The efficacy and tolerability of auto-stimulation-VNS in children with Lennox-Gastaut syndrome
Abdelmoity SA, Abdelmoity AA, Riordan SM, Kaufman C, Le Pichon JB, Abdelmoity A.
Seizure. 2021 Mar;86:168-174.
https://doi.org/10.1016/j.seizure.2021.02.015.
The treatment outcome of #autostimulation (AutoStim) vagus nerve stimulation (#VNS) for Lennox-Gastaut syndrome (#LGS) has rarely been reported in the literature. Thus, for our current theme of LGS and VNS, we would like to highlight a #retrospective study by Abdelmoity et al. (Feb. 2021) on the treatment effects of AutoStim VNS in#pediatric patients with LGS.
The study enrolled 71 pediatric patients with LGS who underwent AutoStim VNS implantation. The average age at implantation was 20.82 months. The average age at #epilepsy onset was 18 months.
𝐒𝐞𝐢𝐳𝐮𝐫𝐞-𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬
Analysis revealed responder rates (≥50% reduction in #seizure frequency) of reporting as 55%, 67.7%, and 65%, respectively, responder rates at 6, 12, and 24 months post-VNS implantation. The seizure-freedom rate at 12 months and 24 months were 11% and 17%, respectively. The results were higher than the previously reported 54% responder rate and 4%-7% seizure-freedom rate in two studies [1,2].
𝐐𝐮𝐚𝐥𝐢𝐭𝐲-𝐨𝐟-𝐥𝐢𝐟𝐞 (𝐐𝐨𝐋) 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬
The most common improvements at 3, 12, and 24 months of follow-up were sleep quality (9 out of 32 patients,), developmental gain (14/37), and attention and alertness (12/23), respectively. Noteworthy, 48% of patients (11/23) reported developmental gains and improved sleep quality at 24 months.
𝐀𝐮𝐭𝐨𝐒𝐭𝐢𝐦 𝐕𝐍𝐒 𝐯𝐞𝐫𝐬𝐮𝐬 𝐭𝐫𝐚𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐕𝐍𝐒
Nine patients (30%) switched to AutoStim VNS from traditional VNS due to battery depletion. Seven of them had a further reduction in seizure frequency, suggesting the AutoStim VNS model can provide better seizure control than the traditional model.
𝐕𝐍𝐒 𝐩𝐚𝐫𝐚𝐦𝐞𝐭𝐞𝐫 𝐬𝐞𝐭𝐭𝐢𝐧𝐠𝐬
Compared to previous studies, a relatively low side effect rate was observed [3, 4]. No explantation or switching off the device was required. Only four patients required adjustments of the parameter settings due to side effects. The supplementary materials provided the standardized protocol for VNS programming followed by the center.
Ref.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049065/pdf/ANE-143-497.pdf
2.https://www.cambridge.org/core/journals/cns-spectrums/article/abs/vagus-nerve-stimulation-and-lennoxgastaut-syndrome-a-review-of-the-literature-and-data-from-the-vns-patient-registry/900728AC5AF78EAB1547E4E2772D34F2
3. https://www.epilepsybehavior.com/article/S1525-5050(10)00802-4/fulltext
4. https://www.sciencedirect.com/science/article/pii/S1059131103002334
