Early Implantation as a Main Predictor of Response to Vagus Nerve Stimulation in Childhood-Onset Refractory Epilepsy.

Autor:	Russo A; 419170IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy., Hyslop A; Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, 5447Nicklaus Children's Hospital, Miami, FL, USA., Gentile V; Child Neurology and Psychiatric Unit, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, 9296University of Bologna, Bologna, Italy., Chiarello D; Child Neurology and Psychiatric Unit, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, 9296University of Bologna, Bologna, Italy., Messana T; 419170IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy., Miller I; Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, 5447Nicklaus Children's Hospital, Miami, FL, USA., Zucchelli M; 9296IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy., Lima M; Pediatric Surgery, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, University of Bologna, Italy., Ragheb J; Department of Neurological Surgery, 5447Nicklaus Children's Hospital, Miami, FL, USA., Pini A; 419170IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria Infantile, Bologna, Italy., Cordelli DM; Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, 5447Nicklaus Children's Hospital, Miami, FL, USA., Resnick T; Child Neurology and Psychiatric Unit, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, 9296University of Bologna, Bologna, Italy., Jayakar P; Child Neurology and Psychiatric Unit, Department of Medical and Surgical Science (DIMEC), S. Orsola Hospital, 9296University of Bologna, Bologna, Italy., Duchowny M; Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, 5447Nicklaus Children's Hospital, Miami, FL, USA.; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk:	angličtina
Zdroj:	Journal of child neurology [J Child Neurol] 2021 Apr; Vol. 36 (5), pp. 365-370. Date of Electronic Publication: 2020 Nov 25.
DOI:	10.1177/0883073820974855
Abstrakt:	Objective: We describe a multicenter experience with vagus nerve stimulator implantation in pediatric patients with drug-resistant epilepsy. Our goal was to assess vagus nerve stimulation efficacy and identify potential predictors of favorable outcome. Methods: This is a retrospective study. Inclusion criteria: ≤18 years at time of vagus nerve stimulator implantation, at least 1 year of follow-up. All patients were previously found to be unsuitable for an excisional procedure. Favorable clinical outcome and effective vagus nerve stimulation therapy were defined as seizure reduction >50%. Outcome data were reviewed at 1, 2, 3, and 5 years after vagus nerve stimulator implantation. Fisher exact test and multiple logistic regression analysis were employed. Results: Eighty-nine patients met inclusion criteria. Responder rate (seizure frequency reduction >50%) at 1-year follow-up was 25.8% (4.5% seizure-free). At last follow-up, 31.5% had a favorable outcome and 5.2% were seizure free. The only factor significantly predicting favorable outcome was time to vagus nerve stimulator implantation, with the best outcome achieved when vagus nerve stimulator implantation was performed within 3 years of seizure onset. Implantation between 3 and 5 years after epilepsy onset correlated with better long-term seizure freedom (13.3% at T5). Overall, 65.2% of patients evidenced improved quality of life at last follow-up. However, 12.4% had adverse events, but most were mild and disappeared after 3-4 months. Conclusions: Early vagus nerve stimulator implantation within 5 years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients. Improved quality of life and a low incidence of significant adverse events were observed.
Databáze:	MEDLINE
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