John Libbey Eurotext

Early vagus nerve stimulator implantation as a main predictor of positive outcome in pediatric patients with epileptic encephalopathy Volume 23, issue 4, August 2021

Figures

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Tables

Authors
1 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età pediatrica, Bologna, Italy
2 Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA
3 Child Neurology and Psychiatric Unit, Departement of Medical and Surgical Science (DIMEC), S. Orsola Hospital, University of Bologna, Italy
4 Section of Pediatrics, Department of Medical Sciences, University of Ferrara, University Hospital Arcispedale Sant’Anna, Ferrara, Italy
5 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOS Epidemiologia e Biostatistica, Bologna, Italy
6 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy
7 Pediatric Surgery, Departement of Medical and Surgical Science (DIMEC), S. Orsola Hospital, University of Bologna, Italy
8 Departments of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
9 Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
* Correspondence: Angelo Russo Department of Paediatric Neurology, IRCCS – Institute of Neurological Sciences of Bologna, via Altura 3, Bologna, Italy

Objective

We describe a multicenter experience with VNS implantation in pediatric patients with epileptic encephalopathy. Our goal was to assess VNS efficacy and identify potential predictors of favorable outcome.

Methods

This was a retrospective study. Inclusion criteria were: ≤18 years at the time of VNS implantation and at least one year of follow-up. All patients were non-candidates for excisional procedures. Favorable clinical outcome and effective VNS therapy were defined as seizure reduction >50%. Outcome data were reviewed at one, two, three and five years after VNS implantation. Fisher's exact test, Kaplan-Meier and multiple logistic regression analysis were employed.

Results

Twenty-seven patients met inclusion criteria. Responder rate (seizure frequency reduction ≥ 50%) at one-year follow-up was 25.9%, and 15.3% at last follow-up visit. The only variable significantly predicting favorable outcome was time to VNS implantation, with the best outcome achieved when VNS implantation was performed within five years of seizure onset (overall response rate of 83.3% at one year of follow-up and 100% at five years). In total, 63% of patients evidenced improved QOL at last follow-up visit. Only one patient exited the study due to an adverse event at two years from implantation.

Significance

Early VNS implantation within five years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients with epileptic encephalopathy. Improved QOL and a very low incidence of adverse events were observed.