Nerve Stimulation In Children Research Articles

Percutaneous Electrical Nerve Stimulation in Children With Therapy Resistant Nonneuropathic Bladder Sphincter Dysfunction: A Pilot Study

We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant, nonneuropathic bladder sphincter dysfunction. In a prospective study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and/or pharmacotherapy. The device for percutaneous electrical nerve stimulation consists of an interface cable, a surface electrode, a percutaneous needle and a portable stimulator. The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz. for 30 minutes once weekly. Every 6 weeks the children were evaluated. Evaluation parameters were urgency, daytime incontinence, voiding frequency, the uroflowmetry curve and bladder capacity. When favorable results were observed after 6 sessions, therapy was continued for another 12 sessions. In 24 children anticholinergics started before stimulation that had only a partial effect were continued during stimulation. In 7 of the 28 children with urgency before therapy it disappeared after therapy and in 10 it improved. Of the 23 children with daytime incontinence before treatment 4 became dry after stimulation and in 12 incontinence decreased. Of the 19 patients who reported disturbed voiding frequency of less than 4 or more than 8 voids daily 16 achieved a normal frequency of 4 to 6 voids daily. In 21 children an abnormal uroflowmetry curve was observed before stimulation, while in 9 the flow curve was normal after therapy. Mean bladder capacity increased significantly from 185.16 to 279.19 ml. Percutaneous electrical nerve stimulation has a significant effect on voiding frequency, the uroflowmetry curve and bladder capacity in children with nonneurogenic bladder sphincter dysfunction

Percutaneous Electrical Nerve Stimulation in Children With Therapy Resistant Nonneuropathic Bladder Sphincter Dysfunction: A Pilot Study

Percutaneous Electrical Nerve Stimulation in Children With Therapy Resistant Nonneuropathic Bladder Sphincter Dysfunction: A Pilot Study

Vagus nerve stimulation therapy in pediatric patients with refractory epilepsy: retrospective study.

This six-center, retrospective study evaluated the effectiveness, tolerability, and safety of vagus nerve stimulation in children. Data were available for 125 patients at baseline, 95 patients at 3 months, 56 patients at 6 months, and 12 patients at 12 months. The typical patient, aged 12 years, had onset of seizures at age 2 years and had tried nine anticonvulsants before implantation. Collected data included preimplant history, seizures, implant, device settings, quality of life, and adverse events. Average seizure reduction was 36.1% at 3 months and 44.7% at 6 months. Common adverse events included voice alteration and coughing during stimulation. Rare adverse events, unique to this age group, included increased drooling and increased hyperactivity. Quality of life improved in alertness, verbal communication, school performance, clustering of seizures, and postictal periods. We concluded that vagus nerve stimulation is an effective treatment for medically refractory epilepsy in children.

Vagus nerve stimulation in children with therapy-resistant epilepsy diagnosed as Lennox-Gastaut syndrome: clinical results, neuropsychological effects, and cost-effectiveness.

We studied the clinical efficacy and tolerability, neuropsychological effects, and cost-effectiveness (direct medical costs, direct nonmedical costs, and indirect costs) of vagus nerve stimulation (VNS) in children with Lennox-like syndrome (n = 16). The situation 6 months before implantation of the device is compared with that 6 months after surgery. Seizure frequency and severity are significantly reduced during VNS: 25% of the patients show a reduction in seizure frequency of 50% or greater; overall seizure reduction is 26.9%. Measures of neuropsychological outcome show a moderate improvement in mental functioning, behavior, and mood. The scores for mood and mental age improve independently of seizure control. Side effects are minor and transient. There is a significant reduction in direct non-health care costs, ergotherapy, and the number of days of sub-optimal functioning of the child. The costs during the 6 postoperative months are 2,876.06 Euros less than the costs during the 6 months before VNS; the payback period is 2.3 years.

