UPMC Children’s Hospital Continues Its Success With Vagus Nerve Stimulation for Epilepsy
January 7, 2019
Since 2005, UPMC Children’s Hospital of Pittsburgh has been a leader in the use of vagus nerve stimulation (VNS) to treat epilepsy in pediatric patients. One of the oldest programs in the country performing VNS implantations, the Epilepsy Surgery Program at UPMC Children’s typically performs 30 to 50 implantation procedures a year.
In April 2018, UPMC Children’s began testing the newest generation of the SenTiva® VNS device from LivaNova that received FDA approval in October 2017. UPMC Children’s is one of the first sites in the country to begin using the new VNS system in pediatric patients. Christina Patterson, MD, director of the UPMC Children’s epilepsy program, says that the newest device offers patients and clinicians a suite of new features and benefits to make the implantation and long-term use of the devices easier and more user friendly.
A major benefit from Dr. Patterson’s perspective is the ability to tune the settings of the device to precisely match the patient’s seizure burden for a better level of control. “For example, if a patient is experiencing seizures more frequently at night, we can program the device to account for that and change function depending on the time of day,” says Dr. Patterson.
VNS devices typically are used when antiepileptic medications are not effective at controlling seizures and when the patient is not a good candidate for another type of surgery. Another important aspect is the ability to titrate an individual’s settings to bring them up to the best therapeutic level for their situation.
“We can program the device to do this over time and cut down on the number and frequency of clinic visits patients need to make for device adjustments. This is a great benefit for our particular patient population because we have many individuals who have to travel from significant distance to get to the hospital,” says Dr. Patterson.
Dr. Patterson, along with neurosurgeon Elizabeth Tyler-Kabara, MD, PhD, have so far implanted more than a dozen of the new devices and are aggregating data for long-term usage studies and research.
VNS — Benefits and Usage
VNS devices typically are used when antiepileptic medications are not effective at controlling seizures and when the patient is not a good candidate for another type of surgery. VNS devices are implanted in an outpatient procedure, and the patient oftentimes will go home the same day, or they may just need a single overnight stay in the hospital before discharge.
“I usually explain to families that one of the goals of VNS therapy is to hopefully minimize the number of other medications that are being used to treat seizures. This can reduce the cumulative side effect burden, which for some can be significant and present quality of life issues beyond those attributable to their underlying epilepsy,” says Dr. Patterson.
In 50 percent of patients with an implanted VNS, clinicians typically see a 50 to 70 percent reduction in seizures. While not a cure-all for epilepsy or seizure disorder, this level of reduction in seizures from a VNS device can substantially reduce a patient’s medication needs and improve their overall quality of life.
VNS — Emerging Benefits and Trials
Depression continues to be a common occurrence in patients with epilepsy. Many epilepsy patients with VNS implants see an improvement in their mood, and this aspect of VNS continues to garner research interest. VNS also has been trialed for use in the treatment of depression and has been FDA approved since 2005 for the treatment of severe, recurrent unipolar and bipolar depression, but broader adoption of the platform as an effective treatment modality is still in its infancy.
