title: Vagus nerve stimulation: effectiveness and tolerability in 64 paediatric patients with refractory epilepsies.
abstract: OBJECTIVE
  We discuss the effectiveness, tolerability, and safety of vagus nerve stimulation (VNS) as adjunctive therapy in 64 paediatric patients with refractory epilepsies.
  
  
  METHODS
  Sixty-four patients (34 male and 30 female) implanted with VNS for refractory epilepsy were analysed. Electroclinical features were compatible with Lennox-Gastaut syndrome in 46 patients, focal epilepsies in 10 patients, Dravet syndrome in three patients, epilepsy with myoclonic-astatic seizures in three patients, and West syndrome in two. The NeuroCybernetic Prosthesis (NCP) system (Cyberonics, Webster, TX, USA) was employed and the following stimulation parameters were used: output current of 1 to 2.5mA, signal frequency of 30Hz, signal pulse width of 500μs, and signal "on" and "off" times of 30  seconds and 5  minutes, respectively.
  
  
  RESULTS
  Of 46 patients with LGS, 30 cases showed a significant improvement in seizure control, with a reduction in seizure frequency of at least 50%. Ten patients with focal epilepsy, three patients with myoclonic-astatic seizures, two patients with Dravet, and two patients with West showed a significant improvement in seizure control, with a reduction in seizure frequency of at least 50%. A good clinical response was evident early and efficacy progressively improved with the duration of treatment up to 36 months. In a significant number of patients, reduced seizure severity and shorter recovery time and hospital stay were also observed. VNS was well tolerated in all patients.
  
  
  CONCLUSIONS
  VNS is an effective and well-tolerated treatment for paediatric patients with refractory epilepsies, improving quality of life and neuropsychological performance.
authors.affiliation: Neurology Department, Hospital de Ninos, Buenos Aires, Argentina.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Cersósimo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bartuluchi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fortini
authors.forename: Alejandra
authors.initials: A
authors.lastname: Soraru
authors.forename: Hugo
authors.initials: H
authors.lastname: Pomata
authors.forename: Roberto H
authors.initials: RH
authors.lastname: Caraballo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D004831:Epilepsies, Myoclonic / Q000628:therapy; D004828:Epilepsies, Partial / Q000628:therapy; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000628:therapy; D065768:Lennox Gastaut Syndrome; D008297:Male; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000628:therapy; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult