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Yeap TB, Koo TH, Ang SY, Ab Mukmin L. Perianaesthetic management on a child with Lennox-Gastaut Syndrome for vagus nerve stimulation (VNS) placement. BMJ Case Rep 2023; 16:e255897. [PMID: 38011949 PMCID: PMC10685940 DOI: 10.1136/bcr-2023-255897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Vagus nerve stimulation (VNS) is a neurostimulatory modality in treating patients with medically resistant epilepsy (MRE). It was introduced in 1997 and has been proven to reduce patients' dependency on antiepileptic drugs and seizure frequency. However, the usage of VNS in children with MRE has been limited, especially those with Lennox Gastaut Syndrome (LGS). Our teenage boy with this syndrome developed MRE and successfully underwent VNS placement. We discuss the perianaesthetic challenges, a brief description of VNS and the reported successes in patients with LGS.
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Affiliation(s)
- Tat Boon Yeap
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Thai Hau Koo
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Laila Ab Mukmin
- Department of Anaesthesia and Intensive Care Unit, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
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Hazkani I, Farje D, Alden T, DiPatri A, Tennant A, Ghadersohi S, Thompson DM, Rastatter J. The Clinical Impact of Vagal Nerve Stimulator Implantation on Laryngopharyngeal Function in Children: A Single-Center Experience. Otolaryngol Head Neck Surg 2023; 168:1521-1528. [PMID: 36939431 DOI: 10.1002/ohn.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children. STUDY DESIGN Case series with chart review. SETTING Tertiary-care children's hospital. METHODS Voice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant. RESULTS There were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep-disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p = .0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score. CONCLUSION LP dysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep-disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Doris Farje
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tord Alden
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Arthur DiPatri
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Amy Tennant
- Division of Pediatric Neurology-Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Liu S, Xiong Z, Wang J, Tang C, Deng J, Zhang J, Guo M, Guan Y, Zhou J, Zhai F, Luan G, Li T. Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy. Ther Adv Chronic Dis 2022; 13:20406223211066738. [PMID: 35070253 PMCID: PMC8771757 DOI: 10.1177/20406223211066738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE. METHODS We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness. RESULTS A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders (p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS (p = 0.010, p = 0.003, respectively). CONCLUSION VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.
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Affiliation(s)
- Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Xiong
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
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Hasegawa H, Van Gompel JJ, Marsh WR, Wharen RE, Zimmerman RS, Burkholder DB, Lundstrom BN, Britton JW, Meyer FB. Outcomes following surgical management of vagus nerve stimulator-related infection: a retrospective multi-institutional study. J Neurosurg 2021; 135:783-791. [PMID: 33339002 DOI: 10.3171/2020.7.jns201385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) is a rare but significant complication after vagus nerve stimulator (VNS) placement. Treatment options range from antibiotic therapy alone to hardware removal. The optimal therapeutic strategy remains open to debate. Therefore, the authors conducted this retrospective multicenter analysis to provide insight into the optimal management of VNS-related SSI (VNS-SSI). METHODS Under institutional review board approval and utilizing an institutional database with 641 patients who had undergone 808 VNS-related placement surgeries and 31 patients who had undergone VNS-related hardware removal surgeries, the authors retrospectively analyzed VNS-SSI. RESULTS Sixteen cases of VNS-SSI were identified; 12 of them had undergone the original VNS placement procedure at the authors' institutions. Thus, the incidence of VNS-SSI was calculated as 1.5%. The mean (± standard deviation) time from the most recent VNS-related surgeries to infection was 42 (± 27) days. Methicillin-sensitive staphylococcus was the usual causative bacteria (58%). Initial treatments included antibiotics with or without nonsurgical procedures (n = 6), nonremoval open surgeries for irrigation (n = 3), generator removal (n = 3), and total or near-total removal of hardware (n = 4). Although 2 patients were successfully treated with antibiotics alone or combined with generator removal, removal of both the generator and leads was eventually required in 14 patients. Mild swallowing difficulties and hoarseness occurred in 2 patients with eventual resolution. CONCLUSIONS Removal of the VNS including electrode leads combined with antibiotic administration is the definitive treatment but has a risk of causing dysphagia. If the surgeon finds dense scarring around the vagus nerve, the prudent approach is to snip the electrode close to the nerve as opposed to attempting to unwind the lead completely.
