Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence

Clinical article

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Object

Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy.

Methods

A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use.

Results

One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type.

Conclusions

Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.

Abbreviations used in this paper:AVM = arteriovenous malformation; IVH = intraventricular hemorrhage; TBI = traumatic brain injury; VNS = vagus nerve stimulation.

Article Information

* Dr. Thompson and Ms. Wozniak contributed equally to this work.

Address correspondence to: Nathan R. Selden, M.D., Ph.D., Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Avenue, CH8N, Portland, Oregon 97239. email: seldenn@ohsu.edu.

Please include this information when citing this paper: published online July 6, 2012; DOI: 10.3171/2012.5.PEDS11489.

© AANS, except where prohibited by US copyright law.

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Figures

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    Illustrations depicting the surgical procedure for implantation of a VNS system. A: The head is positioned in slight extension with a 15° rotation to the right (left illustration). A left-sided transverse incision (dotted line) is created in a skin fold at approximately the C5–6 level, below the carotid artery bifurcation. After dividing the platysma, the sternocleidomastoid muscle and jugular vein are retracted laterally to reveal the vagus nerve (illustrated here elevated by a vessel loop, right illustration). The vagus nerve travels within the carotid sheath, while branches of the ansa cervicalis cross the exposure deep to the platysma but superficial to the sheath. B: Steps for implantation of the vagus nerve anchor and electrode coils. The coil is oriented perpendicular to the nerve and gently stretched using the attached tensioning sutures (1). The midpoint of the stretched coil is slid around the nerve (2). Each end of the coil, aided by its material “memory,” is coiled around the vagus nerve (3 and 4). Proper configuration of the 3 coils (5). Printed with the permission of Andrew Rekito, 2012.

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