Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation
Grasl S, Janik S, Dressler A, Diehm R, Gröppel G, Eichinger K, Grasl MC, Gstoettner W, Feucht M, Vyskocil E, Baumgartner WD.
European Archives of Oto-Rhino-Laryngology (2021) 278:3891–3899
https://doi.org/10.1007/s00405-021-06943-x
Let us continue with our monthly theme of vagus nerve stimulation (#VNS) and improvements in quality of life (#QoL). In Feb. 2021, Grasl et al. published a study examining the effectiveness and safety of VNS Therapy in children and adolescents with drug-resistant epilepsy (#DRE) based on the perspective of a multidisciplinary team of otolaryngologists and neuropediatricians.
Highlights
● The effectiveness and safety of VNS implantation in children and adolescents with DRE were examined based on the perspective of otolaryngologists and neuropediatricians.
● 58.1% of the patients achieved a ≥75-100% reduction in #seizure frequency by VNS Therapy.
● 18.6-60.5% of the patients showed improvements in QoL-related parameters, including #alertness, emotional health, and #cognitive functions.
Seizure-related outcomes were assessed from 43 children with a mean follow-up time of 3±1.3 years. 76.7% of the patients achieved a ≥50% reduction in seizure frequency, and 58.1% achieved a ≥75-100% reduction.
The most common QoL-related parameter improved by VNS Therapy was alertness, with 60.5% of the children experiencing an improvement. However, beneficial effects could be observed for other QoL parameters as well: #mood and energy (41.9%, percentage of patients reporting an improvement); #concentration and progress in schoolwork (39.5%); verbal communication (34.9%); #memory (20.9%) and the development of life skills (18.6%). Possible effects on QoL were further evaluated using the clinical global impression of improvement (#CGI-I) scale. According to the result, 51.2% of patients felt “much improved” or “very much improved” following VNS Therapy. Furthermore, the study identified a positive CGI-I result to be significantly associated with a lower age at VNS implantation as well as a shorter duration between epilepsy onset and surgery.
Noteworthy, in the current study, otolaryngologists were responsible for the surgical and perioperative care. The duration of surgery ranged from 30-200 min, with a low complication rate (2.8% of the cohort suffered from local infection due to implantation) and a median hospitalization duration of 2 days.
In conclusion, considering the combination of favorable seizure control, beneficial effects on QoL, and the evaluation of surgical management, the study suggests avoiding delays in the process of patient selection and consideration of VNS Therapy as a treatment for DRE in children and adolescents.
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