Evaluating vagus nerve stimulation treatment with heart rate monitoring in pediatric patients with intractable epilepsy

Abstract Purpose Vagus nerve stimulation (VNS) is a palliative treatment for intractable epilepsy. While the expected outcome of VNS is well known, the clinical predictors of outcome are not clearly defined. We investigated the predictors and seizure reduction rates of VNS in pediatric patients. Methods We retrospectively reviewed medical records, radiological data, EEG, and clinical outcomes of 47 pediatric patients who underwent VNS implantation in our institution. Chi-squared tests and Fisher’s exact tests were used for categorical variables, and Student’s t test was applied for continuous variables. A paired T test was used for the comparison of pre- and post-insertion for each variable. Results The mean age at the time of VNS surgery was 14.7 years (range, 5–26 years). The mean interval from seizure onset to surgery was 8.3 years (range, 2–16 years). Responders (≥50% reduction in seizure frequency) included 22 patients (47%) at six months postoperatively and 25 patients (53%) at one year postoperatively. The overall mean seizure frequency was reduced from 8.0 per week to 5.1 per week 12 months after implantation (36%, p=0.006). Patients with focal onset epilepsy on electroencephalography (EEG) had 7.5 seizures per week preoperatively, which was reduced to 5.1 seizures per week postoperatively (32%, p=0.009). Patients who did not undergo resection surgery prior to VNS insertion had a reduction rate of 43% (p=0.006). Conclusions Pediatric patients with intractable epilepsy who have focal lesions in eloquent areas or unmatched ictal zones on EEG with multifocal lesions could be good candidates for VNS.

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Vagus nerve stimulation for pediatric patients with intractable epilepsy between 3 and 6 years of age: study protocol for a double-blind, randomized control trial

Trials ◽

10.1186/s13063-018-3087-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 8

Author(s):

Taoyun Ji ◽

Zhao Yang ◽

Qingzhu Liu ◽

Jianxiang Liao ◽

Fei Yin ◽

...

Keyword(s):

Vagus Nerve ◽

Study Protocol ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Randomized Control Trial ◽

Pediatric Patients ◽

Intractable Epilepsy ◽

Double Blind ◽

Randomized Control

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Implanted vagus nerve stimulation in 126 patients: surgical technique and complications

Perspectives in Surgery ◽

10.33699/pis.2020.99.7.304-310 ◽

2020 ◽

Vol 99 (7) ◽

Keyword(s):

Vagus Nerve ◽

Vocal Cord ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Pulse Generator ◽

Operative Procedure ◽

Intractable Epilepsy ◽

Vagal Nerve ◽

University Hospital ◽

Nerve Stimulator

Introduction: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. Methods: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.1−58.4 years). Results: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. Conclusion: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.

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Impact of Subthreshold Transcutaneous Auricular Vagus Nerve Stimulation on the Heart Rate Variability and Atrial Arrhythmias

2020 43rd International Convention on Information, Communication and Electronic Technology (MIPRO) ◽

10.23919/mipro48935.2020.9245390 ◽

2020 ◽

Author(s):

R. Trobec ◽

M. Linden ◽

M. Sinkovec

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Atrial Arrhythmias

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Long Term Effects of Low Frequency (10 Hz) Vagus Nerve Stimulation on EEG and Heart Rate Variability in Crohn's Disease: A Case Report

Brain Stimulation ◽

10.1016/j.brs.2014.08.001 ◽

2014 ◽

Vol 7 (6) ◽

pp. 914-916 ◽

Cited By ~ 26

Author(s):

Didier Clarençon ◽

Sonia Pellissier ◽

Valérie Sinniger ◽

Astrid Kibleur ◽

Dominique Hoffman ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Crohn’S Disease ◽

Case Report ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Low Frequency ◽

Long Term Effects

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Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.5.peds11489 ◽

2012 ◽

Vol 10 (3) ◽

pp. 200-205 ◽

Cited By ~ 30

Author(s):

Eric M. Thompson ◽

Susan E. Wozniak ◽

Colin M. Roberts ◽

Amy Kao ◽

Valerie C. Anderson ◽

...

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Pediatric Patients ◽

Medication Use ◽

Partial Epilepsy ◽

Seizure Duration ◽

Antiepileptic Medication ◽

Generalized Epilepsy

Object Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy. Methods A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use. Results One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type. Conclusions Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.

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