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Affiliation(s)
- Hirotaka Hasegawa
- Departments of1Neurologic Surgery and
- 2Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | | | - Robert E Wharen
- 3Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida; and
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Subgroup analysis of seizure and cognitive outcome after vagal nerve stimulator implantation in children. Childs Nerv Syst 2021; 37:243-252. [PMID: 32361930 DOI: 10.1007/s00381-020-04628-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Vagal nerve stimulator (VNS) implantation at an early age seems to lead to improved quality of life and cognitive outcome. The aim of this analysis is to evaluate whether specific patient or seizure characteristics might lead to better seizure control, cognitive outcome, and higher quality of life in children undergoing VNS implantation. METHODS Primary outcome measure was reduction in seizure frequency. Secondary outcome measures were epilepsy outcome assessed by McHugh and Engel classifications, reduction in antiepileptic drugs (AED), developmental and cognitive outcome, as well as quality of life assessed through the pediatric quality of life (PEDSQL™) questionnaire and care giver impression (CGI) scale. Forty-five consecutive children undergoing VNS implantation were analyzed for the following subgroups: age (categorized to 1-2 years old, 3-5 years old, 6-12 years old, and 13-18 years old), sex, underlying cause (categorized to idiopathic, encephalitis, stroke, syndromic), duration of preoperative seizures (dichotomized to under or above 89 months, corresponding to the median of the whole cohort), and preoperative seizure frequency (dichotomized to under and above 360 seizures per month). RESULTS Encephalitis as the underlying cause for seizures was the only variable significantly associated with higher reduction rate of seizure frequency. Patients with VNS implantation at the age of ≤ 2 years showed a strong association with better developmental and cognitive outcome, as well as quality of life. Shorter duration of preoperative seizures and higher preoperative seizure frequency showed a strong association with better developmental outcome, as well as quality of life. Engel outcome scores were significantly better in patients with epilepsy due to encephalitis (100% Engel I-III). However, patients with epilepsy due to encephalitis showed significantly higher complication rates (71.4%, p = 0.045). CONCLUSIONS Children suffering from epilepsy due to encephalitis show higher seizure reduction rates after VNS implantation when compared with children suffering from epilepsy due to other causes. Developmental and cognitive outcomes as well as quality of life of children undergoing VNS implantation is strongly associated with shorter duration of preoperative seizures and implantation at a young age.
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Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy. Epilepsy Behav 2020; 111:107253. [PMID: 32615417 DOI: 10.1016/j.yebeh.2020.107253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND For patients with generalized epilepsy who do not respond to antiseizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy-resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox-Gastaut Syndrome (LGS) and genetic generalized epilepsy (GGE). METHODS We identified patients with a diagnosis of generalized epilepsy (including LGS and GGE), who underwent VNS implantation at the London Health Sciences Centre and Western University, London, Ontario, since this treatment became available in Canada in 1997 until July 2018. We assessed response to the treatment, including admissions to hospital and complications. RESULTS A total of 46 patients were included in this study with a history of therapy-resistant generalized epilepsy. The mean age at implantation was 24 years (interquartile range [IQR] = 17.8-31 years), significantly younger in the LGS group (p = 0.02) and 50% (n = 23) were female. The most common etiologies were GGE in 37% (n = 17) and LGS in 63% (n = 29). Median follow-up since VNS implantation was 63 months (IQR: 31-112.8 months). Of the LGS group 41.7% (n = 12) of patients had an overall seizure reduction of 50% or more, and 64.7% (n = 11) in the GGE group without statistical significance between the groups. The best response in seizure reduction was seen in generalized tonic-clonic seizures, with a significant reduction in the GGE group (p = 0.043). There was a reduction of seizure-related hospital admissions from 91.3% (N = 42) preimplantation, to 43.5% (N = 20) postimplantation (p < 0.05). The frequency of side effects due to the stimulation was almost equal in both groups (62.1% in LGS and 64.7% in GGE). CONCLUSIONS Vagus nerve stimulation should be considered as a treatment in patients with therapy-resistant generalized epilepsy, especially in cases with GGE.
