Abstracts

To examine the demographics of pediatric epilepsy patients followed in our Comprehensive Epilepsy Center who are currently implanted with VNS. As a secondary measure, to review whether VNS therapy reduced their epilepsy-related hospitalizations. The clinical data for all VNS patients, less than 18 years of age, who were followed at the Comprehensive Epilepsy Clinic over a 2 year period (2003-2004) was collected (n=75). All hospitalizations and emergency room visits for epilepsy or epilepsy-related conditions (i.e. falls, lacerations secondary to seizures) in patients with [gt]1 year of VNS therapy were reviewed (n=60). The annual rate of pre and post-implantation hospitalization utilization was compared. The average age at VNS implantation was 9.28 years (range: 1.5-17 years; 50% girls). The duration of epilepsy prior to implantation was 6.69 years (range: 1-16.5 years). VNS therapy averaged 2.83 years (range: 0.1-7 years). Epilepsy syndromes included: localization-related symptomatic 24 (32%), localization-related idiopathic 5 (6%), generalized idiopathic 4 (5%), generalized symptomatic 12 (16%), Lennox-Gastaut syndrome 21 (28%), mixed 8 (11%) and infantile spasms 1 (1%).
4 patients discontinued VNS therapy secondary to either infection, parental decision, emesis, or seizure exacerbation. The average annual rate of hospitalizations pre-implantation was 0.91 (range: 0-8), vs. 0.43 (range: 0-2.8) post-implantation. Pre-implantation, 18 patients (30%) had no hospital utilization vs. 45 (75%) post-implantation. Although VNS is approved in the U.S. for intractable partial epilepsy in patients [gt]14 years, much younger patients are implanted and the majority of our population (61%) did not have localization-related epilepsy. Side effects requiring discontinuation were low (5%). Post-implantation hospital utilization decreased (47%), and 2.5 times more patients did not require hospitalization. At our institution, an average inpatient stay for seizures is approximately $5000, and for status epilepticus, close to $10,000. Lowered hospital utilization can, therefore, have a significant impact on the long-term cost-effectiveness of VNS therapy and decrease overall patient morbidity.