Vagus Nerve Stimulation in Children with Refractory Seizures Associated with Lennox–Gastaut Syndrome

Vagus nerve stimulation (VNS) is approved for use for refractory partial seizures. Nevertheless, information regarding VNS therapy for special populations, including Lennox-Gastaut syndrome (LGS) is limited. We discuss the effectiveness, tolerability, and safety of VNS therapy in patients with LGS. A six-center, retrospective study evaluated the effectiveness of VNS therapy in patients with LGS at 3 and 6 months and compared preimplant and postimplant seizure frequency. Adverse effects and quality of life (QOL) were included as secondary measures. Fifty patients, median age 13 years, with medically refractory epilepsy, were implanted. Median age at onset of seizures was 1.4 years, and a median of nine anticonvulsants (AEDs) had been tried before implantation. Data-collection forms were designed for retrospectively gathering data on each patient's preimplant history, seizures, implants, device settings, QOL, and adverse events. Median reductions in total seizures were 42% at 1 month, 58.2% at 3 months, and 57.9% at 6 months. The most common adverse events reported were voice alteration and coughing during stimulation. Other uncommon adverse events included increased drooling and behavioral changes. Investigators noted that QOL had improved for some patients in the study. VNS is an effective treatment for medically refractory epilepsy in LGS. This treatment is well tolerated, safe, and may improve QOL.

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy. Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of -1 (much worse) to +1 (much improved). The median follow-up period was 12 months (range, 10-18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P < 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P < 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction. VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

ABSTRACT OBJECTIVE The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy. METHODS Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of −1 (much worse) to +1 (much improved). RESULTS The median follow-up period was 12 months (range, 10–18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P &amp;lt; 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P &amp;lt; 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction. CONCLUSION VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.

Vagal nerve stimulation in children

Vagal nerve stimulation is a new therapeutic option for patients with medically refractory epilepsy. The FDA approved the NeuroCybernetic Prosthesis (NCP) in July 1997 for use in adults and adolescents over the age of 12 years with medically refractory epilepsy. Most of the patients in the initial pilot studies and subsequent extended longitudinal and randomized controlled studies were adults. There were small numbers of children who received the NCP system. However, these were not part of controlled studies. As the system has had greater exposure in the United States and Europe, there are more children who are receiving vagal nerve stimulation (VNS). Initial data from open-label, uncontrolled studies suggest that VNS does have some efficacy and safety for those children with refractory epilepsy who have not responded to appropriate trials of antiepileptic drugs. The questions to be asked and answered are as follows: (1) When is a child medically refractory? (2) What are the criteria for selection for VNS? (3) Which seizure types or syndromes will benefit most from the treatment? and (4) What are the most effective and safe stimulation parameters, and do these vary depending on the seizure type?

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

781 Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

781 Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Maturation of near-field and far-field somatosensory evoked potentials after median nerve stimulation in children under 4 years of age

Objectives: The maturation of subcortical SEPs in young children.Methods: Median nerve SEPs were recorded during sleep in 42 subjects aged 0–48 months. Active electrodes were at the ipsilateral Erb's point, the lower and upper dorsal neck, and the frontal and contralateral centroparietal scalp; reference electrodes were at the contralateral Erb's point, the ipsilateral earlobe and the frontal scalp; bandpass was 10–3000 Hz. The peaks were labelled by their latencies in adults.Results: The peak latencies of N9 (brachial plexus potential) decreased exponentially with age during the first year, but increased with height thereafter. The interpeak latencies (IPLs) N9–N11, which measure conduction between brachial plexus and dorsal column, decreased with age (linear regression). The IPLs N11–P13 and N11–N13b, which measure conduction between the dorsal column and approximately the cervico-medullary junction, did not change across this age range. The IPLs N13a–N20, N13b–N20 and P13–N20, which measure central conduction, showed negative exponential regressions with rapidly decreasing latencies during the first year of life and slowly decreasing latencies thereafter.Conclusions: Maturation of the peripheral segments of the somatosensory pathway progresses more rapidly than that of the central segments. The maturation of central conduction is not completed within the first 4 years of age. Our maturational data may serve as a reference source for subsequent developmental and clinical studies.