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Tsai JD, Yang RC, Chang MY, Fan HC, Hung KL, Tcns VNS. Vagus nerve stimulation for patients with refractory epilepsy: Demographic features and neuropsychological outcomes of the VNS Taiwan child neurology society database. Epilepsy Behav 2020; 111:107186. [PMID: 32534423 DOI: 10.1016/j.yebeh.2020.107186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vagus nerve stimulation (VNS) is an established adjunctive therapy for medically refractory epilepsy, which is commonly associated with cognitive impairment, especially in children in whom seizures may disrupt development that is essential to their intellectual and social maturation. The Taiwan Child Neurology Society intends to expand the use of VNS by reporting the experience in a nationwide population, displaying the demographic features and neuropsychological outcomes of VNS. METHODS The enrollment included 105 patients of all ages and seizure types who underwent VNS implantation for refractory epilepsy. Basic data included etiology, past history, seizure phenotypes, and epileptiform syndromes. For efficacy analysis, seizure frequencies were recorded at the baseline and at 3, 12, 24, and 36 months after VNS implantation. For psychological assessment, intelligence quotients (IQ) and Parental Stress Index (PSI) scores were evaluated before and after the VNS. RESULTS During the study period, 95 patients with VNS had followed seizure frequency, IQ and PSI recording. After implantation, there was a decreased frequency at 3 (P < .001), 12 (P < .001), 24 (P = .010), and 36 (P < .01) months. After implantation, the reduction rate (0-50%) of seizure frequency ranged around 26.1-36.1% from 3 to 36 months. For PSI scores, the VNS significantly improved the PSI- total score (P = .001) and PSI-parent domain (P = .001) but not the PSI-children domain (P = .052). No significant improvement in the IQ test performance was observed. CONCLUSIONS This prospective nationwide database of VNS in Taiwan indicates long-term efficacy of VNS therapy, which has achieved a trend of seizure frequency reduction over a period of up to 36 months. It also shows the trend of decreased parental stress after VNS implantation.
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Affiliation(s)
- Jeng-Dau Tsai
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Rei-Cheng Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yuh Chang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Hueng-Chuen Fan
- Tung's Taichung Metroharbor Hospital, Wuchi, Taichung, Taiwan
| | - Kun-Long Hung
- Department of Pediatrics, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
| | - V N S Tcns
- Vagus Nerve Stimulation Study Group of Taiwan Child Neurology Society
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Jamy R, Kaur M, Pizarro D, Toth E, Pati S. Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study. Epilepsia Open 2019; 4:493-497. [PMID: 31440731 PMCID: PMC6698690 DOI: 10.1002/epi4.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Neuromodulation therapies (VNS, RNS, and DBS) can improve seizure control in persons with epilepsy. However, there is a significant service gap in integrating these therapies in clinical care. Our epilepsy center has established an epilepsy neuromodulation clinic to improve access to patients, communication with referring physicians, track outcome and train future providers in programming neuromodulation devices. We report the (a) treatment outcome of the available neuromodulation therapies (ie, reduction in seizure frequency over 6-12 months follow-up); and (b) demonstrate the benefit of the specialized clinic (rapid titration, continuity of care, superior access for patient and vendors). In this single-center, retrospective study, forty-three adults (VNS = 27; RNS = 16) with drug-resistant epilepsy were followed in the clinic during the 19 months study period. About 44-69% of patients reported > 60% decrease in seizure. All patients were scheduled in the clinic within 2-4 weeks, and stimulations were optimized rapidly. About 40% of patients participated in research while 28% were referred for additional diagnostic studies. Nineteen students and fellows were trained in programming neurostimulator. Epilepsy neuromodulation clinic can serve as an optimal solution for patients as well as providers due to rapid access, better continuity of care, higher recruitment for research studies, and training health professionals.
