RT Book, Section
A1 Kotagal, Prakash
A2 Duchowny, Michael
A2 Cross, J. Helen
A2 Arzimanoglou, Alexis
SR Print(0)
ID 1138412711
T1 Vagus Nerve Stimulation
T2 Pediatric Epilepsy
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071496216
LK accesspediatrics.mhmedical.com/content.aspx?aid=1138412711
RD 2024/04/18
AB There  is  widespread  consensus  that  recurrent  epileptic  seizures  need  treatment  and  the  first  line  of  treatment  invariably  involves  use  of  antiepileptic  drugs  (AEDs).  However,  experience  from  several  large  studies  has  shown  that  only  about  two-thirds  of  patients  can  be  controlled  satisfactorily  with  AEDs  either  as  monotherapy  or  combination  therapy.1,2  The  remaining  patients  have  medically  refractory  epilepsy  and  should  be  evaluated  at  an  epilepsy  center  to  determine  if  they  may  be  candidates  for  excisional  epilepsy  surgery.  Of  this  group  approximately  25%  will  be  offered  a  resection  (personal  observation),  still  leaving  a  sizeable  proportion  of  patients  without  effective  medical  control.  Seizures  in  medically  refractory  patients  have  a  major  impact  on  quality  of  life  (QOL),  and  may  result  in  injuries  or  even  death.3  Treatment  options  consist  of  additional  trials  of  AEDs,  ketogenic  diet,  or  vagus  nerve  stimulation  (VNS  therapy).  Deep  brain  stimulation  remains  investigational.  Figure  57–1  outlines  a  treatment  algorithm  showing  the  diagnostic  and  therapeutic  approach  to  a  patient  with  epilepsy.