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Left vagal nerve stimulation in children with refractory epilepsy. Preliminary observations
J V Murphy1, G Hornig, G Schallert
1Section of Neurology, Children's Mercy Hospital, Kansas City, Mo., USA.
Insights
Periodic left vagal nerve stimulation showed good tolerance and efficacy in children with intractable epilepsies. This intervention may offer a valuable role in managing their seizures and improving overall status.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Medically intractable epilepsies in children pose significant management challenges.
- Vagal nerve stimulation (VNS) is an established therapy for refractory epilepsy in adults.
- Limited data exists on VNS efficacy and tolerance in pediatric populations.
Purpose of the Study:
- To evaluate the tolerance and efficacy of periodic left vagal nerve stimulation (VNS).
- To assess VNS in a cohort of children with medically intractable epilepsies.
- To determine potential improvements in seizure frequency and overall well-being.
Main Methods:
- Implantation of a vagal nerve stimulator in 12 children with refractory epilepsies.
- Follow-up duration ranged from 2 to 14 months.
- Seizure frequency, global status ratings, antiepileptic drug use, and adverse events were systematically recorded.
Main Results:
- Five out of 12 patients experienced over a 90% reduction in monthly seizures.
- Global evaluations indicated no deterioration, with a notable number showing improved status.
- Four patients successfully reduced their antiepileptic drug regimen; no significant adverse events were reported.
Conclusions:
- Vagal nerve stimulation is well-tolerated in pediatric patients with intractable epilepsies.
- VNS may represent a viable adjunctive therapy for managing difficult-to-treat pediatric epilepsy.
- Further research is needed to identify specific epilepsy types or seizure characteristics that respond best to VNS.
Objective:
To observe the tolerance and efficacy of periodic left vagal nerve stimulation in a group of children with medically intractable epilepsies.
Design:
A vagal nerve stimulator (Cyberonics Inc, Webster, Tex) was implanted in 12 children with medically and surgically refractory epilepsies. These children were followed up for 2 to 14 months.
Outcome Measurements:
(1) The number of seizures recorded during the final month of observation was compared with the number recorded during the month before the implantation of the vagal nerve stimulator. (2) Parents were asked to compare overall status of their child, relative to the period prior to using the vagal nerve stimulator, on a global rating scale. (3) The number of antiepileptic drugs at the last visit was compared with the number before the use of this device. (4) Adverse events were recorded.
Results:
Five of the 12 patients had a greater than 90% reduction in the number of monthly seizures. Global evaluation scores indicated that there were no deteriorations from baseline and that there was a considerable number with improved status. Four patients were able to reduce the number of antiepileptic drugs used. No significant adversities were noted.
Conclusions:
The vagal nerve stimulator is well tolerated in children with intractable epilepsies, and it may have a role in their medical management. We were unable to determine specific epilepsies or seizures that were sensitive to this intervention.
