מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Vagus nerve stimulation appears to be a safe and highly effective alternative for children with epilepsy that does not response to anticonvulsants, according to the largest-ever study of this modality in children with epilepsy. The findings appear in the November issue of the Journal of Child Neurology.
"This is a very promising therapy for children with difficult-to-treat epilepsy," study director, Dr. Sandra L. Helmers, of Emory University School of Medicine in Atlanta, commented in a journal statement.
Dr. Helmers' group examined the safety and efficacy of vagus nerve stimulation in 125 children (ages 3 to 18 years) with an average duration of epilepsy of 10 years and a history of failing an average of nine anticonvulsant agents. The investigators used the NeuroCybernetic Prosthesis System, which is already approved by the US Food and Drug Administration for use by selected patients 12 years of age and older. Ninety-five children were available for follow-up 3 months after implantation, 55 were available at 6 months, and 12 were available at 12 months.
The average seizure reduction in the children was 36.1% at 3 months. After 6 months, the average seizure reduction was 44.7%, with a similar reduction maintained at 12 months. Several measures of quality of life also improved, including alertness, verbal communication, school performance, clustering of seizures and postictal periods.
"Vagus nerve stimulation therapy was especially effective in two groups of patients: those with Lennox-Gastaut syndrome and those who had previously undergone epilepsy surgery," the investigators write. "At 6 months, seizure frequency was reduced by more than 75% in more than one third of the patients with Lennox-Gastaut syndrome and by almost one half in the patients who had previously undergone epilepsy surgery."
The most common adverse events associated with vagus nerve stimulation were coughing or voice alteration during stimulation. Rare adverse events included drooling and hyperactivity.
"Findings from this retrospective study reveal an even greater reduction in seizure frequency than in the initial clinical trials of vagus nerve stimulation and are comparable with reductions reported in adolescents and adults," Dr. Helmers said. "Our research indicates that vagus nerve stimulation should be considered as a treatment for [refractory] individuals, even young children."
Dr. Helmers added that early initiation of vagus nerve stimulation in appropriate children may help avoid the development of some serious complications of epilepsy, such as brain damage and death.
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