Vagus nerve stimulation therapy in patients younger than 18 years

Abstract

Nonpharmacologic treatment options are effective in reducing seizures and improving quality of life without the negative side effects associated with antiepileptic drug (AED) therapy among pediatric epilepsy patients. One such treatment, vagus nerve stimulation (VNS) therapy, appears to be particularly effective among pediatric patients with refractory seizures. Seizure severity and frequency, as well as quality of life, are improved with VNS therapy.

Invazív neuromoduláció a gyógyszerrezisztens epilepsziák kezelésében

“…Világszerte több mint 65 000 gyógyszerrezisztens epilepsziás él VNS-készülékkel, köztük számos gyermek, és ebben a populációban szintén hatékonynak és biztonságosnak találták a VNS-terápiát [25]. A kezdeti klinikai obszervációs vizsgálatok alapján az epilepsziaszindrómák többségében hatékonynak bizonyult [26].…”

Neuromodulatory Treatment of Medically Refractory Epilepsy

“…(Saillet et al 2009) Since that time, data from pediatric studies have shown similar outcomes in younger patients. (Wheless et al 2002) In 2005 an open, prospective, randomized, parallel group study directly comparing best medical practice with and without adjunctive VNS Therapy was initiated (http://clinicaltrials.gov/ct2/show/NCT01281280). Long-term data were collected on both health outcomes and seizure frequency to determine if a possible significant clinical benefit in health outcomes over time of best medical practice with or without adjunctive VNS Therapy in patients with drug-resistant epilepsy with partial-onset seizures.…”

Vagus nerve stimulation: current concepts

“…Vagus nerve stimulation is reserved for those who have drug-resistant epilepsy, and the FDA limits its use to patients older than 12 years of age. Note, however, that there is an increasing use of VNS in children younger than 12 years old, 24 in part because of the recognition that earlier control of seizures generally results in improved longterm outcomes. Drug-resistant epilepsy, defined as a failure to attain adequate seizure control after 3 treatment attempts, is a significant problem affecting 35-40% of people with epilepsy.…”

“…Furthermore, there is a suggestion that these patients also showed significant improvement in quality of life measures, which cannot be explained solely by seizure control. 1,4,24,25 Attempts to combine the ketogenic diet and VNS in children have suggested synergistic results; some patients stopped the diet because of a lack of response rather than the restrictiveness of the diet. 11 Except for initial problems with leads and pulse generators, recent studies have shown no difference in complications or adverse effects in children as compared with adults, and the maintenance of VNS therapy over time seems to be higher in children than adults.…”