title: Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children.
abstract: OBJECTIVE
  The management of intractable epilepsy in children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in children who underwent VNS implantation.
  
  
  METHODS
  Forty-one children underwent VNS implantation for epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) children failed to respond to the VNS treatment. The device was removed in five children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances.
  
  
  CONCLUSIONS
  Our results show that VNS implantation can be a safe and effective alternative therapy for children with drug-resistant epilepsy who are not candidates for epilepsy surgery.
authors.affiliation: Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada.
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
authors.forename: William
authors.initials: W
authors.lastname: Logan
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Donner
mesh_terms: D000293:Adolescent; D002648:Child; D004599:Electric Stimulation Therapy / Q000266:history / Q000379:methods*; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D049673:History, 20th Century; D006761:Hospitals; D006801:Humans; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects* / Q000502:physiology