Outcomes of vagal nerve stimulation in a pediatric population

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Outcomes of vagal nerve stimulation in a pediatric population: a single center experience.

Yu C, Ramgopal S, Libenson M, Abdelmoumen I, Powell C, Remy K, Madsen JR, Rotenberg A, Loddenkemper T. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, United States b Department of Pediatrics, The Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States c Department of Physiology, McGill University, Montreal, Quebec, Canada d Clinical Research Program, Boston Children’s Hospital, Boston, MA, United States e Department of Psychology, Emory University, Atlanta, GA, United States f Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States

Source:

Seizure. 2014 Feb;23(2):105-11. doi: 10.1016/j.seizure.2013.10.002. Epub 2013 Oct 17.

Aim:

to evaluate the efficacy of vagus nerve stimulation (VNS) in pediatric patients with medically refractory epilepsy.

Methods:

review of the medical records of 252 consecutive patients who underwent VNS implantation at a single center over a 5-year period. Patients with complete 6- and 12-month follow-up data were included. Analysis was also done across various subgroups including gender, age at implantation, seizure type, abnormal MRI findings pre-implantation, number of medications at baseline, history of SE, and duration of epilepsy.

Results:

complete follow-up data were available for 69 patients. Median seizure reduction for these patients was 50% (Q1: 0%; Q3: 73%) at 6 months and 40% (Q1: _25%; Q3: 75%) at 12 months. When stratified by baseline seizure frequency, there was a significant reduction from baseline of 61% at 6 months and 69% at 12 months for patients in the high-baseline frequency group. There were no significant reductions at month 6 or 12 months for the lower-baseline frequency group. Adverse events were reported in 40.6% (28 out of 69 patients). Six patients had the VNS removed for reasons including lack of efficacy and side effects and were excluded from the study group.

http://www.ncbi.nlm.nih.gov/pubmed/24438620

Comments of reviewer, Prof Van Nieuwenhuizen:

In this study a distinction is made between patients with ”high-baseline frequency” and with “low-baseline frequency”; cut-off point is the median seizure frequency at baseline. Cut-off point was 45 seizures/month. 45 patients were “low”; 34 patients were “high”.
At 6 months 53.6% of all patients had seizure reduction of ≥ 50%; 24.6% of ≥ 75%; 5.8% achieved seizure freedom. 46.4% had a seizure reduction of ≤ 50%; 24.6% experienced an increased number of seizures compared to baseline. The number of patients with increased seizures (17 of 69) is impressive. Median reduction of seizures in the overall population was 50%. “High” had a median reduction of 61%, which was significantly lower than baseline. “Low” experienced a 25% reduction.
At 12 months 40.6% of all patients had a seizure reduction of ≥ 50%; 24.6% ≥ 75%; 5.8% were seizure free. 59.4% had a seizure reduction of ≤ 50%; 28.9% experienced an increased number of seizures compared to baseline frequency. Again, number of patients with an exacerbation is considerable. Median reduction of the overall population was 40%. “High” had a significant median reduction of 69 %, whereas “low” did not show an overall reduction.
This study suggests greater potential of VNS in paediatric patients with higher frequencies. The number of patients with increased seizure frequency (24.6% at 6 months; 28.9% at 12 months) is impressive.

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