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Introduction: Vagus Nerve Stimulation (VNS) is an adjunctive therapy used in intractable epilepsy. This procedure appears to be effective at reducing the frequency of seizures in adults. However, evidence in children is limited. Methods: We report two cases of children with drug resistant epilepsy in whom VNS was implanted. Case Description: Case 1: a 9 year old boy with gelastic epilepsy secondary to hypothalamic hamartoma who underwent a partial resection five years before, with only small decrease in seizure frequency. Case 2: a 2 year old girl with Ohtahara syndrome who was not candidate for surgical resection. Both were developmentally disabled and had multiple daily seizures refractory to antiepileptic drugs. They initially received low-output VNS with gradual increase to high-output parameters. Results: Seizure frequency decreased in more than 70% in both patients with VNS therapy after a preliminary follow-up of respectively 18 and 4 months. Despite being not seizure-free, Case 1 improved significantly his language skills and social behavior and went back to school. Case 2 improved her daytime alertness and motor development. Both had no surgical complication and any side effect was observed. Conclusion: VNS was safe, well-tolerated, reduced significantly seizure frequency in both cases and also improved mental and motor development.

Vagus Nerve Stimulation; drug resistant epilepsy