ABSTRACT
AIM: To describe a series of patients with drug resistant epilepsy treated with vagus nerve stimulation in a national pediatric hospital, evaluating efficacy, safety and tolerability. PATIENTS AND METHODS: A retrospective analysis of 158 pediatric patients with epilepsy resistant to pharmacological and non pharmacological treatment including surgery that were treated with vagus nerve stimulation between 2001-2015. Patients with progressive encephalopathies, and congenital heart disease were excluded. RESULTS: 158 patients (80 male) were included, with a mean age at implantation of 11.4 years and a mean age at evolution of epilepsy of 9.5 years. Time of follow-up: 1-15 years (median: 6.9 years). Patient's age at this time: 2-31 years (median: 14.1 years). Effectiveness: 66.5% of patients showed more or equal at 50% of seizure control at 24 months of implant. Just three patients showed severe side effects (1.8%). Minor side effects were seen in 26 patients (16.4%). Without side effects: 129 (81.8%). CONCLUSION: Vagus nerve stimulation is an effective, tolerable and safe therapy in our pediatric series with refractory epilepsy.
TITLE: Estimulador del nervio vago: tratamiento en 158 pacientes pediatricos con un largo seguimiento.Objetivo. Describir una poblacion pediatrica de pacientes con epilepsia farmacorresistente tratada con estimulador del nervio vago en un hospital nacional de pediatria, evaluando la eficacia, la tolerabilidad y la seguridad del tratamiento. Pacientes y metodos. Se realizo un analisis retrospectivo de 158 pacientes pediatricos seguidos por epilepsia refractaria al tratamiento farmacologico y no farmacologico, incluida la cirugia, que fueron tratados con estimulador del nervio vago entre los años 2001 y 2015. Se excluyeron pacientes con encefalopatias evolutivas y cardiopatias congenitas. Resultados. Se incluyeron 158 pacientes (80 varones) con una edad media de implante de 11,4 años y un tiempo de evolucion de epilepsia preimplante de 9,5 años. El tiempo de seguimiento fue de 1-15 años (mediana: 6,9 años); la edad actual de los pacientes, 2-31 años (mediana: 14,1 años). A los 24 meses postimplante, un 66,5% de los pacientes presento una mejoria mayor o igual al 50% de las crisis previas. Solo tres pacientes (1,8%) presentaron efectos adversos graves, 26 (16,4%) mostraron efectos adversos menores y 129 (81,8%) no mostraron efectos adversos al tratamiento. Conclusion. La terapia con estimulador del nervio vago en esta serie pediatrica con epilepsia refractaria fue eficaz, bien tolerada y segura.
Subject(s)
Drug Resistant Epilepsy/therapy , Vagus Nerve Stimulation , Age of Onset , Anticonvulsants/therapeutic use , Child , Combined Modality Therapy , Drug Resistance , Drug Resistant Epilepsy/drug therapy , Drug Resistant Epilepsy/surgery , Electrodes, Implanted/adverse effects , Female , Follow-Up Studies , Humans , Male , Neurosurgical Procedures , Salvage Therapy , Surgical Wound Infection/etiology , Treatment Outcome , Vagus Nerve Stimulation/adverse effectsABSTRACT
La utilización del estimulador vagal constituye una alternativa válida de tratamiento paliativo en aquellas epilepsias refractarias que no pueden ser tratadas mediante técnicas quirúrgicas a cielo abierto (lobectomias, lesionectomías, desconexiones). Se describen fundamentos del procedimiento, indicaciones del mismo, técnica quirúrgica y experiencia de los autores. (AU)
Subject(s)
Humans , Adult , Vagus Nerve/surgery , Epilepsy/surgery , Electric Stimulation TherapyABSTRACT
La utilización del estimulador vagal constituye una alternativa válida de tratamiento paliativo en aquellas epilepsias refractarias que no pueden ser tratadas mediante técnicas quirúrgicas a cielo abierto (lobectomias, lesionectomías, desconexiones). Se describen fundamentos del procedimiento, indicaciones del mismo, técnica quirúrgica y experiencia de los autores.
Subject(s)
Humans , Adult , Vagus Nerve/surgery , Epilepsy/surgery , Electric Stimulation TherapyABSTRACT
From June 1988 to June 1998, 60 children with extratemporal epilepsies (EE), most of whom were symptomatic, underwent surgery. All patients were studied by means of CT scanning, MRI and scalp EEG. Video-telemetry was used in 40 cases. Intracranial electrodes were placed in 10. Intraoperative ECoG was used in the 35 children who underwent resective procedures and in the 25 in whom disconnection was performed. Surgical procedures were as follows: 24 lesionectomies, 25 disconnecting procedures, 7 polectomies and/or lobectomies, 3 corticectomies and 1 anatomical hemispherectomy. After at least 1 year's follow-up in 48 children, to date 38 are in Engel class I, 7 in class II, 1 in class III and 2 in class IV. That is to say, in 46 of the 48, surgical outcomes ranges from very good to at least worthwhile, as reflected in their classification in Engel class III.
