Abstracts

Pharmacoresistant epilepsy is a serious burden in approximately 20% of children with seizures. Nonpharmacologic, adjunctive treatments like the ketogenic diet and vagus nerve stimulation (VNS) Therapy are helpful, although our knowledge of their long-term efficacy in children still remains limited., We evaluated the long-term outcome (up to 24 months) of VNS Therapy in severely disabled children and adolescents with pharmacoresistant epilepsy in a multicenter, prospective, open label, non-randomized trial. From a total of 156 patients (58% male), 90% had learning disabilities and 89% developmental delay. Median age at implantation was 10 years (range, 2.5 [ndash] 18), and 89 patients (57%) were younger than 12 years. Median age at onset of epilepsy was 1 year (range, 0-12). Median duration of epilepsy was 7.8 years (range, 1.6 [ndash] 18). Epileptic syndromes were diagnosed in 53% of the patients; acquired lesions in 23%; and genetic syndromes in 5%. Etiology was unknown in 19% of the patients. Before VNS Therapy, 60% of the patients were evaluated for epilepsy surgery, and 14% were operated (2 callosotomies, 17 lobectomies and 3 other types of epilepsy surgery). Patients were eligible after failure of at least 5 AEDs, and were evaluated at baseline and at 3, 6, 12 and 24 months after implantation. Efficacy and safety results, magnet use and quality of life (QoL) data were analyzed., A total of 75 patients (48.1%) had 24 months follow-up. Seizure reductions [ge] 50% occurred in 32% of the patients after 3 months, and in 51% after 24 months follow-up (p=0.01). Compared to baseline, there was a statistically significant seizure reduction at every follow-up interval (p=0.0001). In most cases, side effects were well tolerated and could be minimized by reducing pulse width or stimulation frequency. Between 8% and 12% of the patients reported that the magnet was [ldquo]always[rdquo] or [ldquo]most of the time[rdquo] effective in aborting or reducing the intensity and/or duration of their seizures. Decreasing magnet effects were observed over time, except in a small group of patients (10%) where constantly satisfactory magnet effects were reported. More than 50% of the patients had improvements in alertness., These results demonstrate the outstanding long-term efficacy of VNS Therapy in this population of young and severely disabled children and adolescents with up to 24 months follow-up. VNS Therapy was also well tolerated and associated with QoL improvements.,