Ann Child Neurol.  2019 Sep;27(3):63-70. 10.26815/acn.2019.00108.

Treatment Outcomes of Vagus Nerve Stimulation in Lennox-Gastaut Syndrome

Affiliations
  • 1Department of Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
  • 2Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea. childlove@cnu.ac.kr
  • 3Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
  • 4Department of Pediatrics, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, Korea.

Abstract

PURPOSE
Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies and frequently patients with this syndrome respond poorly to antiepileptic drugs. The aim of this study was to evaluate the treatment outcomes of vagus nerve stimulation (VNS) in LGS patients with drug-resistant epilepsy.
METHODS
We analyzed the clinical files, collected over 5 years, of children with LGS who received VNS treatment.
RESULTS
Seven children were included in this study (four males, three females; mean age of VNS insertion 12.4±3.5 years). All the patients had generalized tonic seizures and there were various other seizure types including myoclonic seizures, atonic seizures, and atypical absence seizures. Although two patients had normal imaging, five patients had abnormalities on imaging, including pachygyria, cortical dysplasia, kernicterus, and a chromosomal anomaly. Comparing the baseline seizure frequency to the frequency after the VNS surgery, the seizure frequency at the last follow-up showed a decrease of 57.2% (0% to 100%) on average (P=0.028) and one patient achieved seizure free status. Only two children were given additional antiepileptic drugs with the aim of managing their seizures. There was no mortality or complications related to the VNS therapy except one case requiring intensive care unit admission due to pneumonia. Comparing the results before and after VNS surgery, the VNS therapy also had a tendency to have a positive effect on quality of life (P=0.066).
CONCLUSION
In LGS patients with drug resistant epilepsy who are not candidates for a corpus callosotomy or resective surgery, VNS could be an effective, low-risk adjunct therapy for decreasing seizure frequency.

Keyword

Vagus nerve stimulation; Lennox Gastaut syndrome; Drug resistant epilepsy; Seizures; Quality of life

MeSH Terms

Anticonvulsants
Brain Diseases
Child
Drug Resistant Epilepsy
Epilepsy
Epilepsy, Absence
Female
Follow-Up Studies
Humans
Intensive Care Units
Kernicterus
Lennox Gastaut Syndrome
Lissencephaly
Male
Malformations of Cortical Development
Mortality
Pneumonia
Quality of Life
Seizures
Vagus Nerve Stimulation*
Vagus Nerve*
Anticonvulsants
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