65.2% of patients evidenced improved quality of life at last follow-up. However, 12.4% had adverse events, but most were mild and disappeared after 3-4 months.
Conclusions:
Early vagus nerve stimulator implantation within 5 years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients. Improved quality of life and a low incidence of significant adverse events were observed.
