Clinical neurology and neurosurgery · 2025
Efficacy, safety, and predictors of vagus nerve stimulation in children with drug-resistant epilepsy: A single-center prospective study.
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Zeng Yuanxiang, Zeng Qiao, Peng Xiaoling, Liang Ping, Jiang Li, Zhai Xuan, Hu Yue
Аннотация
OBJECTIVE: To evaluate the safety and effectiveness of vagus nerve stimulation (VNS) in treating drug-refractory epilepsy (DRE) in children and to identify key predictive factors influencing its efficacy.
METHODS: This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan-Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.
RESULTS: At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox-Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.
CONCLUSION: VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.
METHODS: This was a prospective, single-center study conducted from October 2016 to July 2020. A total of 54 children treated with VNS were followed for 24 months. The effectiveness and safety of VNS were assessed at 2, 6, 12, 18, and 24 months. Kaplan-Meier univariate survival analysis and Cox regression analysis were used to identify predictors of treatment response.
RESULTS: At 2, 6, 12, 18, and 24 months, the effectiveness of VNS (defined as a ≥50 % reduction in seizure frequency) was 29.6 %, 20.4 %, 39.6 %, 76.0 % and 75.0 %, respectively. Seizure freedom rates were 0 %, 0 %, 3.8 %, 8.0 % and 10.4 %, respectively. The effectiveness rate for patients with Lennox-Gastaut syndrome at 24 months was 67.7 %. Significant improvements were also observed in neurodevelopmental scores and quality of life (p < 0.05). Cox regression identified absence seizures and abnormal neuroimaging (CT/MRI) as independent negative predictors of VNS response at 18 and 24 months. Adverse events were transient and tolerable, with 5 (9.3 %) cases of transient hoarseness, 3 (5.6 %) of cough, 3 (5.6 %) of decreased appetite, 2 (3.7 %) of skin irritation, 2 (3.7 %) of localized skin infection, and 1 (1.8 %) of menstrual cycle disturbance.
CONCLUSION: VNS is an effective and safe long-term therapy for pediatric DRE, with cumulative benefits over time. The presence of absence seizures and abnormal neuroimaging findings were key predictors of a less favorable response, which may inform clinical decision-making regarding patient selection. Caution is advised when initiating VNS therapy in children with DRE exhibiting these characteristics.