Vagus nerve stimulation in pediatric patients with intractable epilepsy: Case series and operative technique

Patients with epilepsy refractory to medical therapy or who experience into lerable side effects from the medication may benefit from placement and act ivation of a vagus nerve stimulator (VNS) (Cyberonics, Houston, TX). We pre sent our experience with the VNS implanted by a pediatric surgeon and its a ctivation managed by a pediatric neurologist, Six patients (one male and fi ve females) with average age 11 years, 10 months (range 7 years, 4 months t o 18 years, 1 month) received VNS implants at a community-based teaching ho spital. One patient developed a self-inflicted wound complication secondary to persistent trauma at the implant site that led to removal of the implan t. Before VNS implantation the frequency of seizures among the remaining fi ve patients averaged 73 per patient per month (range 20-165), Length of fol low-up averaged 6.5 months (range 1.5-11 months). At most recent follow-up seizure frequency averaged 14 per month (range 1-42); this represents an av erage reduction of 78 per cent (range 30-99%), We conclude that a pediatric surgeon with pediatric neurologic support can safely and effectively perfo rm the VNS implantation at a hospital equipped to administer anesthesia to pediatric patients.