Abstracts

Rationale: Vagus nerve stimulation (VNS) therapy has shown efficasy in children and adults with drug-resistant epilepsy who are not candidates for epilepsy surgery or who failed previous epilepsy surgery. It has been suggested that there may be cognitive and/or behavioral improvement independent of seizure control. However reports on patients with autistic spectrum disorder are sparse. We present the effects of VNS in three patients with Rett Syndrome. Methods: Twenty seven patients underwent implantation of VNS between 1998-2008 at Hacettepe University department of pediatric neurology. Among them three patients were diagnosed with Rett Syndrome. They received VNS as an adjunctive therapy; antiepileptic drugs were adjusted as needed. Results: Patients ranged in age from 7 to 14 years (mean age 11 y); follow up duration ranged between 6 months to 2 years. Manifest seizures started at an average 3 years of age. Two patients showed 25-30% reduction of seizure frequency; as well as decreased seizure severity and duration. Both females showed amelioration of autistic features; they had better eye contact, and decreased stereotypies. Additionally one of them showed improvement in respiratory disturbances, sleep problems and gait. The remaining patient showed no obvious change with respect to seizure frequency and severity, and there were no positive cognitive effects compared to baseline. She showed no improvement in autistic behavior and autonomic sypmtoms. VNS was well tolerated in all patients, with no surgical complications. Conclusions: Vagus nerve stimulation may be a nonpharmacological treatment option for patients with intractable epilepsy and autistism, including patients with Rett Syndrome. Further studies are necessary for determination of seizure outcome as well as effects on cognitive problems and autistic features in this particular group of patients.