Abstracts

RATIONALE: Vagus Nerve Stimulation (VNS) is a unique treatment for epilepsy, approved for use with partial seizures, in those over the age of twelve. Limited experience is available on its use in the very young child, specifically those under 3 years of age. The purpose of this analysis was to gain an insight into the efficacy and experience of VNS use, as reported by the clinicians, surgeons, and families involved.
METHODS: The records of three toddler aged children were retrospectively reviewed during the pre and post operative phase of VNS treatment. Efficacy and tolerability of VNS was evaluated. The surgical procedure was compared to that of adults and older children. The subjective experience of families was documented.
RESULTS: Three patients with refractory epilepsy were considered candidates for VNS. Age ranged from 23 to 36 months. Weight was 8.9 to 10.4 kilos at the time of implant. All 3 patients had gastrostomy tubes. Congenital brain malformations included holoprosencephaly, progressive encephalopathy with coreoathetotic movements, hydrocephalus, and agenesis of the corpus callosum with marked ventriculomegaly. One had a suspected metabolic defect. Pre surgical evaluations indicated that all failed to show efficacy with multiple antiepileptic drug trials. Seizure history included partial and Lennox Gastaut Syndrome. Two children have had VNS implanted and one implant is scheduled. The procedure was well tolerated without surgical or post operative complications. Seizure frequency dramatically improved in the two implanted children. Both had pre implant daily seizures described as too numerous to count and became seizure free post implant. Involved family members described pre operative concerns but post operative satisfaction in choosing VNS. No clear side effects were identified after chronic stimulation settings up to 1.50 current. One child expired from causes considered not related to VNS.
CONCLUSIONS: VNS was found to be a well tolerated and sucessful treatment option in this group of toddlers with multiple neurological disorders. VNS may be a therapeutic intervention to consider with other children under three years of age or in disabled young children of similar size.