Outcomes of vagal nerve stimulation in a pediatric population: A single center experience

Yu, Camilla; Ramgopal, Sriram; Libenson, Mark H.; Abdelmoumen, Imane; Powell, Catherine; Remy, Kenneth E.; Madsen, Joseph R.; Rotenberg, Alexander; Loddenkemper, Tobias

doi:10.1016/j.seizure.2013.10.002

Cited by 25 publications

(21 citation statements)

References 34 publications

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“…We found that VNS therapy contributed to notable reduction of seizure burden in nearly half of patients (Fig. 1), and 33% of our patients responded with ≥50% reduction of seizure frequency after 12 months of therapy, which is similar to many other studies ( 9 , 10 , 12 , 17 , 19 ), while some authors have reported better efficacy ( 16 , 20 - 23 ). The response rate in our patients should be considered from two aspects: firstly, the majority of our patients had severe drug-resistant epilepsy for a very long time before VNS, and some studies indicated that longer duration of epilepsy could be negatively correlated with the efficacy of VNS ( 24 ).…”

Section: Discussionsupporting

confidence: 89%

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

Kavčič

Kajdič

Rener-Primec

et al. 2019

ACC

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SUMMARYTo 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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Section: Discussionsupporting

confidence: 89%

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

Kavčič

Kajdič

Rener-Primec

et al. 2019

ACC

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“…3,7 Beyond the seizure outcome, the study demonstrated the success of a model that integrates service with business, teaching, and research. The outcome of neuromodulation may be confounded by titration of medications that was performed by the referring physician.…”

Section: Discussionmentioning

confidence: 92%

“…3,5,7 The challenge ahead of us is to integrate these different therapies in busy clinical practice. 3,5,7 The challenge ahead of us is to integrate these different therapies in busy clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Practice trends and the outcome of neuromodulation therapies in epilepsy: A single‐center study

et al. 2019

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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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“…In our study, there was no statistically significant predictor of outcome in the ≥ 50% responder analysis. Several studies also could not determine the predictors of outcome based on demographic characteristics [23,32]. This is probably due to the ambiguous mechanism of VNS and widespread projection fibers of the nucleus solitarius tract, which is a transfer center of the vagus nerve [20].…”

Section: Discussionmentioning

confidence: 99%

Predictors of seizure outcome for vagus nerve stimulation in children

Yang

Kim

et al. 2020

Preprint

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Purpose Vagus nerve stimulation (VNS) is a palliative treatment for intractable epilepsy. While the expected outcome of VNS is well known, the clinical predictors of outcome are not clearly defined. We investigated the predictors and seizure reduction rates of VNS in pediatric patients. Methods We retrospectively reviewed medical records, radiological data, EEG, and clinical outcomes of 47 pediatric patients who underwent VNS implantation in our institution. Chi-squared tests and Fisher’s exact tests were used for categorical variables, and Student’s t test was applied for continuous variables. A paired T test was used for the comparison of pre- and post-insertion for each variable. Results The mean age at the time of VNS surgery was 14.7 years (range, 5–26 years). The mean interval from seizure onset to surgery was 8.3 years (range, 2–16 years). Responders (≥50% reduction in seizure frequency) included 22 patients (47%) at six months postoperatively and 25 patients (53%) at one year postoperatively. The overall mean seizure frequency was reduced from 8.0 per week to 5.1 per week 12 months after implantation (36%, p=0.006). Patients with focal onset epilepsy on electroencephalography (EEG) had 7.5 seizures per week preoperatively, which was reduced to 5.1 seizures per week postoperatively (32%, p=0.009). Patients who did not undergo resection surgery prior to VNS insertion had a reduction rate of 43% (p=0.006). Conclusions Pediatric patients with intractable epilepsy who have focal lesions in eloquent areas or unmatched ictal zones on EEG with multifocal lesions could be good candidates for VNS.

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Outcomes of vagal nerve stimulation in a pediatric population: A single center experience

Abstract: VNS provides significant seizure reduction, in particular in pediatric patients with a higher baseline seizure frequency.

Cited by 25 publications

References 34 publications

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

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

Practice trends and the outcome of neuromodulation therapies in epilepsy: A single‐center study

Predictors of seizure outcome for vagus nerve stimulation in children

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