Early Implantation as a Main Predictor of Response to Vagus Nerve Stimulation in Childhood-Onset Refractory Epilepsy
| Autor: | John Ragheb, Trevor Resnick, Antonella Pini, Ann Hyslop, Daniela Chiarello, Duccio Maria Cordelli, Mario Lima, Angelo Russo, Prasanna Jayakar, Mino Zucchelli, Michael Duchowny, Tullio Messana, Valentina Gentile, Ian Miller |
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| Přispěvatelé: | Russo A., Hyslop A., Gentile V., Chiarello D., Messana T., Miller I., Zucchelli M., Lima M., Ragheb J., Pini A., Cordelli D.M., Resnick T., Jayakar P., Duchowny M. |
| Rok vydání: | 2020 |
| Předmět: |
Male
Drug Resistant Epilepsy Adolescent Vagus Nerve Stimulation medicine.medical_treatment Vagus nerve stimulator 03 medical and health sciences Epilepsy 0302 clinical medicine Humans Medicine 0501 psychology and cognitive sciences 050102 behavioral science & comparative psychology Child Retrospective Studies business.industry 05 social sciences Age Factors Infant drug-resistant childhood epilepsy medicine.disease outcome predictor Treatment Outcome Child Preschool Anesthesia Pediatrics Perinatology and Child Health Refractory epilepsy Female Neurology (clinical) business 030217 neurology & neurosurgery Vagus nerve stimulation |
| Zdroj: | Journal of Child Neurology. 36:365-370 |
| ISSN: | 1708-8283 0883-0738 |
| Popis: | 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: | OpenAIRE |
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