COMMENTARY

Vagus Nerve Stimulation for Children With Epilepsy

Epilepsy Notes

Andrew N. Wilner, MD

Disclosures

November 11, 2013

In This Article

Use in the Pediatric Population

A large group of patients with intractable epilepsy are younger than 12 years, including children with Lennox-Gastaut syndrome, Dravet syndrome, and other difficult-to-treat epileptic conditions. Morris and colleagues[3] recently provided an evidence-based guideline for VNS in children that is based on a review of off-label use.

In 13 class 3 studies involving 470 children with partial or generalized epilepsy, 55% had > 50% seizure reduction with VNS. Similarly, in 4 class III studies of 113 children with Lennox-Gastaut syndrome, 55% had > 50% seizure reduction. Mood studies were not available for children. (In 2 class 3 studies of 31 adults with epilepsy, significant improvements in standard mood scales were observed.) Children were 3.4 times more likely than adults to develop an infection at the VNS implantation site.

Conclusion

For more than 15 years, VNS has proven a useful adjunct to pharmaceutical therapy in adults and children with intractable epilepsy. In an evidence-based guideline, Morris and colleagues[3] concluded that VNS "may be considered" for treatment of seizures in children with epilepsy, including those with Lennox-Gastaut syndrome (level C). Improvements in mood, as well as a sense of control over seizures provided by the magnet, may be added benefits. Adverse events, such as postimplant infection and lead fracture, may occur more often in children than in adults.

As with many pediatric therapies, VNS is not FDA-approved for children. Nonetheless, VNS represents a potentially effective and nonsedating treatment option and should be considered for children with intractable epilepsy.

Comments

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