TY - CHAP M1 - Book, Section TI - Vagus Nerve Stimulation A1 - Kotagal, Prakash A2 - Duchowny, Michael A2 - Cross, J. Helen A2 - Arzimanoglou, Alexis PY - 2017 T2 - Pediatric Epilepsy 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - neurology.mhmedical.com/content.aspx?aid=1138412711 ER -