Vagal Nerve Stimulation in Children with Therapy Resistant Epilepsy
Abstract number :
2.143
Submission category :
Year :
2000
Submission ID :
1231
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
H J M Majoie, M W Berfelo, A P Aldenkamp, S M A A Evers, A G H Kessels, M Rous, W O Renier, Epilepsy Ctr Kempenhaeghe, Heeze, Netherlands; Univ Hosp Maastricht, Maastricht, Netherlands; Univ Maastricht, Maastricht, Netherlands; Univ Hosp Nimwegen, Nijmege
RATIONALE: To elucidate the efficacy,tolerability and cost-effectiveness of vagal nerve stimulation in children with pharmacotherapy resistant epilepsy classified as Lennox like syndrome. METHODS: Nineteen children are included,16 with the follow-up longer then one year.Age between 8 and 17 years.Data will be collected during a 6-month period prior to the implantation of the vagal nerve stimulator.These data will be compared with data collected after the operation:each patient serves as his own control.At the baseline and during the follow up contacts at 6,12,18,and 24 month after implantation:history,physical and neurological examination, blood levels of anti-epileptic drugs,ECG,MRI,EEG (registered during minimally 1 hour of which minimally half an hour registration of cerebral activity during sleep)are recorded.The seizure frequency and severity will be obtained by a seizure diary which is to be completed by the parents or attendants of the patient.Cognitive functions,capabilities in daily life and the subjective perceived quality of life will be assessed. The cost-effectiveness is evaluated from a societal perspective.The direct health care costs,direct non-health care costs,and indirect costs are considered as economic end-points. RESULTS: Post-operative complications:none.Eight patients showed a seizure frequency reduction between 25-50%;3 between 50-90%,and 1 patient is seizure free.Seizure frequency was not affected in 4 patients;however,one of these patient showed an improvement in IQ >10%.One patient showed an increase of seizure frequency:the number of his seizures trippled as compared to the preop period. However,the history of this patient shows periods of several month with seizure frequencies comparable to the observed post-op period.Improvement of vigilance was noted in 5 patients.One patient reported improvement of his sleep-pattern.One of two patients with autistic behaviour showed improved social behaviour.Results after one year of vagal nerve stimulation will be available in august 2000. CONCLUSIONS: this study confirms previously published results of vagal nerve stimulation in pharmacotherapy resistent epilepsy.