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PEDIATRICS Vol. 103 No. 4 April 1999, pp. 778-782

Vagal Nerve Stimulation in Epileptic Encephalopathies

Received Feb 26, 1998; accepted Sep 21, 1998.

Alasdair P. J. Parker*, Charles E. PolkeyDagger , Colin D. Binnie§, Catherine Madigan*, Colin D. Ferrieparallel , and Richard O. Robinson*

From the * Newcomen Centre, Guy's Hospital, London, United Kingdom; the Departments of Dagger  Neurosurgery and § Clinical Neurophysiology, King's College Hospital, London, United Kingdom; and the parallel  Department of Paediatric Neurology, Leeds General Infirmary, Leeds, United Kingdom.

Objective.  To study the effect of vagal nerve stimulation (VNS) in children with epileptic encephalopathies.

Methods and Materials.  All children receiving VNS during a 2-year period at our center were studied prospectively for changes in seizure frequency, electroencephalogram (EEG), adaptive behavior, quality of life, and where appropriate, verbal/nonverbal performance. Assessments were made before and for at least 1 year after implant.

Results.  Sixteen children were studied. One device was removed because of infection. Of the remaining 15 children, 4 had a >50% reduction and 2 had a >50% increase in seizure frequency at 1 year after implant. Median reduction in seizure frequency was 17%. There was no trend toward improvement of the EEG or adaptive behavior. Quality of life was unchanged in most areas, except in perceived treatment side effects and general behavior that were improved. In 6 children undergoing further assessment, there was a significant improvement in verbal performance; this did not correlate with reduction in seizure frequency.

Conclusion.  VNS did not significantly improve seizure frequency, severity, adaptive behavior, or the EEG during the first year of treatment for the group as a whole, although 4 children (27%) had a worthwhile reduction in seizure frequency. There were significant improvements in perceived treatment side effects and general behavior.  Key words:  epilepsy, encephalopathy, vagal nerve stimulation.




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