Authors :
Presenting Author: Lalit Bansal, MD – Children's Mercy Hospital
Fatima Jaafar, MD – Children's Mercy Hospital
Anshika Kapoor, Medical Student – University of Missouri Kansas City
Leena Abdelmoity, Medical Student – Kansas University Medical Center
Ahmed Madkoor, Research Student – Children's Mercy Hospital
Christian Kaufman, MD – Children's Mercy Hospital
Ahmed Abdelmoity, MD – Children's Mercy Hospital,
Rationale:
Vagus nerve stimulation (VNS) is increasingly utilized in the management of drug-resistant epilepsy (DRE), yet its long-term efficacy and prognostic indicators remain incompletely understood. This study evaluated both short- and long-term seizure outcomes in pediatric patients with DRE following VNS therapy, with a focus on the influence of stimulation parameters and potential predictors of favorable response.Methods:
A retrospective review was conducted of pediatric patients who underwent VNS implantation between 2003 and 2023 at a level 4 epilepsy center. Seizure burden and non-seizure outcomes were assessed at multiple follow-up intervals. Outcome were further analyzed by seizure type and variations in VNS stimulation parameters.Results:
A total of 400 pediatric patients received VNS therapy, with a mean follow-up duration of 4.92 years (range = 3 months to 18.91 years). Seizure frequency progressively improved, with a responder rate (RR, defined as ≥50% reduction in seizure frequency) reaching 90.5% at last follow-up, and 20.5% of patients achieving seizure freedom. Subgroup analysis revealed RRs of 88.6% for generalized epilepsy, 93.1% for focal epilepsy, and 90% for combined epilepsy, with the highest seizure freedom observed for focal epilepsy (31.6%, P=0.006)). Early VNS implantation (≤2 years from seizure onset) was associated with improved outcomes (P=0.034). Higher stimulation parameters, particularly ultra-rapid duty cycle, correlated with greater seizure reduction (P=0.018). Quality of life improved in 90% of patients, including enhancement in attention, development, and academic performance. VNS therapy was well-tolerated, with mostly mild adverse events; the most common was obstructive sleep apnea, which was managed through parameter adjustments.Conclusions:
This study underscores the long-term efficacy and safety of VNS therapy in pediatric DRE, particularly in patients receiving higher duty cycle and output current. Early implantation, focal epilepsy and optimized stimulation parameters were associated with better seizure control and substantial improvements in quality of life. Funding:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.