title: Vagus nerve stimulation in children less than 3 years with medically intractable epilepsy.
abstract: OBJECTIVE
  To describe the characteristics of children less than three years of age with medically intractable epilepsy, who underwent Vagus Nerve Stimulator (VNS) therapy at Children's Hospital of Pittsburgh between 2004 and 2011.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Seventeen patients were identified; adequate follow-up was available for 15. Median follow up duration was 4.3 years (1.4-10.2 years). 12/15 (80%) had a known etiology for their epilepsy. All patients had more than 1 seizure per week prior to VNS and a history of status epilepticus was frequent (40%, 6/15). Five patients (33%) reported improved seizure frequency at one year after VNS. A normal MRI was associated with seizure improvement (p=0.007). No patient had status epilepticus after VNS at one-year follow-up. At three years after VNS, four patients had experienced status epilepticus with only one patient experiencing multiple episodes. Complications were seen in 2/15 (13%) patients and in 2/21 (9.5%) procedures.
  
  
  CONCLUSIONS
  A normal MRI was associated with seizure improvement at one year in children less than three years of age at the time of VNS implant. The degree of overall seizure reduction was modest, but the frequency of status epilepticus was decreased after VNS implant. VNS was tolerated well in this age group.
authors.affiliation: Division of Child Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
authors.forename: Luis
authors.initials: L
authors.lastname: Fernandez
authors.affiliation: Division of Child Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Department of Pediatrics and Neurology, Pittsburgh, PA, United States.
authors.forename: Satyanarayana
authors.initials: S
authors.lastname: Gedela
authors.affiliation: University of Pittsburgh, School of Medicine, Department of Neurosurgery, Pittsburgh, PA, United States.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Tamber
authors.affiliation: Division of Child Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Department of Pediatrics and Neurology, Pittsburgh, PA, United States. Electronic address: Yoshimi.Sogawa@chp.edu.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Sogawa
mesh_terms: D000927:Anticonvulsants; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*
chemical_list: D000927:Anticonvulsants
keywords: Children; Dravet syndrome; Status epilepticus; VNS; Vagus nerve stimulator