Abstracts

RATIONALE: Intermittent stimulation of the left vagus nerve is approved as an adjunctive therapy for medically intractable epilepsy in children and adults 12 years and older with partial onset seizures. Management of children under 12 years of age with intractable epilepsy, specifically those with epileptic encephalopathies remains challenging despite the availability of many new drugs. This study reports outcomes on a series of 19 children, ages four to ten years who had a vagus nerve stimulator(VNS)placed over a three-year period between 1/98 and 1/01.
METHODS: Data was gathered using retrospective chart review, seizure calendars, VNS manufacturer registry information and parent telephone contact. All devices were implanted in a single institution by two neurosurgeons. No patient under 12 years of age implanted in the three year period was excluded. Thirteen(68%) of patients had idiopathic generalized epilepsy, four(21%) had symptomatic-mixed epilepsy and two(11%) had Lennox Gastaut Syndrome. Nineteen patients(100%)were developmentally delayed with 11(60%)developing seizures prior to one year of age. Duration of epilepsy ranged from three to ten years with a median duration of five years.
RESULTS: Responder rates(defined as a greater than 50% decrease in seizure frequency) were 58% at six months(n=19), 72% at 12 months(n=15), and 50% at 18 months(n=8). The number of antiepileptic medications was reduced by one or two in 27% of patients at 12 months and 33% at 18 months. Post-ictal period was reduced in 58% of the patients at six months. Increased alertness was reported in 79% and cognitive benefits in 89% of the patients at six months. No explants for infection or other reasons occurred and no patients were worse.
CONCLUSIONS: Our study indicates that the VNS has efficacy in children under 12 years of age with generalized epilepsies, similar to that reported in adults with partial onset seizures. Although clearly not a cure or sole therapy for most patients, our findings support its role as a safe and effective adjunctive therapy for medically intractable epilepsy in young children.
Disclosure: Grant - Cyeronics, Inc. supports an investigator initiated research study by Paul Levisohn, MD.; Honoraria - Paul Levisohn MD accepts honoraria for speaking for Cyberonics, Inc.