Improved quality of life and cognition after early vagal nerve stimulator implantation in children

OBJECTIVE: In patients with drug-resistant epilepsy, reduction of seizure duration and frequency at an early age is beneficial. Vagal nerve stimulator (VNS) was shown to reduce seizure frequency and duration in children; however, data in children under the age of 12âEuro¯years are sparse. The aim of this study was to compare seizure outcome and quality of life after early (≤5âEuro¯years of age) and late (textgreater5âEuro¯years of age) implantation of VNS in children. METHODS: This study reviewed 45 consecutive children undergoing VNS implantation. Primary outcome measure was the reduction of seizure frequency. Secondary outcome measures were epilepsy outcome assessed by the McHugh and Engel classifications, reduction of antiepileptic drugs (AEDs), psychomotor development, and quality of life measured by the Pediatric Quality of Life (PEDSQLâ"¢) questionnaire and caregiver impression (CGI) scale. The mean follow-up time was 72.3âEuro¯months (±39.8âEuro¯months). RESULTS: Out of 45 patients included, in 14 (31.1%), VNS was implanted early and in 31, (68.9%) late. Reduction of seizure frequency, McHugh and Engel classifications, and reduction of AED were comparable in both groups. Quality of life measured by the CGI scale (2.1âEuro¯Â±âEuro¯1.7 in the early group vs. 3.6âEuro¯Â±âEuro¯1.6 in the late group; pâEuro¯=âEuro¯0.004), as well as the difference of total PEDSQLâ"¢ Core scores (12.0âEuro¯Â±âEuro¯24.0 in the early group vs. -5.2âEuro¯Â±âEuro¯14.9 in the late group; pâEuro¯=âEuro¯0.01) and cognitive PEDSQLâ"¢ Core (30.6âEuro¯Â±âEuro¯32.0 in the early group vs. 2.4âEuro¯Â±âEuro¯24.3 in the late group; pâEuro¯=âEuro¯0.03) between preoperative and follow-up was significantly higher in the early implantation group. CONCLUSION: Early VNS implantation in children leads to a significantly better quality of life and cognitive outcome compared with late implantation while reduction of seizure frequency and epilepsy outcome seems comparable. Therefore, in children with drug-resistant epilepsy, VNS implantation should be considered as early as possible.