Early Implantation as a Main Predictor of Response to Vagus Nerve Stimulation in Childhood-Onset Refractory Epilepsy

Author:

Russo Angelo1ORCID,Hyslop Ann2,Gentile Valentina3,Chiarello Daniela3,Messana Tullio1,Miller Ian2,Zucchelli Mino4,Lima Mario5,Ragheb John6,Pini Antonella1,Cordelli Duccio Maria2,Resnick Trevor3,Jayakar Prasanna3,Duchowny Michael27

Affiliation:

1. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy

2. Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children’s Hospital, Miami, FL, USA

3. Child Neurology and Psychiatric Unit, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy

4. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy

5. Pediatric Surgery, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, University of Bologna, Italy

6. Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, FL, USA

7. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

Abstract

Objective: We describe a multicenter experience with vagus nerve stimulator implantation in pediatric patients with drug-resistant epilepsy. Our goal was to assess vagus nerve stimulation efficacy and identify potential predictors of favorable outcome. Methods: This is a retrospective study. Inclusion criteria: ≤18 years at time of vagus nerve stimulator implantation, at least 1 year of follow-up. All patients were previously found to be unsuitable for an excisional procedure. Favorable clinical outcome and effective vagus nerve stimulation therapy were defined as seizure reduction >50%. Outcome data were reviewed at 1, 2, 3, and 5 years after vagus nerve stimulator implantation. Fisher exact test and multiple logistic regression analysis were employed. Results: Eighty-nine patients met inclusion criteria. Responder rate (seizure frequency reduction >50%) at 1-year follow-up was 25.8% (4.5% seizure-free). At last follow-up, 31.5% had a favorable outcome and 5.2% were seizure free. The only factor significantly predicting favorable outcome was time to vagus nerve stimulator implantation, with the best outcome achieved when vagus nerve stimulator implantation was performed within 3 years of seizure onset. Implantation between 3 and 5 years after epilepsy onset correlated with better long-term seizure freedom (13.3% at T5). Overall, 65.2% of patients evidenced improved quality of life at last follow-up. However, 12.4% had adverse events, but most were mild and disappeared after 3-4 months. Conclusions: Early vagus nerve stimulator implantation within 5 years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients. Improved quality of life and a low incidence of significant adverse events were observed.

Publisher

SAGE Publications

Subject

Neurology (clinical),Pediatrics, Perinatology and Child Health

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