Vagal Nerve Stimulation for Treatment of Young Children with Medically Refractory Epilepsy.
Abstract number :
2.339
Submission category :
Year :
2001
Submission ID :
940
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
T.E. Thomas, MD, Neurosurgery, Sainte-Justine Hospital, Montreal, QC, Canada; A. Bouthillier, MD, Neurosurgery, Sainte-Justine Hospital, Montreal, QC, Canada; A. Lortie, MD, Neurology, Sainte-Justine Hospital, Montreal, QC, Canada; J-C. Marchal, MD, Neuro
RATIONALE: Left vagal nerve stimulation (VNS) is an increasingly popular treatment for medically refractory epilepsy. However specific indications and efficacy, particularly in young children, remain unclear. The purpose of this study was to evaluate the efficacy of VNS in a cohort of children implanted at our center, and to assess them for factors predictive of outcome.
METHODS: The first ten children with medically refractory epilepsy who were implanted at our institution were followed prospectively two months prior to and every month after VNS surgery. Seizure frequency, stimulation parameters, efficacy of self-stimulation, and side effects were monitored at each follow-up visit. In addition, EEG, neuropsychological and quality of life evaluations were performed on each patient both before and twelve months after surgery. Average follow-up is seven months (range 2-12 months). Medical treatment was not modified during the first six months of follow-up.
RESULTS: We implanted five girls and five boys, with a mean age of 8.3 [plusminus]3.3 years. Six patients had partial epilepsies and four had generalized epilepsies, including one with Lennox-Gastaut syndrome. Mean baseline seizure frequency was 275 per month. Mean seizure reduction at last follow-up was 76%, with a range of 0%- 100%. Eight out of ten children demonstrated a greater than 85% decrease in seizure frequency. A statistically significant and progressive decrease in mean seizure frequency was noted as early as one month postoperatively. Overall behavioral improvement was observed in all patients, but only one child showed an improvement in global IQ. No factor was identified as a marker for favorable outcome, but the two patients who failed to improve suffered from cryptogenic partial epilepsies, had lower seizure counts, and were implanted at a relatively older age compared to our cohort.
CONCLUSIONS: VNS demonstrated major seizure reduction in eight of ten children in the cohort studied. We also observed a significant improvement in behavior in all children, independent of seizure outcome. In general, our cohort suggests that young children with generalized epilepsies tend to have a more favorable outcome.