The effect of vagus nerve stimulator in controlling status epilepticus in children
Gedela S, Sitwat B, Welch WP, Krafty RT, Sogawa Y.
Seizure. VOLUME 55, P66-69, 2, 01, 2018
https://doi.org/10.1016/j.seizure.2018.01.010
Vagus nerve stimulation (#VNS) may have beneficial effects on the prevalence of status epilepticus (#SE) in patients with drug resistant epilepsy (#DRE).
This #retrospective study by Gedela et al. 2018 aimed to elucidate the effectiveness of VNS-therapy on the incidence of SE and seizure frequency in #pediatric patients with DRE at the Children’s Hospital of Pittsburgh, Pittsburgh, USA.
Highlights
• The proportion of patients affected by SE was reduced following VNS-implantation.
• VNS-therapy significantly decreased the frequency of generalized convulsive #seizures.
• The median follow-up time was 2.7 years post VNS-insertion.
A total of 16 patients (median age at the point of implantation: 9 years) with a history of two or more episodes of SE and at least one year follow-up post-VNS insertion (median follow-up time: 2.7 years) were included in the study. 10/16 patients had experienced at least one SE during the year prior to VNS-insertion.
As a primary objective, the occurrence of SE during the year preceding VNS surgery was compared with the corresponding values one year post VNS-insertion. Furthermore, the effect of VNS on seizure frequency was analyzed (secondary outcome).
Interestingly, at the one-year follow-up post VNS-insertion, the proportion of patients suffering from episodes of SE was reduced from 63% pre-VNS-insertion to 25% post VNS-insertion (not statistically significant). Furthermore, when analyzing the frequency of generalized convulsive seizures, a significant reduction in seizure frequency was observed for 69% of the patients at the one-year follow-up and for 75% of the patients at the last follow-up point. However, when combining all seizure types, no significant effect of VNS-therapy on seizure burden could be observed.
The current study is limited by its retrospective design and the absence of a control group, which lower the evidence level of the study outcomes. Furthermore, the low number of participants might obscure otherwise statistically significant effects of VNS.
Despite its limitations, the results from the current paper implicate important beneficial effects of VNS on the incidence of SE and the frequency of generalized convulsive seizures in patients with DRE. An important patient group in much need of new treatment modalities.
