Vagus Nerve Stimulation for Medically Refractory Epilepsy in Children with Brain Malformations

Vagal nerve stimulation is approved for medically refractory partial epilepsy in children older than 12 years of age. However, it has been shown in the literature that vagal nerve stimulation is also quite efficacious in children younger than 12 with generalized epilepsy and brain malformations. We report a case series of children younger than 12 who responded well to vagal nerve stimulation. A retrospective review was conducted at our institution for pediatric patients from 1997 to 2013 who were younger than 12 years of age and had pharmacoresistant epilepsy and brain anomalies resulting in static encephalopathy. Our hospital’s institutional review board approved the study. The variables included epilepsy type, current anticonvulsants, failed anticonvulsant, epilepsy type, imaging data, other comorbidities and effect of vagal nerve stimulation on seizure frequency. Three patients were identified who received vagal nerve stimulator were between 6-9 years of age. Two of these patients were diagnosed with generalized epilepsy and one with Lennox-Gastaut syndrome. The etiologies included lissencephaly, cortical dysplasias and asymmetry of the cerebral hemispheres, respectively. They were taking an average of 2-3 anticonvulsants and had failed treatment with at least 2 anticonvulsants. The patients showed marked decrease in the seizure frequency during the 6-month and 1-year follow-up. Vagal nerve stimulation was found to be efficacious in this subgroup of difficult pediatric patients with pharmacoresistant generalized epilepsy and epileptic encephalopathy.