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Early vagal nerve stimulator implantation in children: personal experience and review of the literature

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Abstract

Aim

Data concerning the benefit of vagal nerve stimulation (VNS) in children under the age of 12 years is sparse. It was shown that reduction of seizure frequency and duration at an early age could lead to better psychomotor development. We therefore compare the outcome between early (≤ 5 years of age) and late (> 5 years of age) implantation of VNS in children.

Methods

This study is a prospective review of patients analyzing primarily the reduction of seizure frequency and secondarily epilepsy outcome assessed by the McHugh and Engel classification, reduction of antiepileptic drugs (AED), psychomotor development measured by the Vineland Adaptive Behavior Scale (VABS), and quality of life using the caregiver impression (CGI) scale. Mean follow-up time was 36 and 31 months in the early and late group, respectively.

Results

Out of 12 consecutive VNS implantations for therapy refractory epilepsy, 5 were early implantations and 7 late implantations. Reduction of seizure frequency, McHugh and Engel classification, quality of life, psychomotor development and reduction of AED were comparable in both groups. One patient in the late group suffered from a postoperative infection resulting in explanation of the VNS device and re-implantation on the opposite side, while mortality rate was 0%.

Conclusions

VNS seems to be a safe and feasible therapy in children even under the age of 5 years. Responder rate, quality of life, and psychomotor development do not seem to be influenced by the child’s age at implantation; however, larger studies analyzing the outcome of early VNS implantation are warranted.

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Acknowledgments

We would like to thank Mrs. Marianne Schulz for her editorial help.

Author information

Author notes

  1. Jehuda Soleman and Corine Knorr contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Jehuda Soleman, Corine Knorr, Luigi Mariani & Raphael Guzman

  2. Division of Pediatric Neurosurgery, Children’s University Hospital of Basel (UKBB), Basel, Switzerland

    Jehuda Soleman, Corine Knorr, Luigi Mariani & Raphael Guzman

  3. Department of Pediatric Neurology, Children’s University Hospital of Basel (UKBB), Basel, Switzerland

    Alexandre N. Datta

  4. Department of Pediatric Neurology, University Hospital of Bern, Bern, Switzerland

    Susi Strozzi

  5. Department of Pediatric Neurology, Children’s Hospital of Bellinzona, Bellinzona, Switzerland

    Gian Paolo Ramelli

Authors
  1. Jehuda Soleman
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  2. Corine Knorr
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  3. Alexandre N. Datta
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  7. Raphael Guzman
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Corresponding author

Correspondence to Jehuda Soleman.

Ethics declarations

The study protocol was approved by the local ethics committee (EKNZ, Basel, Switzerland).

Conflict of interest

The authors have no disclosures and no conflict of interest.

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Soleman, J., Knorr, C., Datta, A.N. et al. Early vagal nerve stimulator implantation in children: personal experience and review of the literature. Childs Nerv Syst 34, 893–900 (2018). https://doi.org/10.1007/s00381-017-3694-5

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  • DOI: https://doi.org/10.1007/s00381-017-3694-5

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