young children

Soleman J, Stein M, Knorr C, et al. Epilepsy & Behavior, 88 (2018):139-145.

The ability to control seizures in children with epilepsy is critical to a child’s development, cognitive function, and quality of life. Approximately one third of children with epilepsy have drug resistant epilepsy. In some children with drug resistant epilepsy, a vagus nerve stimulator (VNS) can help decrease the number or length of seizures, lower the number of urgent hospitalizations, and improve quality of life.

Purpose

The purpose of this study was to compare seizure outcome and quality of life in children who had a VNS implanted early (5 years of age or younger) or late (older than 5 years of age).

Description of Study

  • Information from 45 children undergoing implantation of VNS were included.
  • Outcome was measured by looking at
    • Seizure frequency
    • Epilepsy outcome using a scale from seizure freedom to no worthwhile improvement
    • Ability to reduce anti-seizure medications
    • Psychomotor development and cognition
    • Quality of life
  • Caregiver impressions and a pediatric quality of life scale (PEDSQL) were used to assess quality of life (physical, emotional, social, and school function) and cognition.
  • Parents were asked to complete the PEDSQL twice:
    • 3 months before surgery
    • 3 months after surgery
  • Most of the data in this study were based on parental reporting (because of age of child or disability of child). Whenever possible, child’s reporting was included.

Summary of Study Findings

  • 14 children had their VNS implantation early and 31 children had their VNS implantation late.
  • Decrease in seizure frequency and epilepsy outcome was similar in both groups.
  • Decrease in anti-seizure medication was similar in both groups.
  • The early group showed significant improvement in quality of life and cognitive outcomes as compared to the late group.
  • The duration of epilepsy from seizure onset until VNS placement was significantly shorter in children with early implantation of VNS, which may have contributed to findings of improvement in cognitive outcome and quality of life.

What does this mean?

  • This study suggests that early use of VNS may lead to a better quality of life and improved cognitive outcome in some children with drug resistant epilepsy.
  • This study confirms overall benefits of VNS implantation in children with drug resistant epilepsy.
  • This study shares that early implantation of VNS is safe and feasible. It encourages consideration of this therapy even in children under 5 years of age.
  • This study included a small group of 45 children. Further research is needed examining the possible benefits of early VNS implantation in children.

Article published in Epilepsy & Behavior, November 2018.

Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
12/2018
Reviewed By: 
Joseph I. Sirven MD
on: 
Tuesday, December 11, 2018