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Ashraf Mahmoud M, El Rashidi O, Halim G, Amgad Elkholy M, Aglan O, Rahman El Sabbagh A, Kamel Basha A, Hamdi H, El Sayed AM, Amin Saleh D, Shatla R, Abdel Ghany W. The dual effect of vagus nerve stimulation in pediatric patients with drug-resistant epilepsy: Is there more than seizure control? Epilepsy Behav Rep 2024; 27:100653. [PMID: 38841319 PMCID: PMC11150965 DOI: 10.1016/j.ebr.2024.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 06/07/2024] Open
Abstract
This is a retrospective and comparative pilot study to investigate the role of vagus nerve stimulation (VNS) in improving cognitive functions in the pediatric age group with drug resistant epilepsy (DRE). It was conducted from January 2018 to February 2023. Children between the ages of 4 and 18 years were divided into two groups, the "VNS group" and the "best medical treatment (BMT) group". Follow up period was 12 months. Demographic, clinical, etiological and investigational data were recorded. Cognitive assessment using the Modified Mini-Mental State Examination for children (MMSE) was recorded at baseline and 12 months later for each group. 76.4 % of patients were classified as epilepsy secondary to cerebral palsy. 75 % of patients showed ≥ 50 % seizure frequency reduction among the VNS group as compared to 12.5 % in the BMT group. None of both groups achieved seizure freedom. At 12 months, both BMT and VNS groups showed statistically significantly improved overall cognitive score from baseline records (p = 0.027) and (p = 0.012), respectively, with a significantly higher improvement in VNS group. Also, statistical sub-analysis of cognitive subscales in cerebral palsy patients in both groups was conducted and revealed a significant improvement (p = 0.02) in the VNS group. We concluded that there is a potential role of VNS in improving cognitive functions which was shown by using a cost-effective screening tool. A significant effect was observed specially in cerebral palsy patients. This is very beneficial in limited-resources countries since VNS has good safety profile, high seizure control, and added value to cognitive functions.
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Affiliation(s)
| | | | - George Halim
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | - Osama Aglan
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | | | - Hussein Hamdi
- Neurosurgery Department, Tanta University, Tanta, Egypt
| | | | - Dina Amin Saleh
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - R.H. Shatla
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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Jaseja H. Management of Spasticity in Cerebral Palsy: An Electroencephalogram-Oriented Novel Approach. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1701191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractCerebral palsy (CP) is commonly associated with spasticity though the exact pathophysiology is still unknown. Management of spasticity is an important aspect of care because it can adversely affect quality of life. Patients with CP also commonly exhibit interictal epileptiform discharges (IEDs) on their electroencephalograms (EEGs) even without clinical epilepsy. This brief article studies the relationship between spasticity and IEDs. Based on the intrinsic relationship between the two and available pathophysiological evidence of spasticity, the author suggests a mandatory EEG in all patients with CP and spasticity and consideration for initiation of IEDs when detected.
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