Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy

Alexopoulos, Andreas V.; Kotagal, Prakash; Loddenkemper, Tobias; Hammel, Jeffrey; Bingaman, William

doi:10.1016/j.seizure.2006.06.002

Cited by 169 publications

(135 citation statements)

References 33 publications

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“…Typically, these symptoms abate with time or alteration of the stimulation parameters. 2,3,19,36,44,50 Significant or permanent injuries to the vagus nerve or development of dysphagia following implantation were rare (< 0.5%) in our series, and the rate is comparable to rates reported for other series (≤ 4%). The rate of infection was under 3%, which is comparable to rates reported in most large series (0%-8%) and similar to those reported for other implantable devices.…”

Section: Complications and Cosmetic Considerationssupporting

confidence: 86%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

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Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1–18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days–11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children.

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Section: Complications and Cosmetic Considerationssupporting

confidence: 86%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

View full text Add to dashboard Cite

show abstract

“…Indeed, younger patients implanted before the age of 12 years appeared to respond better than the older group of pediatric patients. 57 Notably, five of six children with Lennox-Gastaut syndrome had a 90% reduction of seizures at 30 months of follow-up. Other studies have demonstrated similar favorable responses of seizures associated with Lennox-Gastaut to VNS.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 92%

“…34,56 Longterm follow-up at 36 months revealed a mean seizure frequency reduction of 74%. 57 Strong associations between improved seizure severity and QOL have been made, as has been seen in the adult population. 34,58 In fact, Յ80% of patients had an improvement in the parental conception of the child's QOL.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 94%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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“…38,63 Long-term, follow-up at 36 months revealed a mean seizure frequency reduction of 74%. 64 VNS does appear to be a potential option for children under the age of Food and Drug Administration-approved indications. A recent report of VNS in children less than 5 years old demonstrated that 83% of patients had a significant decrease in seizure frequency at 22 months of follow-up.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 99%

“…Indeed, younger patients implanted before the age of 12 years appeared to respond better than the older group of pediatric patients. 64 Notably, children with Lennox-Gastaut syndrome have been shown to respond very favorably to VNS 66,67 The efficacy of VNS appears to compare favorably to corpus callosotomy in these patients. 68 Other studies have demonstrated similar seizure reduction in tuberous sclerosis complex.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 99%

Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

2009

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal anti-epileptic drug therapy. Chronic, intermittent vagus nerve stimulation has been proven to be an effective option for many patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, vagus nerve stimulation, as an adjunct to medical therapy, may result in significant improvements in quality of life. Vagus nerve stimulation is generally well-tolerated, as device implantation is associated with a low rate of perioperative complications, and the majority of side effects are stimulation-dependent and thus reversible.

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Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy

Cited by 169 publications

References 33 publications

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus Nerve Stimulation for Epilepsy and Depression

Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

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