LAUSR

Since its first reported use in humans in 1988, vagus nerve stimulation (VNS) is currently considered an effective palliative treatment for children with refractory epilepsy [1]. With these considerations in mind, we enjoyed reading the excellent article by Santhumayor et al. published in your esteemed journal [2]. Elegantly, the authors discussed the current knowledge and understanding of VNS utility in children and young adults with intractable epilepsy [2]. Although we agree with the authors’ positioning to further understand if there is a prolonged time-dependent benefit to auto-stimulation-enabled VNS therapy [2], we must not fail to highlight that VNS treatment may be useful to minimize SUDEP occurrence. Sudden unexpected death in epilepsy (SUDEP) accounts for a large number of deaths in children with epilepsy [3]. Although specific causes of SUDEP in children remain unknown, children with uncontrolled epilepsy or frequent generalized tonic–clonic seizures are at the highest risk for SUDEP [3]. The most common mechanisms of SUDEP in children are related to cardiac and respiratory abnormalities during and between seizures [3]. Importantly, it is clear in the literature that the best way to prevent SUDEP in childhood is good control of seizures [4]. However, although the availability of pharmacological and surgical treatment for epilepsy has expanded, these procedures are still limited in clinic efficacy [4]. In these lines, epileptologists have used therapeutic devices, including VNS, in order to minimize the occurrence of SUDEP [5]. In fact, many studies have evaluated the effect of VNS therapy on autonomic nervous system, demonstrating that this therapy does not cause significant changes in heart rate variability and blood pressure in individuals with epilepsy [5]. Importantly, several clinical findings have also demonstrated that SUDEP rates decrease over time in patients with drug-resistant epilepsy being treated with adjunctive VNS therapy [5]. In the same way, our research group obtained similar results with VNS procedure [4]. Briefly, we studied 36 patients up to 18 years old, with drug-resistant epilepsy submitted to VNS therapy [4]. We observed a reduction of at least 50% of seizures in 61.3% of the cases, and 12.1% of the individuals had more than 90% of seizure frequency reduction, strongly suggesting that VNS therapy can be considered a potential line of defense against SUDEP [4]. Overall, which lessons did we learn? Firstly, epilepsy in children is a systemic condition. Secondly, the risk of a child dying from SUDEP is now widely recognized. Third, VNS therapy has a possible protective effect against SUDEP. Finally, the excellent article-discussed here [2] should reinforce translational research to explore the potential benefits of VNS therapy for children with epilepsy and mainly in the prevention of SUDEP in this population.