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Vagus nerve stimulation: a 20-year Australian experience
Charles F Yates1,2,3, Kate Riney4,5, Stephen Malone4,5
1Department of Neurosurgery, Queensland Children's Hospital, Brisbane, QLD, Australia. Charles.Yates@health.qld.gov.au.
Insights
Vagus nerve stimulation (VNS) therapy offers significant long-term seizure reduction in children, with most patients retaining the treatment. Cessation is typically due to minimal benefit, not patient factors.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Management
Background:
- Vagus nerve stimulation (VNS) therapy, approved in the mid-1990s, shows efficacy in pediatric populations.
- Limited studies assess VNS outcomes beyond two years in children.
- Small pediatric cohort sizes restrict generalizability of current outcome assessments.
Purpose of the Study:
- To evaluate long-term outcomes and complications of VNS therapy in a large pediatric cohort.
- To assess VNS efficacy and safety over a 20-year period.
- To identify factors influencing VNS therapy outcomes in children.
Main Methods:
- Retrospective review of pediatric VNS insertions from 1999-2020.
- Inclusion criteria required a minimum of 1-year follow-up.
- Assessment included demographics, epilepsy details, seizure outcomes, and complications.
Main Results:
- Over 7 years of follow-up, 51.3% achieved ≥50% seizure reduction; 73.7% had Engel III outcome or better.
- 14.9% were seizure-free, and 81.6% retained long-term therapy.
- Side-effects occurred in 17.1%, but cessation was rare (3.9%); most cessation (13.2%) was due to minimal benefit.
Conclusions:
- VNS therapy provides significant long-term benefit for a majority of pediatric patients.
- Most patients retain VNS therapy, with minimal benefit being the primary reason for cessation.
- Outcomes are not influenced by underlying demographics, epilepsy etiology, or seizure type.
Background:
Vagus nerve stimulation (VNS) therapy was first approved in the mid-1990s in the USA, Europe and Australia, with demonstrable efficacy in paediatric populations. Benefit in seizure frequency reduction can be observed up to 2 years post-intervention; however, few studies assess outcomes beyond this period. Furthermore, paediatric cohort sizes are small, limiting generalisability of outcome assessments. We evaluate VNS insertion outcomes and complications or side-effects in a large paediatric cohort, over a 20-year period from Queensland's first VNS insertion.
Methods:
A retrospective review was conducted of all paediatric VNS insertions at the Queensland Children's Hospital (QCH) and the Mater Children's Hospital/Mater Children's Private Hospital (MCH/MCPH) Brisbane. A minimum of 1-year follow-up from 1999 to 2020 was required for inclusion. Patients were assessed on demographics, epilepsy details, seizure outcomes and complications or side-effects.
Results:
In this extended follow-up cohort (76 patients, 7.2 ± 5.3 years), 51.3% of patients had ≥ 50% seizure frequency reduction, while 73.7% experienced an Engel III outcome (worthwhile benefit) or better. Eleven patients (14.9%) were seizure-free at follow-up, and 81.6% retained long-term therapy. Stimulation-related side-effects are common (17.1%) but rarely result in stimulation cessation (3.9%). Cessation occurred in 14 patients (18.4%) and most commonly related to minimal benefit (13.2%). Demographics, aetiology, seizure nature and surgical factors did not influence outcomes.
Conclusion:
Over extended treatment periods, a large proportion of patients will benefit significantly from VNS therapy. Approximately 4 of 5 patients will retain VNS therapy, and in cases of cessation, this is most commonly related to minimal benefit. Underlying demographics, aetiology or seizure nature do not influence outcomes. This 20-year Queensland assessment of VNS therapy outcomes informs long-term expectation of VNS therapy.