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Affiliation(s)
- Rabia Jamy
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Manmeet Kaur
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Diana Pizarro
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Emilia Toth
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Sandipan Pati
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
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Kavčič A, Kajdič N, Rener-Primec Z, Krajnc N, Žgur T. Efficacy and tolerability of vagus nerve stimulation therapy (VNS) in Slovenian epilepsy patients: younger age and shorter duration of epilepsy might result in better outcome. Acta Clin Croat 2019; 58:255-264. [PMID: 31819321 PMCID: PMC6884381 DOI: 10.20471/acc.2019.58.02.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To review the outcome of vagus nerve stimulation (VNS) therapy in all implanted Slovenian patients with drug-resistant epilepsy, data on 48 patients implanted between 2001 and 2015 were obtained retrospectively from medical records. The outcome was assessed in 2016. Out of 48 patients, 39 responded at follow up. The seizure frequency was reduced in 18 (46.2%) patients; 13 (33.3%) of them reported ≥50% reduction after 12 months of therapy. The responder rate was higher among patients implanted before the age of six years. Ictal severity decreased in 22 (56.4%), seizure duration in 19 (48.7%) and post-ictal recovery time in 22 (56.4%) patients. Favorable effects on the quality of life (QOL) were improved alertness in 33.3%, concentration in 41.0%, energy and mood in 38.5%, and memory in 17.9% of patients. Reduced seizure burden and improved QOL were more often observed in patients implanted at a younger age. Shorter duration of epilepsy was significantly associated with QOL improvement. Adverse effects were transient. Overall positive effects showed VNS to be a safe, well-tolerated and effective adjunctive treatment in most severe drug-resistant epilepsy patients. Implantation at a younger age and shorter duration of epilepsy before implantation could be important predictors of better outcome.
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Affiliation(s)
| | - Nina Kajdič
- 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 2Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3Department of Pediatrics, Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia; 4Department of Clinical Neurophysiology, Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zvonka Rener-Primec
- 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 2Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3Department of Pediatrics, Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia; 4Department of Clinical Neurophysiology, Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Natalija Krajnc
- 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 2Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3Department of Pediatrics, Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia; 4Department of Clinical Neurophysiology, Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomaž Žgur
- 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 2Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3Department of Pediatrics, Slovenj Gradec General Hospital, Slovenj Gradec, Slovenia; 4Department of Clinical Neurophysiology, Medical Centre Ljubljana, Ljubljana, Slovenia
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Soleman J, Stein M, Knorr C, Datta AN, Constantini S, Fried I, Guzman R, Kramer U. Improved quality of life and cognition after early vagal nerve stimulator implantation in children. Epilepsy Behav 2018; 88:139-145. [PMID: 30269032 DOI: 10.1016/j.yebeh.2018.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In patients with drug-resistant epilepsy, reduction of seizure duration and frequency at an early age is beneficial. Vagal nerve stimulator (VNS) was shown to reduce seizure frequency and duration in children; however, data in children under the age of 12 years are sparse. The aim of this study was to compare seizure outcome and quality of life after early (≤5 years of age) and late (>5 years of age) implantation of VNS in children. METHODS This study reviewed 45 consecutive children undergoing VNS implantation. Primary outcome measure was the reduction of seizure frequency. Secondary outcome measures were epilepsy outcome assessed by the McHugh and Engel classifications, reduction of antiepileptic drugs (AEDs), psychomotor development, and quality of life measured by the Pediatric Quality of Life (PEDSQL™) questionnaire and caregiver impression (CGI) scale. The mean follow-up time was 72.3 months (±39.8 months). RESULTS Out of 45 patients included, in 14 (31.1%), VNS was implanted early and in 31, (68.9%) late. Reduction of seizure frequency, McHugh and Engel classifications, and reduction of AED were comparable in both groups. Quality of life measured by the CGI scale (2.1 ± 1.7 in the early group vs. 3.6 ± 1.6 in the late group; p = 0.004), as well as the difference of total PEDSQL™ Core scores (12.0 ± 24.0 in the early group vs. -5.2 ± 14.9 in the late group; p = 0.01) and cognitive PEDSQL™ Core (30.6 ± 32.0 in the early group vs. 2.4 ± 24.3 in the late group; p = 0.03) between preoperative and follow-up was significantly higher in the early implantation group. CONCLUSION Early VNS implantation in children leads to a significantly better quality of life and cognitive outcome compared with late implantation while reduction of seizure frequency and epilepsy outcome seems comparable. Therefore, in children with drug-resistant epilepsy, VNS implantation should be considered as early as possible.