Left vagal nerve stimulation in children with medically refractory epilepsy

Objective: To assess the use of intermittent left vagal nerve stimulation in a large population of children with pharmacoresistant epilepsy. Study design: Sixty children who were entered into controlled or compassionate use protocols of left vagal nerve stimulation all had been monitored for at least 3 months after their left vagal nerve stimulators were activated. Results: The age range was 3½ to 18 years (median 15 years). Sixteen of these 60 patients were younger than 12 years. Fifty-seven percent of the patients had partial complex seizures, and generalized tonic clonic seizures occurred in 27%. After 3 months of intermittent stimulation of the left vagal nerve, a median reduction in seizure frequency of 23% occurred in 60 patients. At 6 months the median reduction was 31% in 55 patients, at 12 months 34% in 51 patients, and at 18 months 42% in 46 patients. Improvement was not associated with any seizure type or seizure cause. Adverse events during stimulation included fever, coughing, colds, and voice alteration. None of these necessitated cessation of stimulation. Complications included aspiration pneumonia and necrosis of skin overlying the generator. Conclusions: Intermittent stimulation of the left vagal nerve appears to be a safe, adjunctive therapy for the treatment of children with epilepsy intractable to available antiepileptic drugs. The reduction in seizure frequency in children was similar to that reported in adults. (J Pediatr 1999;134:563-6)

Subcortical somatosensory evoked potentials after median nerve stimulation in children

We report our normative data of subcortical somatosensory evoked potentials (SEPs) after median nerve stimulation from a group of 55 children 4-15 years of age and 18 young adults 18-29 years of age. We recorded near-field potentials from the brachial plexus, the cervical cord and the somatosensory cortex. The far-field potentials P13, P14 and N18 from the brainstem were recorded from the scalp electrodes, when a non-cephalic reference at the contralateral Erb's point or an ear reference was used. The N9 (brachial plexus), N13a (dorsal horn), P13 (caudal medulla oblongata), N18 (medulla oblongata) and N20 (somatosensory cortex) were present in all subjects. The N13b (dorsal column near the foramen magnum or cuneate nucleus) was observed in all children and in 16 adults, P14 (medial lemniscus) in 52 children and 17 adults. The median nerve SEPs provide reliable information about the function of the somatosensory pathway from the upper limb. The subcortical median nerve SEPs should be particularly useful to detect lesions of the upper cervical cord and the cervicomedullary junction. The subcortical SEPs remain unchanged during sleep and facilitate reliable SEP recordings, when sedation is necessary in infants and children.

Left vagal nerve stimulation in children with refractory epilepsy. Preliminary observations.

To observe the tolerance and efficacy of periodic left vagal nerve stimulation in a group of children with medically intractable epilepsies. A vagal nerve stimulator (Cyberonics Inc, Webster, Tex) was implanted in 12 children with medically and surgically refractory epilepsies. These children were followed up for 2 to 14 months. (1) The number of seizures recorded during the final month of observation was compared with the number recorded during the month before the implantation of the vagal nerve stimulator. (2) Parents were asked to compare overall status of their child, relative to the period prior to using the vagal nerve stimulator, on a global rating scale. (3) The number of antiepileptic drugs at the last visit was compared with the number before the use of this device. (4) Adverse events were recorded. Five of the 12 patients had a greater than 90% reduction in the number of monthly seizures. Global evaluation scores indicated that there were no deteriorations from baseline and that there was a considerable number with improved status. Four patients were able to reduce the number of antiepileptic drugs used. No significant adversities were noted. The vagal nerve stimulator is well tolerated in children with intractable epilepsies, and it may have a role in their medical management. We were unable to determine specific epilepsies or seizures that were sensitive to this intervention.

Electrophysiological study on hydranencephaly

An electrophysiological study was performed on 2 children with hydranencephaly diagnosed by CT and/or MRI. Case 1 was a 4-month-old boy who had no rostral tissues above the midbrain. Case 2 was a 5-year-old boy in whom CT showed retention of the thalamus. Short latency somatosensory evoked potentials (SSEP) in both cases exhibited the absence of cortical activity (N1 and P4) with the preservation of waves of brain stem origin. However, in case 1, wave component No was not observed, while No was seen in case 2. It was postulated, thus, that the No component of SSEP on median nerve stimulation in children, which corresponds to N16 in adults, may originate in the thalamus.

Short Latency Somatosensory Evoked Potentials Following Median Nerve Stimulation in Children

Short Latency Somatosensory Evoked Potentials Following Median Nerve Stimulation in Children