Intermittent vagal nerve stimulation in paediatric patients: 1-year follow-up

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Abstract
Object: Vagal nerve stimulation (VNS) has recently been proposed as a valid treatment for adult patients with drug-resistant partial epilepsy. Little experience in children has been reported. In order to evaluate the clinical efficacy and tolerance of VNS, we studied 13 paediatric patients with drug-resistant partial epilepsy. Methods: Improvement in seizure frequency was estimated by calculating the percentage of change in seizure frequency during each 3-month period following initiation of VNS, compared with the 3-month period prior to the implantation of the VNS device. The improvement in quality of life (QOL) was evaluated with the Vineland Behavior Adaptive Scale (VBAS). Results: In all patients, the surgical procedure was well tolerated. A recent modification of the implantation technique needing only a single cervical incision, has further reduced the aesthetic damage, particularly in small children who have a reduced muscular mass. Three months after the surgical procedure, 10 of the 13 patients demonstrated a seizure reduction rate greater than 50%. At the 1-year follow-up these positive results were maintained: 6 out of 8 patients continued to demonstrate a seizure reduction rate greater than 50%. Comparison with the pre-implantation period also showed a significant improvement in QOL in 4 out of 8 patients. We conclude that VNS is a valid treatment modality in children with drug-resistant partial epilepsy.

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