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Affiliation(s)
- Jehuda Soleman
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel; Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland.
| | - Maya Stein
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Corine Knorr
- Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Alexandre N Datta
- Department of Pediatric Neurology, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Shlomi Constantini
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Fried
- Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Guzman
- Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Uri Kramer
- Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel
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Morrison-Levy N, Go C, Ochi A, Otsubo H, Drake J, Rutka J, Weiss SK. Children with autism spectrum disorders and drug-resistant epilepsy can benefit from epilepsy surgery. Epilepsy Behav 2018; 85:200-204. [PMID: 30032808 DOI: 10.1016/j.yebeh.2018.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this research was to evaluate a cohort of children with both autism spectrum disorder (ASD) and drug-resistant epilepsy (DRE) after epilepsy surgery to determine predictors of best outcome. METHODS Retrospective chart review was done for 29 children ages 2 to 18 years with ASD and DRE who had neurosurgical intervention for seizure management over 15 years at one institution. All subjects had at least 1 year of follow-up. Data abstraction included demographic information, seizure diagnosis, treatment, investigations, surgical intervention, neuropsychological assessment, and outcome. Statistical analysis software (SAS) was used for statistical analysis. Engel classification was used to assess seizure outcome. RESULTS Fifteen subjects had resective surgery. Fourteen had palliative surgery with vagal nerve stimulator (VNS) insertion (13) and corpus callosotomy (1). Of the 29 subjects, 35% had class I outcome (all in the resective group). When combining all subjects (resective and palliative), 66% of subjects benefited with class I-III outcomes. In the total cohort, age at time of surgery was significant, with class I outcome more frequently seen in the younger age group when compared with classes II-IV (p = 0.01). CONCLUSION A subset of children with ASD can benefit from resective surgery, and for those who are not candidates, a VNS can offer significant improvements in seizure control.
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Affiliation(s)
- Nadine Morrison-Levy
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Cristina Go
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Ayako Ochi
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Hiroshi Otsubo
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - James Drake
- Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - James Rutka
- Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Shelly K Weiss
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Soleman J, Knorr C, Datta AN, Strozzi S, Ramelli GP, Mariani L, Guzman R. Early vagal nerve stimulator implantation in children: personal experience and review of the literature. Childs Nerv Syst 2018; 34:893-900. [PMID: 29255920 DOI: 10.1007/s00381-017-3694-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/10/2017] [Indexed: 01/14/2023]
Abstract
AIM Data concerning the benefit of vagal nerve stimulation (VNS) in children under the age of 12 years is sparse. It was shown that reduction of seizure frequency and duration at an early age could lead to better psychomotor development. We therefore compare the outcome between early (≤ 5 years of age) and late (> 5 years of age) implantation of VNS in children. METHODS This study is a prospective review of patients analyzing primarily the reduction of seizure frequency and secondarily epilepsy outcome assessed by the McHugh and Engel classification, reduction of antiepileptic drugs (AED), psychomotor development measured by the Vineland Adaptive Behavior Scale (VABS), and quality of life using the caregiver impression (CGI) scale. Mean follow-up time was 36 and 31 months in the early and late group, respectively. RESULTS Out of 12 consecutive VNS implantations for therapy refractory epilepsy, 5 were early implantations and 7 late implantations. Reduction of seizure frequency, McHugh and Engel classification, quality of life, psychomotor development and reduction of AED were comparable in both groups. One patient in the late group suffered from a postoperative infection resulting in explanation of the VNS device and re-implantation on the opposite side, while mortality rate was 0%. CONCLUSIONS VNS seems to be a safe and feasible therapy in children even under the age of 5 years. Responder rate, quality of life, and psychomotor development do not seem to be influenced by the child's age at implantation; however, larger studies analyzing the outcome of early VNS implantation are warranted.
