Long-term effects of vagus nerve stimulation in refractory pediatric epilepsy: A single-center experience

Dilek Yalnizoglu,Didem Ardicli,Burcak Bilginer,Bahadir Konuskan,Kader Karli Oguz,Nejat Akalan,Güzide Turanli,Serap Saygi,Meral Topcu

doi:10.1016/j.yebeh.2020.107147

Dilek Yalnizoglu, Didem Ardicli + Show 7 more

Open Access

https://doi.org/10.1016/j.yebeh.2020.107147

Copy DOI

Journal: Epilepsy & Behavior	Publication Date: Jun 27, 2020
Citations: 13	License type: cc-by

Affiliation: Hacettepe University

Abstract

IntroductionVagus nerve stimulation (VNS) has been used as an adjunctive therapy for both children and adults with refractory epilepsy, over the last two decades. In this study, we aimed to evaluate the long-term effects and tolerability of VNS in the pediatric drug-resistant epilepsy (DRE) and to identify the predictive factors for responsiveness to VNS. MethodsWe retrospectively reviewed the medical records of pediatric patients who underwent VNS implantation between 1997 and 2018. Patients with ≥50% reduction of seizure frequency compared with the baseline were defined as “responders”. The clinical characteristics of responders and nonresponders were compared. ResultsA total of 58 children (male/female: 40/18) with a mean follow-up duration of 5.7 years (3 months to 20 years) were included. The mean age at implantation was 12.4 years (4.5 to 18.5 years). Approximately half (45%) of our patients were responders, including 3 patients (5.8%) who achieved seizure freedom during follow-up. The age of seizure-onset, duration of epilepsy, age at implantation, and etiologies of epilepsy showed no significant difference between responders and nonresponders. Responders were more likely to have focal or multifocal epileptiform discharges (63%) on interictal electroencephalogram (EEG), when compared to nonresponders (36%) (p = .07). Vocal disturbances and paresthesias were the most common side effects, and in two patients, VNS was removed because of local reaction. ConclusionOur series had a diverse etiological profile and patients with transition to adult care. Long-term follow-up showed that VNS is an effective and well-tolerated treatment modality for refractory childhood onset epilepsy. Age at implantation, duration of epilepsy and underlying etiology are not found to be predictors of responsiveness to VNS. Higher response rates were observed for a subset of patients with focal epileptiform discharges.

Highlights

Vagus nerve stimulation (VNS) has been used as an adjunctive therapy for both children and adults with refractory epilepsy, over the last two decades
We aimed to evaluate the long-term effects and the tolerability of VNS therapy in pediatric patients followed in our center and to compare the clinical characteristics between responders and nonresponders
The VNS implantation was performed in 24 patients (41%) b12 years of age and in 34 (59%) ≥ 12 years of age

Summary

Introduction

Vagus nerve stimulation (VNS) has been used as an adjunctive therapy for both children and adults with refractory epilepsy, over the last two decades. We aimed to evaluate the long-term effects and tolerability of VNS in the pediatric drug-resistant epilepsy (DRE) and to identify the predictive factors for responsiveness to VNS. Long-term follow-up showed that VNS is an effective and well-tolerated treatment modality for refractory childhood onset epilepsy. Over the past two decades, vagus nerve stimulation (VNS, Cyberonics®) has become an accepted treatment modality with a predictable and benign side-effect profile for both pediatric and adult patients with DRE, who are not suitable candidates for epilepsy surgery or have failed surgery [5]. There are limited numbers of studies with long-term outcomes especially more than 10 years follow-up period of VNS therapy in the pediatric age group [8,11,12]

Objectives

Methods

Results

Discussion

Conclusion