VNS in children

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Vagal nerve stimulation in children under 12 years old with medically intractable epilepsy

S Healy & J Lang & J Te Water Naude & F Gibbon & P Leach

Childs Nerv Syst: published online May 17, 2013

Abstract

Objective

This study aims to assess the efficacy and safety of vagal nerve stimulation (VNS) in children less than12 years old operated on at the University Hospital Wales.

Methods

Retrospective review of patients undergoing VNS insertion, over a 3-year period, was undertaken. All children had a minimum follow-up period of 2 years. Sixteen patients were identified via the paediatric epilepsy surgery database. A case note review and telephone evaluation was conducted. Seizure frequency using the McHugh classification was the primary outcome measure, with anti-epileptic drug (AED) use as a secondary outcome measure.

Results

There were 10 males and 6 females. The mean time with epilepsy prior to surgery was 5.7 years and the mean age at the time of surgery was 7.6 years. Overall, nine (56 %) children experienced a reduction in their seizure frequency of

50 % or more. Of these, four (25 %) had a reduction of more than 80 %. Seven children (44 %) had no reduction in their seizure frequency, although two of these patients reported benefit regarding seizure control and post-ictal recovery. The VNS system was removed in two patients due to infection and no benefit, respectively. Half of the cohort (50 %) reduced the number of anti-epileptic drugs post-surgery, and there was an overall mean reduction of AED of 0.5.

Conclusion

This study suggests that VNS is a safe and effective adjuvant therapy in children under 12 years old, with over half reporting significant benefit. Further studies are needed to enable preoperative selection of patients in order to maximise the potential benefit.

http://www.ncbi.nlm.nih.gov/pubmed/23681311

Comments reviewer, Prof Van Nieuwenhuizen:

Studies in children below the age of 12 years are scarce, so this study is welcome to learn about efficacy and side effects of VNS in young children. On the other hand this study has several limitations: the number of patients is modest (16) and with regards to epilepsy diagnosis (causes, syndromes) there is much heterogeneity. The proposed McHugh classification is not generally accepted as preferred classification for the efficacy of VNS therapy.

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