VNS in children; more than just seizure reduction

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Epilepsy is one of the most common neurological disorders in children. In roughly one-third of these children, antiepileptic medications are not a successful form of seizure control. If surgery to treat the epilepsy is not possible, vagus nerve stimulation (VNS) may prove to be a good treatment alternative. The effectiveness and safety of VNS has been proven in clinical trials with adults. There is currently no conclusive evidence to suggest similar results can be achieved in children.

Epilepsy is one of the most common neurological disorders in children

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In addition to studying the effect of VNS on the frequency and severity of epileptic seizures, Klinkenberg also researched the safety and side effects of this treatment method. The participating children were divided into two groups, one of which was given ‘high’ therapeutic stimulation and the other ‘low’ active control stimulation. The study had the following results: (1) The severity of the seizures, measured using questionnaires, was reduced in the participating children. (2) The treatment had a very positive effect on the children’s moods. This effect was most pronounced in the children who were treated longest with VNS (39 versus 20 weeks).(3) The positive effect on mood did not correspond to the effect of VNS on the attacks. It can therefore be seen as a ‘positive side effect’ that is important because mood problems are common in people with epilepsy. (4) VNS has no negative effect on the children’s cognitive function. This is valuable because anti-epileptic medications can have a negative effect on cognitive functioning. (5) VNS has minimal side effects, which include voice changes, coughing and sore throat.

The study did not predict a positive outcome of VNS. Further research is necessary to determine the predictive value of interleukine-6 in the blood prior to the implantation of the stimulator. Whether there is an explanation for the difference in effect in children and adults has yet to be determined.

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Although further research needs to be conducted on the effects of VNS, certainly given the modest number of children whose epilepsy frequency was halved (the measure of effective treatment), VNS certainly has its advantages. VNS treatment was the last resort for many of the children who participated in this study. Even the smallest chance of improvement without side effects is considered a win for these patients. For children with therapy-resistant epilepsy, a chronic condition with many unstable factors, it involves more than just a reduction in frequency – more importantly, their sense of wellbeing is on the line. A reduction in severity, more control, and improved mood all have a positive effect on the child and therefore the entire family.

The vagus nerve is an important nerve in the neck, which connects the brain with other parts of the body. Stimulating this nerve can potentially reduce the number of epileptic seizures. During an operation, a small device known as a stimulator is placed under the skin. This stimulator is connected to the nerve via an electrode. The stimulator can be remotely set and activated.

Why is this so important

Epilepsy is one of the most common neurological disorders in children. With vagus nerve stimulation as a possible solution, children could be treated with a safe method if medicine doesn’t work.

Biography

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Dr.Sylvia Klinkenberg is a pediatric neurologist at the Maastricht University Medical Centre (MUMC). She recently received her PhD for her work about Vagus Nerve Stimulation in Children.

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My expertise

pediatric neurology, vagus nerve stimulation, epilepsy, children