Left vagal nerve stimulation in children with medically refractory epilepsy. The Pediatric VNS Study Group.

Abstract

To assess the use of intermittent left vagal nerve stimulation in a large population of children with pharmacoresistant epilepsy. Sixty children who were entered into controlled or compassionate use protocols of left vagal nerve stimulation all had been monitored for at least 3 months after their left vagal nerve stimulators were activated. The age range was 3 to 18 years (median 15 years). Sixteen of these 60 patients were younger than 12 years. Fifty-seven percent of the patients had partial complex seizures, and generalized tonic clonic seizures occurred in 27%. After 3 months of intermittent stimulation of the left vagal nerve, a median reduction in seizure frequency of 23% occurred in 60 patients. At 6 months the median reduction was 31% in 55 patients, at 12 months 34% in 51 patients, and at 18 months 42% in 46 patients. Improvement was not associated with any seizure type or seizure cause. Adverse events during stimulation included fever, coughing, colds, and voice alteration. None of these necessitated cessation of stimulation. Complications included aspiration pneumonia and necrosis of skin overlying the generator. Intermittent stimulation of the left vagal nerve appears to be a safe, adjunctive therapy for the treatment of children with epilepsy intractable to available antiepileptic drugs. The reduction in seizure frequency in children was similar to that reported in adults.