title: Vagus Nerve Stimulation in Intractable Epilepsy Associated With SCN1A Gene Abnormalities.
abstract: Mutations in the SCN1A gene cause a spectrum of epilepsy syndromes. There are 2 syndromes that are on the severe end of this spectrum. The classic severe form, Dravet syndrome, is an epileptic encephalopathy of childhood, causing cognitive decline as well as intractable seizures. Severe Myoclonic Epilepsy of Infancy-Borderline (SMEIB) is a term used to include cases with similar severities as those with Dravet syndrome, but lacking a single feature of classic severe myoclonic epilepsy of infancy. Vagus nerve stimulation is a nonpharmacologic treatment for intractable epilepsy. A retrospective review was conducted of patients with deleterious SCN1A mutations who had vagus nerve stimulation placement for treatment of their intractable epilepsy. These children had onset of their epilepsy between 3 and 29 months of age. Seizure control was assessed 6 months after implantation. Twenty patients are included in the study, with 12 implanted at our institution. Nine of the 12 patients implanted at our institution, who had confirmed pre- and post-implantation seizure assessments, showed improvement in seizure control, which was defined as >50% reduction in generalized tonic-clonic seizures, and 4 of those 12 reported improvement in cognitive or speech development. Seven of the 8 patients not implanted at our institution reported subjective benefit, with 4 relating "marked improvement" or seizure freedom. Vagus nerve stimulation appears to impart a benefit to children with deleterious SCN1A gene abnormalities associated with intractable epilepsy.
authors.affiliation: 1 Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fulton
authors.affiliation: 2 Carolinas Pediatric Neurology Care, Concord, NC, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Van Poppel
authors.affiliation: 1 Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: McGregor
authors.affiliation: 1 Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Basanagoud
authors.initials: B
authors.lastname: Mudigoudar
authors.affiliation: 1 Division of Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Wheless
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000235:genetics / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D062550:NAV1.1 Voltage-Gated Sodium Channel / Q000235:genetics*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*
chemical_list: D062550:NAV1.1 Voltage-Gated Sodium Channel; C568242:SCN1A protein, human
keywords: SCN1A; VNS therapy; intractable epilepsy; neurostimulation; pediatrics; seizures