[MS1] Morning Seminar 1: VNS

[MS1-2S-1] Vagus Nerve Stimulation in Children with Intractable Epilepsy

^○MASANORI TAKEOKA^{1, 2} (1.Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA, 2.Harvard Medical School, Boston, MA, USA)

Vagus nerve stimulation (VNS) has been an effective treatment for intractable epilepsy, with the first human implantation by Penry et al in 1988. VNS has been approved by the European Community in 1994 and Food and Drug Administration in USA in 1997, for patients older than 12 years of age. Since then, VNS has been used in younger children as well, and has shown much efficacy in partial and generalized epilepsies, including seizures seen in Lennox-Gastaut syndrome. Mean seizure reduction has been reported as 55.8% in a large retrospective study with 436 patients, while at least 50% seizure reduction has been reported in or more seizures in the range of 40-60% of patients, across various studies. A newer VNS system with cardiac-based seizure detection for activation has been recently approved, and has been widely used in adults and children. VNS is effective in seizure reduction including cases of seizure freedom, improvement in mood, alertness and other measures of quality of life. The efficacy of VNS appears to increase with time during the initial few years after implantation, and maintained over longer periods, reported in the studies of 8-10 years. Overall VNS appears to be an effective and safe treatment option for children with medically intractable epilepsy, even in cases where resective epilepsy surgery was not helpful or is not indicated.