VAGUS NERVE STIMULATION: Treatment of 171 pediatric patients with a long-term follow-up
Abstract number :
3.375
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2016
Submission ID :
243687
Source :
www.aesnet.org
Presentation date :
12/5/2016 12:00:00 AM
Published date :
Nov 21, 2016, 18:00 PM
Authors :
Santiago Flesler, Hospital Nacional de Pediatria JP Garrahan; Gabriela Reyes, Hospital Nacional de Pediatria JP Garrahan; Sebastian Fortini, hospital Nacional de Pediatria JP Garrahan; Belen Ramos, hospital Nacional de Pediatria JP Garrahan; Ricardo Cerso
Rationale: Vagus nerve stimulation (VNS) was introduced in 1997 as an adjunctive therapy for partial seizures. To date, over 100.000 patients worldwide have been treated with VNS therapy. The objective of this study was to describe a series of pediatric patients with refractory epilepsy treated with VNS in a long term follow up and evaluate efficacy and safety. Methods: A retrospective analysis of the clinical charts of 171 children who suffered from epilepsy resistant to pharmacological and nonpharmacological treatment, including surgery, that were treated with VNS between march 2001 and march 2016. Patients with progressive encephalopathies, systemic diseases, and congenital heart disease were excluded. Effectiveness assessment was measured with McHugh-Engel classification. Results: 171 patients (89 male) were included. Mean age at epilepsy onset: 2.2 years. Mean age at implantation: 11.4 years. Time of follow-up: 1 to 15 years (median 6.8). Epilepsy syndromes were: West (5), spasms without hypsarrhythmia (4), Lennox-Gastaut (96), Dravet (8), epilepsy with myoclonic-atonic seizures (21), focal epilepsies (35), bilateral Rasmussen (1), FIRES (1). Effectiveness: At 12 months: Class I: 53 (31%); Class II: 55 (32.2%); Class III: 31 (18.1%); Class IV: 18(10.6%); Class V: 14 (8.1%). At 24 months: Class I: 71 (41.5%); Class II: 45 (26.3 %); Class III: 28 (16.3%); Class IV: 18 (10.6%); Class V: 9 (5.3%). Three patients died: 1 of respiratory infection, 1 of status epilepticus, 1 of SUDEP. Severe side effects: 3 (1.8%) -1 recurrent paralysis (0.6%), 2 postsurgical infection (1.2%). Minor side effects: 27 (15.7 %) (cough, hoarseness, odynophagia, others). Conclusions: VNS is an effective and safe therapy. A reduction in seizures including status epilepticus and Hospital admissions was found. Improvement in cognition, behavior and quality of life was observed. A cumulative improvement in seizure control was also observed. VNS therapy was an effective treatment for epileptic encephalopathy, specially LGS. Funding: I have not.
Clinical Epilepsy