Objective

To compare efficacy, response in specific epilepsy syndromes, sustenance of response, effect on quality of life (QOL) and adverse effects between vagus nerve stimulation (VNS) and Ketogenic diet (KD).

Method

Retrospective review of case notes and direct patient interaction to discuss QOL.

Results

Pre- and post intervention data were available on 50 and 30 children for KD and VNS respectively. Follow up data, with reducing numbers, were available for upto 5 years for VNS and 2 years for KD. With VNS, 53% (16) patients reported over 50% reduction in seizures at 1y, 48% (14) at 2y, and 55% (10) at 5y. With KD, 40% (20) reported over 50% reduction at 1y and 38% (19) at 2y. KD was very effective in all patients with myoclonic astatic epilepsy (MAE) whereas VNS seemed more efficacious in unclassified multifocal epilepsies. Discontinuance rate was 16% for VNS due to infection and inefficacy and 46% for KD due to inefficacy and intolerance.

Conclusion

In our cohort, VNS was more effective than KD as a long term treatment for pharmacoresistant epilepsies. However, KD was extremely effective in MAE. Family feedback suggested an improvement in QOL with VNS even without significant seizure reduction, whereas with KD this effect was achieved only through reduction of seizure burden. Our results potentially could help in patient selection as both modalities of treatments pose their own risks and affect QOL of child and family.