Authors :
Presenting Author: Chelsey Ortman, MD – University of Texas at Austin, Dell Medical School
Kristen Arredondo, MD – University of Texas at Austin, Dell Medical School
Daniel Freedman, DO – Dell Medical School
Mohammed Omar Iqbal, MD – University of Texas at Austin, Dell Medical School
Kevin Kumar, MD, PhD – University of Texas at Austin, Dell Medical School
Elizabeth Tyler-Kabara, MD, PhD – The University of Texas at Austin, Dell Medical School
Elias Rizk, MD, PhD – University of Texas at Austin, Dell Medical School
Rationale:
Vagus nerve stimulation (VNS) placement has been approved by the FDA for treatment of medically intractable epilepsy for children ages 4 years old and above. However, given the disabling effects of uncontrolled epilepsy in young children on development, quality of life, and SUDEP risk, investigational use of VNS in children younger than 4 years of age has been implemented in some institutions.Methods:
A retrospective chart review was completed for all patients who underwent VNS placement at Ascension Dell Children's Medical Center from January 1, 2018 to June 1, 2024. Variables collected included age, gender, total follow-up time, anti-seizure medications (ASMs) previously trialed, current list of ASMs, seizure frequency prior to surgery, seizure frequency at last follow-up, MRI abnormalities, epilepsy etiology, epilepsy syndrome, ILAE seizure type, and reported complications.Results:
There was a total of 10 patients ages 12 months old to 3.9 years old who underwent VNS placement at Ascension Dell Children's Medical Center from January 1, 2018 to June 1, 2024. Of the 10 patients who underwent VNS placement, analysis was completed for 7 patients with at least 1 year of follow-up. The median length of follow-up was 5.3 years, with range 1.1 year to 6.9 years. Median age of patients with adequate follow-up was 3.0 years old, with range 2.5 to 3.9 years old. No permanent or disabling complications were reported for any patient. One patient experienced transient behavioral concerns that improved when settings were adjusted, with auto stimulation threshold reduced from 40% to 20%. Seizure frequency was improved in 3 of 7 patients (43%) at last follow-up. ASMs were reduced in 2 of 7 patients (29%) at last follow-up.
Conclusions:
Off-label VNS placement in children less than 4 years of age at a single institution was well-tolerated without significant complications. Reassuringly, there was no hardware-related or surgical-related complications in this cohort. There was variable seizure control and reduction in use of anti-seizure medication, however this may be related to limitations related to the sample size. Additional longitudinal data with a multicenter cohort will allow for a more detailed understanding of which patients are most likely to respond to VNS placement.
Funding:
No internal or external funding was obtained in support of this project.