Vagus nerve stimulation in children with therapy-resistant epilepsy diagnosed as Lennox-Gastaut syndrome: clinical results, neuropsychological effects, and cost-effectiveness.
We studied the clinical efficacy and tolerability, neuropsychological effects, and cost-effectiveness (direct medical costs, direct nonmedical costs, and indirect costs) of vagus nerve stimulation (VNS) in children with Lennox-like syndrome (n = 16). The situation 6 months before implantation of the device is compared with that 6 months after surgery. Seizure frequency and severity are significantly reduced during VNS: 25% of the patients show a reduction in seizure frequency of 50% or greater; overall seizure reduction is 26.9%. Measures of neuropsychological outcome show a moderate improvement in mental functioning, behavior, and mood. The scores for mood and mental age improve independently of seizure control. Side effects are minor and transient. There is a significant reduction in direct non-health care costs, ergotherapy, and the number of days of sub-optimal functioning of the child. The costs during the 6 postoperative months are 2,876.06 Euros less than the costs during the 6 months before VNS; the payback period is 2.3 years.
Majoie
H J
HJ
Epilepsy Center Kempenhaeghe, Heeze, The Netherlands. majoiem@kempenhaeghe.nl
Berfelo
M W
MW
Aldenkamp
A P
AP
Evers
S M
SM
Kessels
A G
AG
Renier
W O
WO
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003362:Cost-Benefit Analysis; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000150:complications / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D013577:Syndrome; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology*
D000927:Anticonvulsants