Left vagal nerve stimulation in children with refractory epilepsy. Preliminary observations

J. V. Murphy, G. Hornig and G. Schallert
Section of Neurology, Children's Mercy Hospital, Kansas City, Mo., USA.

OBJECTIVE: To observe the tolerance and efficacy of periodic left vagal nerve stimulation in a group of children with medically intractable epilepsies. DESIGN: A vagal nerve stimulator (Cyberonics Inc, Webster, Tex) was implanted in 12 children with medically and surgically refractory epilepsies. These children were followed up for 2 to 14 months. OUTCOME MEASUREMENTS: (1) The number of seizures recorded during the final month of observation was compared with the number recorded during the month before the implantation of the vagal nerve stimulator. (2) Parents were asked to compare overall status of their child, relative to the period prior to using the vagal nerve stimulator, on a global rating scale. (3) The number of antiepileptic drugs at the last visit was compared with the number before the use of this device. (4) Adverse events were recorded. RESULTS: Five of the 12 patients had a greater than 90% reduction in the number of monthly seizures. Global evaluation scores indicated that there were no deteriorations from baseline and that there was a considerable number with improved status. Four patients were able to reduce the number of antiepileptic drugs used. No significant adversities were noted. CONCLUSIONS: The vagal nerve stimulator is well tolerated in children with intractable epilepsies, and it may have a role in their medical management. We were unable to determine specific epilepsies or seizures that were sensitive to this intervention.