Abstracts

OBJECTIVE: At the end of this activity the participants should be able to discuss the outcome of vagus nerve stimulation (VNS) Therapy among pediatric patients in a private-practice setting.
RATIONALE: Much of the data on the outcome of VNS Therapy describes patients treated in clinical trials or at epilepsy centers. This report describes pediatric patients followed in a private practice setting.
METHODS: Demographic and seizure syndrome information were compiled for patients aged 17 years and younger who received VNS Therapy and were followed in a private practice setting. Changes in seizure frequency were tracked after 3 and 12 months of VNS Therapy and physician-assessed changes in quality of life were noted after 12 months.
RESULTS: Of the 35 VNS patients aged 17 years or younger, 18 were males. Median age at implant was 12 years (range, 2 to 17). Median age at seizure onset was 1.5 years (range, 0 to 9), and median duration of epilepsy was 7.9 years (range, 0 to 17). Epilepsy syndrome was listed as localized for 12 (34.3%) patients, generalized for 16 (45.7%), Lennox-Gastaut for 6 (17.1%) and JME for 1 (2.9%). All 35 patients have not been implanted for 12 months, therefore, data on changes in seizure frequency and quality of life are provided for 24 patients after 3 months of VNS Therapy and for 14 patients after 12 months. Median seizure reduction after 3 months was 72.52% (range, -100 to 90.91) with 19 (79%) patients reporting reductions of 50% or more, 11 (46%) of 75% or more, and 3 (13%) reporting no seizures. Median seizure reduction after 12 months was 70% (range, -100 to 100) with 10 (71%) patients reporting reductions of 50% or more, 5 (36%) of 75% or more, and 1 (7%) reporting no seizures. Quality of life measures had improved for 64% of the patients in alertness; for 50% in verbal communication, mood, and postictal period; and for 36% in memory, achievement at work or school, and seizure clustering at 12 months.
CONCLUSIONS: Median seizure frequency reductions among this private practice pediatric cohort are somewhat greater than the clinical trial experience. Although reasons for the difference are not clear, further comparisons of device setting parameters and concomitant antiepileptic drugs may yield further insight into achieving greater seizure frequency reductions through VNS therapy. VNS is a practical treatment alternative for the private practice pediatric epilepsy clinic.
(Disclosure: Honoraria - Cyberonics, Inc.)