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Affiliation(s)
- Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland.
| | - Corine Knorr
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Alexandre N Datta
- Department of Pediatric Neurology, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Susi Strozzi
- Department of Pediatric Neurology, University Hospital of Bern, Bern, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatric Neurology, Children's Hospital of Bellinzona, Bellinzona, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland
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13
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Patel A, Wang L, Gedela S. Health Care Utilization Following Vagus Nerve Stimulation Therapy in Pediatric Epilepsy Patients From a Pediatric Accountable Care Organization. J Child Neurol 2018; 33:136-139. [PMID: 29172909 DOI: 10.1177/0883073817743639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vagus nerve stimulation has been a therapy for epilepsy approved by the US Food and Drug Administration (FDA) for patients 4 and older and shown efficacy and safety in younger pediatric patients. METHODS The authors performed a retrospective analysis utilizing Medicaid claims from an accountable care organization to measure the intervention of vagus nerve stimulation therapy in regard to unplanned health care utilization. Thirteen unique patients were included who had vagus nerve stimulation therapy who had at least 6 months of continuous enrollment in a managed Medicaid health plan. Comparison with 12 months of data before and after vagus nerve stimulation implantation was performed. RESULTS Patients had statistically significant fewer unplanned inpatient visits per patient per enrollment month after vagus nerve stimulation implantation. CONCLUSION Utilizing claims data, vagus nerve stimulation implantation demonstrates a reduction in unplanned hospitalizations.
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Affiliation(s)
- Anup Patel
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,2 Ohio State University College of Medicine, Columbus, OH, USA
| | - Ling Wang
- 3 Data Resource Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Satyanarayana Gedela
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,2 Ohio State University College of Medicine, Columbus, OH, USA
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14
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Englot DJ, Rolston JD, Wright CW, Hassnain KH, Chang EF. Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy. Neurosurgery 2017; 79:345-53. [PMID: 26645965 PMCID: PMC4884552 DOI: 10.1227/neu.0000000000001165] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response. OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS. METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies. RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom. CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients. ABBREVIATIONS: AED, antiepileptic drug VNS, vagus nerve stimulation
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Affiliation(s)
- Dario J Englot
- *UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California; ‡Department of Neurological Surgery, University of California, San Francisco, California; §Cyberonics, Inc., Houston, Texas
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Oliveira TVHFD, Francisco AN, Demartini Junior Z, Stebel SL. The role of vagus nerve stimulation in refractory epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:657-666. [DOI: 10.1590/0004-282x20170113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 06/07/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.
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Timarova G, Šteňo A. Late-onset jaw and teeth pain mimicking trigeminal neuralgia associated with chronic vagal nerve stimulation: case series and review of the literature. BMC Neurol 2017; 17:113. [PMID: 28619068 PMCID: PMC5473002 DOI: 10.1186/s12883-017-0892-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/06/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Vagal nerve stimulation (VNS) for refractory epilepsy is well established. Trigeminal neuralgia itself is a common disease in adults, and thus, late-onset pain in the trigeminal region under VNS, which is extremely rare, may not be recognized as caused by VNS. CASE PRESENTATION Two patients with drug-resistant symptomatic epilepsy treated with chronic VNS experienced stimulation-related pain in the lower and upper jaw and teeth on the side of stimulation. No evidence of local spread of the stimulation current was present. The pain started with a delay of years after device implantation and weeks after the last increase in the pacing parameters. At the time of onset, the pain was not recognized as VNS-related, leading to extensive examinations. The trigeminal neuralgia-like pain resolved after adjustment of the stimulation current intensity. In one of the patients, the pain disappeared within one to two days following every epileptic seizure. To our knowledge, this is the first case report of late-onset trigeminal pain under VNS revealing a direct link between epileptogenic and pain processes. CONCLUSION A painless interval between the last change of the pacing parameters and trigeminal pain can lead to the erroneous interpretation that this is a typical trigeminal neuralgia. The lack of its recognition as a side effect of VNS can lead to unnecessary examinations and delayed adjustment of stimulation parameters. In patients with signs of late-onset trigeminal pain under VNS with normal electrode impedance and no evidence of local current spread, the replacement of the VNS lead does not seem to be beneficial. A review of the literature on VNS side effects including pain and device malfunctions was undertaken.
