226. Seizure Control and Outcomes Following Vagal Nerve Stimulator Implantation With Heart Rate Detection For Pediatric Epilepsy

Authors: Taemin Oh; Taemin Oh, MD; John Burke, MD, PhD; Joan Hwang, BA; Emily Moon, BS; Adam Numis, MD; Kurtis Auguste, MD (San Francisco, CA)

Introduction:

Vagal nerve stimulators (VNS) are an important treatment option in the management of drug-resistant epilepsy. Recent iterations of these implants can deliver an electrical current timed with the onset of ictal tachycardia to achieve seizure control. Here, we compare the efficacy and safety profile of VNS implants with and without heart rate detection in treating pediatric patients with epilepsy.

Methods:

Data were retrospectively collected from 2012-2018 on pediatric patients with pharmaco-resistant epilepsy treated with VNS implantation at a comprehensive epilepsy center. Patient demographics, seizure control at 1-month and 24-month follow up, and number of adverse events were compared for patients who received VNS with or without heart rate detection. Unpaired t-tests and two-tailed, Fisher’s exact tests were employed to compare the two cohorts.  

Results:

In sum, 102 patients underwent VNS implantation (VNS with heart rate detection=72; VNS without heart rate detection=30). There were no significant differences in age at onset, gender, or number of failed antiepileptics between the two groups. At 1-month follow-up, there were no significant differences in the reduction of seizure frequency or duration between the two groups. Overall, 83% of patients had long-term 2-year follow-up and, at that time point, both groups had equivalent rates of improvement in seizure frequency and duration. However, there was a trend towards VNS with heart rate detection resulting in complete seizure freedom (12% versus 6.5% of patients with no seizures who received VNS with or without heart rate detection, respectively).

Conclusion:

In this large series of pediatric epilepsy patients, we show that implantation of VNS with heart rate detection can be performed safely and with seizure control outcomes comparable to those without heart rate detection. Among children who are not good surgical candidates, VNS remains a critical treatment option in achieving better seizure control.