Introduction: This study will review data variables that lead to improved outcome in pediatric VNS patients. It will also review surgical technique for single incision implantation. It is among the largest pediatric series ever presented.

Methods: Data was gathered on 53 patients of a single neurosurgeon undergoing vagus nerve stimulator implantation from 2003 to 2009. Patients were followed for a minimum of 1 year and follow-up data recorded for seizure frequency, VNS variables, and complications. Patients who had surgery in 2005 or later had a single clavicular incision and patients prior to 2005 had a neck incision and an axillary incision.

Results: 53 pediatric (>18 years of age) patients were implanted over the study time frame. Mean DC-DC conversion was 1.5 in patients with 3mm leads and 2.2 in patients with 2mm leads. 81% of patients had a >50% reduction in seizures. 45% of patients had a >75% reduction in seizures. 18% of patients became seizure free. 12% of patients had no change in seizure frequency. There were no permanent morbidities, nor any mortality. Variables related to improved outcomes were DC-DC conversion, duration of epilepsy, and size of lead implanted(p<0.01).

Conclusions: VNS continues to be a safe and highly effective treatment modality for multi-focal refractory epilepsy, regardless of age. Results and complication rates did not significantly vary for variables of patient age or single or two incision techniques. The 3 mm leads had a lower DC to DC conversion. Lower DC-DC conversion led to improved seizure control.

Patient Care: We will help identify ways in which VNS may be more effectively implanted.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand that pediatric patients have a similar outcome to adult patients with VNS 2) Identify factors that may improve outcome with VNS 3) Understand the anatomical issues involved with a single sub-clavicular incision for VNS implantation

References: Seizure. 2005 Oct;14(7):504-13. Epub 2005 Sep 19. Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood. Hallböök T, Lundgren J, Stjernqvist K, Blennow G, Strömblad LG, Rosén I. Neurosurgery. 2000 Dec;47(6):1353-7; discussion 1357-8. Efficacy of vagal nerve stimulation in children with medically refractory epilepsy. Patwardhan RV, Stong B, Bebin EM, Mathisen J, Grabb PA. Pediatr Neurol. 2006 Nov;35(5):323-6. Vagus nerve stimulation for intractable seizures in children. Saneto RP, Sotero de Menezes MA, Ojemann JG, Bournival BD, Murphy PJ, Cook WB, Avellino AM, Ellenbogen RG.