Improved quality of life and cognition after early vagal nerve stimulator implantation in children

Jehuda Soleman; Maya Stein; Corine Knorr; Alexandre N Datta; Shlomi Constantini; Itzhak Fried; Raphael Guzman; Uri Kramer

doi:10.1016/j.yebeh.2018.09.014

Improved quality of life and cognition after early vagal nerve stimulator implantation in children

Epilepsy Behav. 2018 Nov:88:139-145. doi: 10.1016/j.yebeh.2018.09.014. Epub 2018 Sep 27.

Authors

Jehuda Soleman¹, Maya Stein², Corine Knorr³, Alexandre N Datta⁴, Shlomi Constantini², Itzhak Fried², Raphael Guzman³, Uri Kramer⁵

Affiliations

¹ Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel; Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland. Electronic address: jehuda.soleman@gmail.com.
² Departments of Neurosurgery and Pediatric Neurosurgery, Tel-Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel.
³ Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland.
⁴ Department of Pediatric Neurology, Children's University Hospital of Basel (UKBB), Basel, Switzerland.
⁵ Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel.

PMID: 30269032
DOI: 10.1016/j.yebeh.2018.09.014

Abstract

Objective: In patients with drug-resistant epilepsy, reduction of seizure duration and frequency at an early age is beneficial. Vagal nerve stimulator (VNS) was shown to reduce seizure frequency and duration in children; however, data in children under the age of 12 years are sparse. The aim of this study was to compare seizure outcome and quality of life after early (≤5 years of age) and late (>5 years of age) implantation of VNS in children.

Methods: This study reviewed 45 consecutive children undergoing VNS implantation. Primary outcome measure was the reduction of seizure frequency. Secondary outcome measures were epilepsy outcome assessed by the McHugh and Engel classifications, reduction of antiepileptic drugs (AEDs), psychomotor development, and quality of life measured by the Pediatric Quality of Life (PEDSQL™) questionnaire and caregiver impression (CGI) scale. The mean follow-up time was 72.3 months (±39.8 months).

Results: Out of 45 patients included, in 14 (31.1%), VNS was implanted early and in 31, (68.9%) late. Reduction of seizure frequency, McHugh and Engel classifications, and reduction of AED were comparable in both groups. Quality of life measured by the CGI scale (2.1 ± 1.7 in the early group vs. 3.6 ± 1.6 in the late group; p = 0.004), as well as the difference of total PEDSQL™ Core scores (12.0 ± 24.0 in the early group vs. -5.2 ± 14.9 in the late group; p = 0.01) and cognitive PEDSQL™ Core (30.6 ± 32.0 in the early group vs. 2.4 ± 24.3 in the late group; p = 0.03) between preoperative and follow-up was significantly higher in the early implantation group.

Conclusion: Early VNS implantation in children leads to a significantly better quality of life and cognitive outcome compared with late implantation while reduction of seizure frequency and epilepsy outcome seems comparable. Therefore, in children with drug-resistant epilepsy, VNS implantation should be considered as early as possible.

Keywords: Drug-resistant epilepsy; Pediatric neurosurgery; Psychomotor development; Quality of life; Vagal nerve stimulator.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age Factors
Child
Child, Preschool
Cognition*
Drug Resistant Epilepsy / physiopathology
Drug Resistant Epilepsy / psychology
Drug Resistant Epilepsy / therapy*
Female
Follow-Up Studies
Humans
Infant
Male
Quality of Life*
Retrospective Studies
Treatment Outcome
Vagus Nerve Stimulation*