Use of the Vagus Nerve Stimulator in Children with Intractable Epilepsy: The Children's Hospital of Philadelphia Experience.
Abstract number :
3.090
Submission category :
Year :
2000
Submission ID :
1754
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Colin M Roberts, Peter H Berman, Lawrence W Brown, Amy R Brooks-Kayal, Robert R Clancy, Ann-Christine Duhaime, Susan E Melamed, Stephen G Ryan, A. G. Christina Bergqvist, Children's Hosp of Philadelphia, Philadelphia, PA.
RATIONALE: Vagus nerve stimulation (VNS) is an efficatious treatment of intractable epilepsy in adults. Little published data is available regarding its use in children. We describe the experience at a large university-based epilepsy program. METHODS: Retrospective chart analysis was performed on 19 children with intractable epilepsy, 9 girls, 10 boys, mean age 13y (3y,7m - 20y,11m) at time of VNS implantation. Mental retardation was present in 89%, cerebral palsy in 26%, though only 5% were non-ambulatory. Mean age at first seizure was 2y,5m (4m-7y,6m). Prior febrile convulsions occurred in 15%, status epilepticus in 68%. Structural MRI abnormalities were present in 42%. 13 subjects had partial onset seizures, 4 had Lennox-Gastaut syndrome (1 with mitochondrial cytopathy), 2 had idiopathic primary generalized seizures (1 with LKS/ESES). Mean number of antiepileptic drugs used prior to VNS was 10.8 (7-18). Ketogenic diet was used in 53%, 25% concurrent with VNS. Epilepsy surgery evaluations were performed on 95%, 16% underwent a surgical procedure. Data was collected at 1m, 3m, 6m, and 9m after implantation regarding percent reduction in frequency of the most debilitating seizure type, reduction in seizure duration, abortion of seizures with magnet, and change in post-ictal phase. RESULTS: At 1m, ?50% seizure reduction occurred in 26%, 35% at 3m, 46% at 6m, and 50% at 9m. Ability to abort seizure with magnet, shorten seizure or post-ictal phase was reported by 84.2% at 1m and 3m, 92.3% at 6m, and 90% at 9m. There were no post-operative complications. One patient developed severe glossopharyngeal neuralgia which resolved with decrease of band width. Transient hoarseness with cough was reported by all 19 patients following increase in VNS settings. CONCLUSIONS: VNS is an efficatious and safe therapy, even in children with neurological impairment and severely intractable epilepsy. Our data supports previously reported reductions in seizure frequency, duration, and length of post-ictal phase. Implantation should be considered in children refractory to pharmacologic, nutritional, and alternate surgical interventions.