title: Vagus Nerve Stimulation in children: A focus on intellectual disability.
abstract: BACKGROUND
  Vagus Nerve Stimulation (VNS) can be an efficacious add-on treatment in patients with drug-resistant epilepsy, who are not eligible for surgery. Evidence of VNS efficacy in children with intellectual disability (ID) is scarce.
  
  
  OBJECTIVE
  The purpose of this study was to review all available VNS data in the pediatric population (≤18 years old) and focus on the subpopulation with ID since appropriate treatment of these children is often challenging and complex.
  
  
  METHODS
  Cochrane, EMBASE, PubMed and MEDLINE were used to collect all research associated to VNS and ID (or synonyms) leading to a total of 37 studies. Seven studies showed the results of patients with ID and those without separately; thereby only these studies were included in the VNS meta-analysis.
  
  
  RESULTS
  Our meta-analysis showed that VNS was less effective in pediatric epilepsy patients with ID compared to those without ID (Mantel-Haenszel meta-analysis; p = 0.028, OR 0.18 (CI 95% 0.039-0.84)). However, there were no prospective controlled studies. Numerous studies reported quality of life (QoL) improvements in this subpopulation. The most common adverse events were transient and well tolerated. Side effects on cognition and behavior were not reported.
  
  
  CONCLUSIONS
  These results might be a reason to consider VNS early on in the treatment of this subgroup. The significantly greater amount of retrospective studies, differences in follow-up (FU), lack of control data, heterogeneous series and limited number of patients could have biased the outcome measurements. Hence, current data do not exclude VNS for children with drug-resistant epilepsy and ID but should be interpreted with caution.
authors.affiliation: Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Sourbron
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Klinkenberg
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, The Netherlands.
authors.forename: Alfons
authors.initials: A
authors.lastname: Kessels
authors.affiliation: Department of Neurology, Epilepsy Center Kempenhaeghe, The Netherlands.
authors.forename: Helenius Jurgen
authors.initials: HJ
authors.lastname: Schelhaas
authors.affiliation: Department of Development and Regeneration, Section Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Lagae
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Epilepsy Center Kempenhaeghe, The Netherlands. Electronic address: majoiem@kempenhaeghe.nl.
authors.forename: Marian
authors.initials: M
authors.lastname: Majoie
mesh_terms: D004827:Epilepsy / Q000150:complications / Q000628:therapy*; D006801:Humans; D008607:Intellectual Disability / Q000150:complications / Q000628:therapy*; D010372:Pediatrics / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000009:adverse effects*
keywords: Alternative treatment; Drug-resistant epilepsy; Meta-analysis; Neurostimulation; Quality of life; VNS