Sunday, February 12, 2017
VNS may be more effective in children WITHOUT intellectual disability.
In specialty epilepsy treatment, a common clinical question is: who might benefit from earlier vns? VNS may be more effective in children WITHOUT intellectual disability. -JR
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. 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. 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. 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. 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.
Eur J Paediatr Neurol. 2017 Jan 30. pii: S1090-3798(17)30071-5. doi: 10.1016/j.ejpn.2017.01.011. [Epub ahead of print]
Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Alternative treatment; Drug-resistant epilepsy; Meta-analysis; Neurostimulation; Quality of life; VNS