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Affiliation(s)
- Gabriela Timarova
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Dérer's University Hospital, Limbova str.5, 83305, Bratislava, Slovak Republic.
| | - Andrej Šteňo
- Department of Neurosurgery, Faculty of Medicine, Comenius University, Dérer's University Hospital, Bratislava, Slovak Republic
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Bodin E, Le Moing AG, Bourel-Ponchel E, Querne L, Toussaint P, Berquin P. Vagus nerve stimulation in the treatment of drug-resistant epilepsy in 29 children. Eur J Paediatr Neurol 2016; 20:346-51. [PMID: 26922364 DOI: 10.1016/j.ejpn.2016.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/04/2016] [Accepted: 01/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Vagus nerve stimulation (VNS) has been demonstrated to be safe and effective for adults and children with drug-resistant epilepsy and is able to improve most types of epilepsy. The aim of this study, in a paediatric population, was to assess the overall efficacy of vagus nerve stimulation on seizures, to assess tolerability and quality of life. METHODS This single-centre, retrospective study reviewed the files of 29 children in whom a vagus nerve stimulator was implanted between 1995 and 2012. The response rate (greater than 50% reduction of the seizure frequency), antiepileptic efficacy according to the type of epilepsy or age at implantation or age at onset of epilepsy, the time-course of seizures, adverse effects, overall quality of life and number of hospitalisations were studied. RESULTS In our population, vagus nerve stimulation achieved a significant reduction in the seizure frequency throughout follow-up (p = 0.015). Response rates were 59% at 3 months, and 66% at 6 months, and the response rate then remained stable at about 70%. Stimulation tended to be more effective in patients with non-idiopathic partial epilepsy than in patients with non-idiopathic and idiopathic generalised epilepsy (0.01 < p < 0.11). No other predictive factors of efficacy were identified. Patients, parents, caregivers reported improvement in overall quality of life in 38% of patients during clinical interviews. A significant reduction in the number of hospitalisations due to a reduction of seizure frequency was observed after implantation (p = 0.03). VNS was stopped because of complications or insufficient efficacy in 9 cases. CONCLUSION Vagus nerve stimulation is a safe and effective treatment option in children with drug-resistant epilepsy who are not candidates for surgery.
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Affiliation(s)
- Emilie Bodin
- Service de Neurologie Pédiatrique, CHU d'Amiens, Amiens, France.
