Acta Neurochir (Wien). 2012 Oct 21. [Epub ahead of print]
Vagus nerve stimulation in drug-resistant epilepsies. Analysis of potential prognostic factors in a cohort of patients with long-term follow-up.
Source
Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy.Abstract
BACKGROUND:
The results of vagus nerve stimulation (VNS) for the treatment of drug-resistant epilepsies are highly variable due to the lack of defined patient's selection criteria and a follow-up of published studies being generally too short. Here we report the outcome of VNS in a series with long-term follow-up and try to identify subgroups of patients who could be better candidates for this procedure.METHOD:
We studied 53 patients (33 male, 20 female) with a prospectively recorded follow-up (mean, 55.96 ± 43.53 months). The monthly average seizure frequency for each patient at baseline, 3, 6, 12 months, and each year until the latest follow-up after implant was measured and the percentage of "responders" and response time (RT) were calculated. We investigated the following potential prognostic role of these factors: age of onset of epilepsy, pre-implant epilepsy duration, etiology, and age at implant.RESULTS:
Globally, 40 % of patients responded to VNS (mean RT, 14.85 ± 16.85 months). Lesional etiology (p = 0.0179, logrank test), particularly ischemia (p = 0.011, Fisher exact test) and tuberous sclerosis (p = 0.0229, Fisher exact test), and age at implant <18 a="a" age="age" an="an" and="and" associated="associated" at="at" best="best" better="better" duration="duration" epilepsy="epilepsy" implant="implant" in="in" lesional="lesional" logrank="logrank" observed="observed" p="p" patients="patients" pre-implant="pre-implant" response="response" results="results" subgroup="subgroup" test="test" the="the" to="to" vns.="vns." were="were" with="with" years="years">CONCLUSIONS:
The best candidate to VNS seems to be a patient with lesional etiology epilepsy (particularly post-ischemic and tuberous sclerosis) and a short duration of epilepsy who undergo VNS younger than 18 years.- PMID:
- 23086106
- [PubMed - as supplied by publisher]
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- Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration.[Childs Nerv Syst. 2010]
- Review Clinical course of young patients with Dravet syndrome after vagal nerve stimulation.[Eur J Paediatr Neurol. 2011]
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