# Vagus nerve stimulation for spike-and-wave activation in sleep in a pediatric patient: a case report

## TL;DR

A child with spike-and-wave activation in sleep showed improvement after vagus nerve stimulation, with reduced seizures and better development.

## Contribution

This case report demonstrates the potential efficacy of VNS in reducing SWAS and improving outcomes in a pediatric patient with EE-SWAS.

## Key findings

- VNS led to seizure freedom and disappearance of SWAS on EEG in a 4.8-year-old boy with EE-SWAS.
- Neurodevelopmental improvements were observed following VNS without additional medications.
- Discontinuation of VNS led to a resurgence of SWAS on EEG.

## Abstract

Evidence regarding the efficacy of vagus nerve stimulation (VNS) in treating developmental and epileptic encephalopathy/ epileptic encephalopathy with spike-and-wave activation in sleep (DEE/EE-SWAS), particularly its impact on the SWAS remains limited. We present a boy with EE-SWAS who was treated with VNS at 4.8 years of age.

A male patient developed seizures at 2.3 years of age. At 2.8 years of age, electroencephalography (EEG) showed SWAS, leading to regression in cognitive, motor, and language functions. Administration of multiple anti-seizure medications (ASMs) achieved poor efficacy, and repeated corticosteroids resulted in only transient improvement. He was treated with VNS at 4.8 years of age. Seizure freedom was achieved at 1.3 years postoperatively. The SWAS pattern was not observed on follow-up EEG 2 years after implantation. Concurrently, his neurodevelopment improved. No new ASMs or corticosteroids were added during this period. VNS was interrupted due to pulse generator battery depletion at 5.6 years after implantation. Increased SWI was showed on the EEG 6 months after the interruption of stimulation.

Early VNS intervention should be considered in addition to conventional medication for young children with SWAS who have greater distance from the self-limited age.