| | | | - Emilie Bourel-Ponchel
- Service d'Explorations Fonctionnelles du Système Nerveux de l'Enfant, CHU d'Amiens, Amiens, France
| | - Laurent Querne
- Centre de Référence des Troubles du Langage et des Apprentissages, CHU d'Amiens, Amiens, France
| | | | - Patrick Berquin
- Service de Neurologie Pédiatrique, CHU d'Amiens, Amiens, France
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18
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The neuropsychological outcome of pediatric patients with refractory epilepsy treated with VNS--A 24-month follow-up in Taiwan. Epilepsy Behav 2016; 56:95-8. [PMID: 26851647 DOI: 10.1016/j.yebeh.2015.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/24/2015] [Accepted: 12/26/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Multiple studies have reported the benefits of vagus nerve stimulation (VNS) on neuropsychological outcomes. The aim of this study was to investigate how VNS affects cognition and psychosocial adjustment in children with refractory epilepsy (RE), and to determine the efficacy of VNS in a Taiwanese population. METHODS We conducted a one-group pretest-posttest study on pediatric patients with RE. The study comprised 19 males and 18 females, all aged <18 years. We recorded seizure frequency at 3, 12, and 24 months after VNS device implantation. Intelligence quotients (IQ) were assessed using the Wechsler Intelligence Scale for Children - IV. The Parental Stress Index (PSI) scores were evaluated by a pediatric psychologist. RESULTS Vagus nerve stimulation device implantation significantly reduced seizure frequency at 3, 12 and 24 months, especially in young children (<12 years). No significant improvement in IQ test performance was observed, though there were significant improvements in the PSI, especially in young children. CONCLUSIONS Vagus nerve stimulation device implantation does not significantly improve cognition function, but it does significantly reduce seizure frequency and stress in parent-child relationships, especially in young children (<12 years). These findings suggest that VNS should be considered as an alternative therapy for patients proven to have seizures that are medically refractory, especially those younger than 12 years of age.
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Wasade VS, Schultz L, Mohanarangan K, Gaddam A, Schwalb JM, Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy Behav 2015; 53:31-6. [PMID: 26515157 DOI: 10.1016/j.yebeh.2015.09.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/19/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable epilepsy. Most studies have demonstrated short-term seizure outcomes, usually for up to 5 years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term seizure and psychosocial outcomes in patients with intractable epilepsy on VNS therapy for more than 15 years. We identified patients who had VNS implantation for treatment of intractable epilepsy from 1997 to 2013 at our Comprehensive Epilepsy Program and gathered demographics including age at epilepsy onset and VNS implantation, epilepsy type, number of antiepilepsy drugs (AEDs) and seizure frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine patients' current seizure frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. Seizure outcomes were based on modified Engel classification (I: seizure-free/rare simple partial seizures; II: >90% seizure reduction (SR), III: 50-90% SR, IV: <50% SR; classes I to III (>50% SR)=favorable outcome). A total of 207 patients underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at epilepsy onset of 9.4 years (range: birth to 60 years). There were 35 (39%) patients with extratemporal epilepsy, 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) patients with an output current >2 mA and 14 (16%) with rapid cycling. Of the 80 patients with seizure frequency information, 16 (20%) had a modified Engel class I outcome, 14 (18%) had class II, 24 (30%) had class III, and 26 (33%) had class IV. Eighty percent said having VNS was worthwhile. Among the 90 patients, 43 patients were ≥ 18 years old without developmental delay in whom psychosocial outcomes were further analyzed. There was a decrease in the number of patients driving (31% vs 14%, p=0.052) and working (44% vs 35%, p=0.285) and an increase in the number of patients using antidepressant medication (14% vs 28%, p=0.057) at the time of survey compared to before VNS. In this subset, patients with >50% SR (60%) were taking significantly fewer AEDs at the time of survey compared to patients with unfavorable outcomes (median: 3 vs 4, p=0.045). The associations of >50% SR with the psychosocial outcomes of driving, employment, and antidepressant use were not significant, although 77% of this subset said VNS was worthwhile. This is the first study that assesses both seizure and psychosocial outcomes, and demonstrates favorable seizure outcomes of >50% SR in 68% of patients and seizure freedom in 20% of patients. A large majority of patients (80%) considered VNS therapy worthwhile regardless of epilepsy type and psychosocial outcomes.
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Affiliation(s)
- Vibhangini S Wasade
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA.
| | - Lonni Schultz
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Karthik Mohanarangan
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Aryamaan Gaddam
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Jason M Schwalb
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
| | - Marianna Spanaki-Varelas
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Public Health Sciences, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA; Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
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3T-MRI in patients with pharmacoresistant epilepsy and a vagus nerve stimulator: A pilot study. Epilepsy Res 2015; 110:62-70. [DOI: 10.1016/j.eplepsyres.2014.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/25/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022]
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