Authors :
Presenting Author: Bailey Caldwell, APRN – Cincinnati Children's Hospital
Ravindra Arya, MD, DM – Cincinnati Children's Hospital Medical Center
Daniel Clark, MD PhD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Skoch Jesse, MD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Matthew Grace, APRN – Cincinnati Children's Hospital
Hansel Greiner, MD – University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center
Rationale:
Vagal nerve stimulation (VNS) is a widely used adjunctive therapy for drug-resistant epilepsy, but clinical consensus on titration strategies and predictors of response are lacking. Traditional titration protocols are gradual, but accelerated strategies may expedite therapeutic benefit. This study evaluated the safety of a newly devised protocol for rapid titration, the relationship between stimulation parameters and seizure response, and early clinical predictors of long-term response. We hypothesized that pediatric patients with a higher propensity to frequent generalized seizures would benefit from rapid titration of VNS. Methods:
A retrospective cohort study was conducted on pediatric patients who underwent first VNS implantation between August 2022 and June 2024 at Cincinnati Children’s Hospital. Early optimal titration was defined as achieving ≥1.00 mA within thirty days post-implant. Patients were stratified by seizure type, stimulation parameters, and early clinical response (e.g., seizure frequency, severity, magnet responsiveness). Treatment response was defined as a ≥50% reduction in seizure frequency at 6 months, as reported in clinical notes. Safety was assessed by monitoring adverse events related to stimulation and defined by adverse effects requiring readmission for VNS adjustments or an urgent office visit for VNS adjustments. Results:
A total of 59 patients were included (mean age 9.6 +/- 4.6 years). The most common etiology was structural (n=27), then idiopathic generalized epilepsy (n=19), followed by genetic encephalopathy (n=9). More than one seizure type could be represented per patient. The most common seizure type was GTCs (n=30). No serious stimulation-related adverse events were reported. The responder rate ( >50% reduction in seizures) at 6 months for patients with available data regardless of seizure type was 27/44 patients (61%). Twenty-four patients underwent rapid titration. Among patients who reached early optimal stimulation, 12/19 (63%) with available data were responders at 6 months followup, compared to 15/25 (60%) who did not reach early optimal stimulation (n.s.).
Conclusions:
Rapid titration of VNS to therapeutic current appears safe and well-tolerated in pediatric patients. These findings support the implementation of early, goal-directed VNS programming strategies to maximize therapeutic benefit.Funding:
No external funding was received for this study.