Long-term results of vagal nerve stimulation for adults with medication-resistant epilepsy who have been on unchanged antiepileptic medication.García-Navarrete E, Torres CV, Gallego I, Navas M, Pastor J, Sola RG.
SourceDivision of Neurosurgery, Department of Surgery, University Hospital La Princesa, Universidad Autónoma, Madrid, Spain.
PURPOSE:Several studies suggest that vagal nerve stimulation (VNS) is an effective treatment for medication-resistant epileptic patients, although patients' medication was usually modified during the assessment period. The purpose of this prospective study was to evaluate the long-term effects of VNS, at 18 months of follow-up, on epileptic patients who have been on unchanged antiepileptic medication.
METHODS:Forty-three patients underwent a complete epilepsy preoperative evaluation protocol, and were selected for VNS implantation. After surgery, patients were evaluated on a monthly basis, increasing stimulation 0.25mA at each visit, up to 2.5mA. Medication was unchanged for at least 18 months since the stimulation was started. The outcome was analysed in relation to patients' clinical features, stimulation parameters, epilepsy type, magnetic resonance imaging (MRI) results, and history of prior brain surgery.
RESULTS:Of the 43 operated patients, 63% had a similar or greater than 50% reduction in their seizure frequency. Differences in the responder rate according to stimulation intensity, age at onset of epilepsy, duration of epilepsy before surgery, previous epilepsy surgery and seizure type, did not reach statistical significance. Most side effects were well tolerated.
CONCLUSIONS:62.8% of our series of 43 medication-resistant epileptic patients experienced a significant long-term seizure reduction after VNS, even in a situation of on unchanged medical therapy. Patient characteristics predictive of VNS responsiveness remain subject to investigation. Controlled studies with larger sample sizes, on VNS for patients with medication-resistant epilepsy on unchanged medication, are necessary to confirm VNS efficacy for drug-resistant epilepsy, and to identify predictive factors. Copyright © 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
- [PubMed - indexed for MEDLINE]
Related citations in PubMed
- Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases.[J Neurosurg Pediatr. 2011] Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. Elliott RE, Rodgers SD, Bassani L, Morsi A, Geller EB, Carlson C, Devinsky O, Doyle WK. J Neurosurg Pediatr. 2011 May; 7(5):491-500.
- The efficacy of vagal nerve stimulation in children with pharmacoresistant epilepsy: practical experience at a Turkish tertiary referral center.[Eur J Paediatr Neurol. 2010] The efficacy of vagal nerve stimulation in children with pharmacoresistant epilepsy: practical experience at a Turkish tertiary referral center. Arhan E, Serdaroglu A, Kurt G, Bilir E, Durdağ E, Erdem A, Aksakal FN, Ozcelik A, Baykaner K. Eur J Paediatr Neurol. 2010 Jul; 14(4):334-9. Epub 2009 Oct 21.
- Vagus nerve stimulation for medically refractory epilepsy: a long-term follow-up study.[Seizure. 2007] Vagus nerve stimulation for medically refractory epilepsy: a long-term follow-up study. Ardesch JJ, Buschman HP, Wagener-Schimmel LJ, van der Aa HE, Hageman G. Seizure. 2007 Oct; 16(7):579-85. Epub 2007 May 31.
- Review Clinical course of young patients with Dravet syndrome after vagal nerve stimulation.[Eur J Paediatr Neurol. 2011] Review Clinical course of young patients with Dravet syndrome after vagal nerve stimulation. Zamponi N, Passamonti C, Cappanera S, Petrelli C. Eur J Paediatr Neurol. 2011 Jan; 15(1):8-14. Epub 2010 Oct 23.
- Review Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children.[Childs Nerv Syst. 2006] Review Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children. Benifla M, Rutka JT, Logan W, Donner EJ. Childs Nerv Syst. 2006 Aug; 22(8):1018-26. Epub 2006 Jul 1.