Chonnam Med J.  2008 Apr;44(1):31-36. 10.4068/cmj.2008.44.1.31.

Therapeutic Effects of Vagus Nerve Stimulation in Intractable Childhood Epilepsy: Experience for 12 Months after VNS Implantation

Affiliations
  • 1Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea. yjwoo@chonnam.ac.kr

Abstract

Vagus nerve stimulation (VNS) is presently considered an effective mode of treatment in intractable epilepsy. Its efficacy in children, however, has not been as well studied. This study was performed to evaluate the efficacy of the procedure in the pediatric age group. 6 patients who received VNS implantation in Chonnam National University Hospital from July 2006 to February 2008 have been evaluated about the efficacy of seizure control and the presence of side effects after VNS implantation for more than a year at least. Mean age of the patients at the time of VNS implantation were 10 years 3 months. Mean duration of follow-up was 14 months. Six patients included three cases with Lennox-Gastaut syndromes, one generalized tonic seizure, one generalized tonic clonic seizure, and one complex partial seizure. Three patients showed more than 50% reduction in seizure frequency compared with baseline at 3 months after the implantation. Among them, one showed complete seizure ablation, another showed no change in seizure frequency and the other showed increased frequency of seizure at 9 months after the implantation. The other three patients showed no change in seizure frequency. One of them, however, showed reduction of seizure intensity. Cough (2 cases), hoarseness (2), and wobbling voice (1) developed after VNS implantation. Most of these adverse effects disappeared without any treatment. In this study, one patient showed complete seizure ablation, but VNS was insignificant in five patients. Long-term follow up and adjustment of parameters such as output current, duty cycle are in need.

Keyword

Epilepsy; Vagus Nerve; Electric stimulation

MeSH Terms

Child
Cough
Electric Stimulation
Epilepsy
Follow-Up Studies
Hoarseness
Humans
Seizures
Vagus Nerve
Vagus Nerve Stimulation
Voice

Reference

1. Pellock JM, Appleton R. Use of new antiepileptic drugs in the treatment of childhood epilepsy. Epilepsia. 1999. 40:6. S29–S38.
Article
2. Nam SO. The pharmacotherapy of childhood epilepsy. Korean J Pediatr. 2004. 47:821–826.
3. Boon P, Vandekerckhove T, Achten E, Thiery E, Goossens L, Vonck K, et al. Epilepsy surgery in Belgium, the experience in Gent. Acta Neurol Belg. 1999. 99:256–265.
4. Penry JK, Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia. 1990. 6:4. S40–S43.
Article
5. Wheless JW, Maggio V. Vagus nerve stimulation therapy in patients younger than 18 years. Neurology. 2002. 59(6 suppl 4):S21–S25.
Article
6. Fisher RS, Krauss GL, Ramsey E, Laxer K, Gates J. Assessment of vagus nerve stimulation for epilepsy: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1997. 49:293–297.
Article
7. Fisher RS, Handforth A. Reassessment: vagus nerve stimulation for epilepsy: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1999. 53:666–669.
Article
8. Vonck K, Van Laere K, Dedeurwaerdere S, Caemaert J, De Reuck J, Boon P. The mechanism of action of vagus nerve stimulation for refractory epilepsy: the current status. J Clin Neurophysiol. 2001. 18:394–401.
Article
9. Zabara J. Peripheral control of hypersynchronous discharge in epilepsy. Electroencephalogr Clin Neurophysiol. 1985. 61:162.
Article
10. Ben-Menachem E, Hamberger A, Hedner T, Hammond EJ, Uthman BM, Slater J, et al. Effects of vagus nerve stimulation on amino acids and other metabolites in the CSF of patients with partial seizures. Epilepsy Res. 1995. 20:221–227.
Article
11. Hammond EJ, Uthman BM, Wilder BJ, Ben-Menachem E, Hamberger A, Hedner T, et al. Neurochemical effects of vagus nerve stimulation in humans. Brain Res. 1992. 583:300–303.
Article
12. Garnett E, Nahmias C, Scheffel A, Firnau G, Upton AR. Regional cerebral blood flow in man manipulated by direct vagal stimulation. Pacing Clin Electrophysiol. 1992. 15:1579–1580.
Article
13. Ko D, Heck C, Grafton S, Apuzzo ML, Couldwell WT, Chen T, et al. Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2(15)O blood flow imaging. Neurosurgery. 1996. 39:426–430.
Article
14. Ko D, Grafton S, Gott P, Heck C, DeGiorgio C. PET 15O cerebral blood flow study of vagus nerve stimulation: progressive changes over time and correlation with efficacy. Epilepsia. 1998. 39:6. S101.
15. Wilder BJ, Uthman BM, Hammond EJ. Vagal stimulation for control of complex partial seizures in medically refractory epileptic patients. Pacing Clin Electrophysiol. 1991. 14:108–115.
Article
16. DeGiorgio CM, Schachter SC, Handforth A, Salinsky M, Thompson J, Uthman B, et al. Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia. 2000. 41:1195–1200.
Article
17. Morris GL 3rd, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group EO1-EO5. Neurology. 1999. 53:1731–1735.
Article
18. Murphy JV. Left vagal nerve stimulation in children with medically refractory epilepsy. The Pediatric VNS Study Group. J Pediatr. 1999. 134:563–566.
Article
19. Hornig GW, Murphy JV, Shallert G, Tilton C. Left vagus nerve stimulation in children with refractory epilepsy: an update. South Med J. 1997. 90:484–488.
Article
20. Lundgren J, Amark P, Blennow G, Str . mblad LG, Wallstedt L. Vagus nerve stimulation in 16 children with refractory epilepsy. Epilepsia. 1998. 39:809–813.
Article
21. Hosain S, Nikalov B, Harden C, Li M, Fraser R, Labar D. Vagus nerve stimulation treatment for Lennox-Gastaut syndrome. J Child Neurol. 2000. 15:509–512.
Article
22. Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol. 2002. 1:477–482.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr