Vagus nerve stimulation (VNS) is a safe and effective therapy that has been available for over 20 years for adults and children with drug resistant epilepsy (DRE). Since U.S. Food and Drug Administration approval in 1997, VNS has been implanted in over 100,000 patients including over 30,000 children as an adjunctive therapy in reducing the frequency of seizures in patients 4 years of age and older with focal seizures that are refractory to antiseizure medications. VNS Therapy® has evolved over time and currently offers closed-loop, responsive stimulation as well as advanced features that streamline dosing and patient management. Advanced Practice Providers (APPs) such as nurse practitioners, physician assistants and clinical nurse specialists are integral in a comprehensive healthcare team, and dedicated VNS clinics have formed at comprehensive epilepsy centers across the world that are often managed by APPs. This approach improves access, education, and continuity of care for those with VNS or those considering VNS. Here we provide a review for APPs on the VNS Therapy® system focused on new features, dosing, and troubleshooting strategies with the goal to provide guidance to those managing VNS patients.

AIM Screening for cognitive impairment, developmental delay, and neuropsychiatric problems is not always performed in children with epilepsy. The aim of this study was to assess the value of this screening and its validity for determining previously unidentified ('actionable') problems in children with epilepsy. METHOD RESULTS We screened 236 children overall (136 males [58%], 100 females [42%]; mean age[SD] 6y 7mo [4y 6mo]). Of these, 176 children (75%) had established epilepsy diagnoses and 60 (25%) were patients with new-onset epilepsy. Of those with new-onset disease, 22 (37%) were determined not to have epilepsy. Positive findings by test were 82% (ASQ), 54% (mCHAT), 15%, (SCQ), and 58% (SDQ). Findings were actionable in 46 children (20%): 18% of findings in children with established epilepsy and 23% of findings in patients with new-onset epilepsy. Of the 46 children for whom further referrals were made, the parents of 28 (61%) have pursued further evaluations. INTERPRETATIONIn this study, children with existing and new-onset diagnoses of epilepsy had actionable screening findings. These findings support the development of systematic screening of comorbidities for children with epilepsy.Children with epilepsy are at a higher risk of developmental, cognitive, and behavioral difficulties that may have consequences lasting into adulthood. 1These problems can be present at onset 2,3 or develop during the course of epilepsy, possibly in association with the occurrence of seizures, the treatment of epilepsy, or the possible comorbidity with epilepsy of cognitive, neurodevelopmental, and psychiatric disorders. While recommendations exist for routine screening for developmental delay and autism in all infants and toddlers 5 and depression in adolescents, 6 adherence to these recommendations has not been measured. Given that children with epilepsy are at particularly high risk of these difficulties, we sought to assess the value of a routine screening program in our hospital-based epilepsy center. METHOD PatientsThe parents of all patients seen in either the monitoring unit or the ketogenic diet clinic of the epilepsy center were asked to complete a series of screening questionnaires. The comorbidity screening program has been part of standard care in our center since November 2010. The patients seen in the epilepsy monitoring unit were either established patients of the clinic or new patients who were being evaluated for the first time and had not yet received a diagnosis of epilepsy.Parents provided written informed consent and the children assented as appropriate for their age and level of development. All procedures were approved by the Ann and Robert H Lurie Children's Hospital of Chicago institutional review board. MeasuresDevelopment was assessed using the Ages and Stages Questionnaire (ASQ, age 1-66mo). Each screening instrument used took 10 to 15 minutes to complete. Depending on the age of the child, the combination of screening questionnaires took parents 20 to 50 minutes to complete, with the majority f...

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