Abstracts

Despite therapy with multiple anticonvulsants refractory epilepsy in pediatric patients with Tuberous Sclerosis is a common occurrence. Epilepsy often begins as infantile spasms and progresses over time to Lennox Gastaut Syndrome. In other patients focal seizures from a single cortical tuber or multi-focal seizures from multiple cortical tubers are observed. Vagus nerve stimulation offers an alternative therapy for refractory seizures in these patient. A retrospective review of 425 patients followed in the Tuberous Sclerosis Clinic at the University of Chicago identified pediatric patients in which vagus nerve stimulation therapy was performed . Age, Sex, duration of vagus nerve stimulation, seizure frequency prior to stimulator implantation, and at most recent clinic visit were obtained. In addition, seizure type and anticonvulsant therapy were also recorded. Individual and mean seizure reduction were calculated. Subjective impression on quality of life after Vagus nerve stimulation was also obtained from primary caregivers. Of the 10 patients 5 were female. Mean age was 9.2 yr . Mean follow up was 26.15 [plusmn] 22.7 months. Mean stimulation current was 1.875 [plusmn] 0.57 ma. Mean seizure frequency prior to stimulator implantation was 4.3[plusmn] 2.8 seizures per day. Mean seizure frequency after stimulation was 1.6[plusmn] 1.5 seizures per day. (p=0.017) . Mean seizure reduction was 70.0 [plusmn]18.0 percent . All patient had seizure reduction greater than 47%. Vagus nerve stimulation is an effective adjunctive anticonvulsant therapy for refractory seizures in children with Tuberous Sclerosis. Mean seizure frequency was reduced from 4.3 to 1.6 seizures per day p=0.017. A greater than 47% reduction of seizure frequency was observed in all 10 children in our study. In addition, over half of the children were judged subjectively by their primary care givers to be more alert and have improved performance in school. In two of the ten children rapid stimulation parameters produced an increase in seizure frequency compared to standard stimulation parameters. Early use of Vagus Nerve Stimulation in children with Tuberous Sclerosis improves seizure control and subjective quality of life for these patients.