SAN ANTONIO—Vagus nerve stimulation (VNS) can safely reduce seizures in pediatric patients with medically refractory epilepsy, according to research presented at the 64th Annual Meeting of the American Epilepsy Society.
Takamichi Yamamoto, MD, of the New York University Langone Medical Center, and colleagues performed a retrospective analysis to determine VNS’s indications, effectiveness, and safety in children younger than 15. The study included 70 patients (38 girls) who were implanted with the VNS Therapy System (Cyberonics, Inc, Houston) and followed for 29 to 150 months, with an average follow-up of 83.3 months.
Indications for Treatment
In 56 patients—28 with generalized epilepsy and 28 with multifocal epilepsy—VNS was indicated because cranial surgery was not appropriate. Twelve patients received VNS because of failed cranial surgery. One patient received the treatment because of unsuitability for cranial surgery due to poor general condition, and another received it because the patient’s family preferred trying VNS first.
Effective and Safe
VNS reduced seizures by 80% or more in 19 patients, by 50% or more in 18 patients, and by less than 50% in 20 patients, while 13 patients showed no response to the treatment in terms of seizure frequency. No obvious differences were observed in the responder rates of patients with localization-related epilepsy and those with generalized epilepsy. Furthermore, no significant differences were observed in seizure reduction between patients treated with VNS alone and those treated with both VNS and cranial surgery.
Only one patient had a perioperative complication—a wound infection—and this patient’s VNS was explanted immediately. Other patients experienced such transient adverse effects as hoarseness, cough, dyspnea, headache, tingling sensations, and nausea.
“Seizure reduction by VNS for pediatric patients was demonstrated in this study, consistent with other reports,” the researchers concluded. “In the pediatric medically refractory epilepsy population, VNS is a well-tolerated and safe treatment option providing important palliative improvement in seizure control, especially for generalized or multifocal epilepsy.”
—Jack Baney