SUMMARYPurpose: Vagus nerve stimulation (VNS) is used increasingly as adjunctive therapy for refractory epilepsy. Studies of VNS in children report mainly seizure frequency reduction as a measure of efficacy and clinical details are often scanty. We report our experience with VNS in children with refractory epilepsy and emphasize the positive effects of VNS in terms of seizure severity. Methods: We reviewed 26 consecutive children who had VNS with a minimum follow-up period of 18 months. We examined their clinical characteristics, seizure types, seizure frequency, epilepsy syndrome diagnosis, and response to VNS in terms of seizure frequency and seizure severity.Results: Fifty-four percent of patients responded to VNS with ‡50% seizure frequency reduction. Patients with Lennox-Gastaut syndrome (LGS) and tonic seizures had a higher responder rate; 78% (seven of nine patients) (p < 0.01). Status epilepticus (SE) episodes were reduced or ceased in the four patients with recurrent SE. Seizure severity, duration, and recovery time decreased in all responders. Increased alertness was reported in all responders and three nonresponders. Conclusion: Decreased seizure severity, recovery time, abolition of daytime drop attacks, and reduced hospitalization due to SE improved patients' lives over and above the benefit from seizure frequency reduction. KEY WORDS: Vagus nerve stimulation, Tonic seizures, Lennox-Gastaut syndrome.Vagus nerve stimulation (VNS) is a form of neurostimulation therapy, primarily indicated for refractory epilepsy. It consists of a generator implanted in the anterior chest wall that delivers intermittent electric stimuli to the brain via a bipolar electrode coiled around the left vagus nerve in the neck. The generator cycles continuously at predetermined parameters. VNS is being used increasingly as adjunctive therapy for patients with epilepsy that is resistant to antiepileptic medications and not suitable for resective surgery. First performed in humans in 1988 for treatment of refractory epilepsy (Penry & Dean, 1990), VNS is used to treat an estimated >50,000 patients worldwide (De Herdt et al., 2007). The majority of patients treated with VNS have focal epilepsy, but in children, VNS is used more often in patients with symptomatic generalized epilepsy (Parker et al., 1999;Frost et al., 2001;Majoie et al., 2001Majoie et al., , 2005Nagarajan et al., 2002). Most studies report a 50% or greater reduction of seizure frequency in 40-50% of patients (Ben-Menachem et al., 1994;Amar et al., 1998;Handforth et al., 1998;Morris & Mueller, 1999;Vonck et al., 2004;De Herdt et al., 2007) without any greater benefits in certain syndromes or seizure types.The exact mechanism by which VNS modulates seizures is not known. The vagus nerve, comprising 80% afferent fibers originating from the heart, lungs, larynx, pharynx, and gastrointestinal tract, transmits visceral sensory information to the central nervous system. The vagus nerve projects primarily to the nucleus of the solitary tract, which has projections to mult...

The Melbourne technique of total vault remodeling consistently achieves a virtually normal head shape. After analysis of the first 30 cases, the authors recommend this as their technique of choice for severe scaphocephaly when the full constellation of deformities is present.