Abstracts

Rationale: VNS appears to be more efficacious in some pediatric epileptic syndromes, (especially in Lennox-Gastaut and Lennox-like syndromes) when compared to adults. The early generators were quite big and not suitable for use in young children. The generator size has diminished over the years, making it possible to use in small children. We describe the adverse events found in children under the age of 8 years. Methods: Twenty-nine children with Lennox-Gastaut or Lennox-like syndrome younger than 8 years old were submitted to VNS. Age ranged from 1.5-8 years (mean= 4.9 years). The generator was implanted in the infraclavicular region in all patients. Stimuli paradigm included 5 minutes "off", 30 sec "on", 30 Hz, 300msec and intensity up to 3.5mA. Results: There was no mortality, immediate morbidity or infections. Cough was noted in 4 children, and managed by slowing the pace of intensity increase. One child had choking at intensity higher than 2.5mA. Three children had seizure frequency increase with stimulation higher than 2.5mA and needed reduction in the intensity of stimulation. Three children had previous tracheostomy and their course after VNS was uneventful. Conclusions: VNS is safe in young children. The adverse events profile seemed similar and less prevalent compared to adults. Infectious complications were rarer when compared to adults. Higher intensity stimulation can be used in this patient population and is related to better seizure control, although some children might exhibit seizure frequency worsening in the higher end and need intensity reduction to previous levels. Funding: None