Abstracts

RATIONALE: We report on the changes in academic performance, for 12 refractory pediatric partial seizure patients, with implantation of the Vagus Nerve Stimulator (VNS). Current anticonvulsant medications were not removed until significant changes were already recorded due to the addition of the VNS. These academic changes were clearly not the result of decreases in or removal of cognitively impairing medications!
METHODS: These observations are the result of a retrospective chart review of 12 patients with refractory partial seizures. All took multiple medications before and after the implantation of the VNS. They ranged in ages from 11 - 17 years old (6 Female: 6 Male) and had to be able to answer questions about their academic situations and their treatment. Every patient had a normal IQ[ssquote]s on the WISC R. All patients were interviewed during routine clinic visits for improvements over the first six months of VNS placement in many areas of their lives. Specifically questions regarding class room placements (regular vs. resource classes vs. home school) were asked of both the patient and the parents. Finally, each child / adolescent was questioned about future academic plans.
RESULTS: Twelve pediatric aged refractory partial seizure patients were reviewed for academic improvements since the placement of the VNS. Nine of the twelve children / adolescents reported positive changes in their school performance since the VNS implantation and activation! Only three students lacked improvement or regressed during their first 6 months with the VNS.
Two students, who were home schooled for the previous year due to their inability to pass resource course material, were now in a normal class room setting and passing the material! Three students who were failing resource classes were now passing that academic material. One other student moved from vocational trade school to regular classes. Three students are now confident enough in their academic abilities to be planning to attend junior college. These improvements were not due to a reduction in seizure medications after the implantation of the VNS because no changes were made with medications until after these improvements were seen. Other improvements such as a memory of the child[ssquote]s newspaper route were also reported by these children.
CONCLUSIONS: It has been suggested that improvements in alertness and sleep cycle seen after the implantation and activation of the VNS are due to cholinergic mechanism which are stimulated by the VNS (Malow, et. al., 2001). Holmes et al, 2001 have shown in animal models that cholinergic neurons responsible for memory are destroyed in kindling models of epilepsy. They have additionally suggested that in kindled epilepsy animal models the pharmacological augmentation of cholinergic neurons seems to slow the kindling process. Perhaps these academic improvements are also the result of protection of the forebrain cholinergic neurons by the Vagus Nerve Stimulator currents.
At the end of this activity the reader should be able to answer questions about the VNS[ssquote]s ability to show academic improvements in refractory seizure children. They should also be able to discuss possible cholinergic mechanisms which would explain these findings.
(Disclosure: Other - Consulting and Beta testing PDA program)