Hello, everyone. My name is Jerry Garcia, and today I'll be giving a presentation on a 20-year retrospective review of vagus nerve stimulation in children with LGS. So LGS is an epileptic syndrome characterized by a severe seizure burden that, over time, becomes progressively difficult to control. And so the prognosis of this syndrome is typically poor. So the purpose of the study was to determine VNS efficacy, safety, and tolerability in LGS patients younger than 19 years of age. The cohort of this chart review consisted of 38 children that underwent VNS surgery between 1998 and 2018 at UAB Children's of Alabama. The main variables that were analyzed are provided here, and the response rates were defined by achieving a greater than 50% reduction in seizure frequency. It is important to note that chart records were incomplete for some patients, and I'll be sure to point those out throughout this presentation. The tables provided here break down the demographics of the cohort by race, ethnicity, and gender. What's interesting to note here is that most of the children were under 12 years of age at the time of surgery. Most of the children started presenting with seizures at a really young age with a median age of seizure onset of one year and a median age of implantation of seven years. 36.8% of the children had some type of intracranial epilepsy surgery prior to the surgery. Additionally, the median number of anti-epileptic drugs attempted prior to the surgery was six. This table breaks down the frequency of seizures before the surgery. Chart records were incomplete for this specific variable in three patients, so they weren't included in this specific calculation. This table breaks down the percentage of patients who are responders at different follow-up periods. The response rates were pretty similar from years one to five, but they seem to increase from six months to five years. The median total follow-up duration was 5.9 years, and there's one patient that is still currently receiving follow-up since 1998, which is why the range goes up to 22 years here. And the right column here elucidates the number of patients that had complete records for this specific variable. This table just breaks down the frequency of seizures at the different follow-up periods that I mentioned in the previous slide. The percentage of patients having daily seizures decreased to 28% at five years, and the percentage having less than one seizure per month increased to 24% at five years. So during the VNS procedure, there were no complications in any of the children, and the number of adverse events experienced by patients at different follow-up periods are indicated in this table, which I will be expanding upon in the next slide. As you can see in these tables here, there were a variety of different adverse events experienced by the children, with the most common one being cough. It is important to note that all the adverse effects either resolved over time or with modifications and simulation parameters. No adverse effects were experienced at year five of follow-up in those patients that did have complete chart records. The infection rate was 6.1% within three months post-surgery in 33 patients, not 38 since five of the patients had incomplete chart records. An infection occurred in one patient at six months and at another patient at 24 months, and there were no deaths reported in any of these patients. Out of the 38 patients in this cohort, six of them needed a VNS revision at some point during their life, and I'd like to note that these revisions were not related to battery depletion. As you can see in this table down here, most revisions were due to a malfunctioning VNS device, and the two patients that I mentioned in the previous slide that had an infection received the revision and did not discontinue the VNS device. I'd also like to emphasize that all the patients that required a revision did indeed obtain a revision, so no patients discontinued their device. Therefore, the discontinuation rate was 0%. So to conclude, LGS is indeed a devastating disorder, but our cohort demonstrated a response rate of 60% by five months of follow-up. Furthermore, it appears that complications are infrequent and not severe enough to warrant discontinuing the device. And that is the end of my presentation. Thank you so much for your time.

vagus nerve stimulation

Lennox-Gastaut Syndrome

epileptic syndrome

efficacy

safety