Vagal Nerve Stimulation in Childhood Onset Refractory Epilepsy: Follow Up of 14 Cases.
Abstract number :
2.340
Submission category :
Year :
2001
Submission ID :
315
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Topcu, MD, Pediatric Neurology, Hacettepe University, Ankara; G. Turanli, MD, Pediatric Neurology, Hacettepe University, Ankara; D. Yalnizoglu, MD, Pediatric Neurology, Hacettepe University, Ankara; D. Genc-Acikgoz, MS, Pediatric Neurology, Hacettepe U
RATIONALE: Vagal nerve stimulation (VNS) has shown efficacy in both children and adults with refractory epilepsy. Improved seizure control, decreased number of antiepileptic drugs (AEDs), and maintanance with lower doses of AEDs may contribute to cognitive functions in patients with intractable seizures. We studied seizure outcome and neuropsychological evaluation following VNS in childhood onset refractory epilepsy.
METHODS: Fourteen patients were studied with age at implant between 11-20 years, and age at seizure onset between newborn period and 8 years. Follow up duration ranged between 3 months and 2 years. Four patients failed corpus callosotomy, and 2 had resective surgery for epilepsy. Nine patients had symptomatic partial epilepsy, 2 had cryptogenic partial epilepsy, one had generalized epilepsy, and 2 had Lennox-Gastaut Syndrome. All patients had cognitive and/or behavioral issues. Ten patients had a baseline neuropsychological evaluation, and 7 underwent re-evaluation at 3 months. Record of seizure type and frequency was obtained during one month baseline period, and continued following implant. At implant the stimulator was activated to deliver 0.25 mA for 30 seconds to repeat every 5 minutes. During follow up visits parameters were changed and AEDs were adjusted.
RESULTS: At 3 months 4 patients had 50% decrease in seizure frequency, one had 60% decrease, and 2 had more than 90% decrease. Seven patients had no significant change in seizure frequency, however seizure severity and duration remarkably decreased. Neuropsychological evaluation of 7 patients at 3 months revealed significant gains in higher cortical functions in one, and no obvious change in five. One patient showed mild decline compared to baseline. The most common side effect was mild voice alteration.
CONCLUSIONS: VNS has proved efficacious in patients with childhood onset refractory epilepsy. Side effects are well tolerated. Further studies are required to evaluate the long term effects of VNS on cognitive function.
Disclosure: Materials - Cyberonics