Use of Vagus Nerve Stimulator in Refractory Epilepsy
DOI:
https://doi.org/10.47924/neurotarget2007378Keywords:
vagal nerve stimulation, refractory epilepsy, Argentina experienceAbstract
Introduction: Vagal nerve stimulation (VNS) is an alternative treatment for patients with refractory epilepsy. We report the effects of VNS on seizure frequency and severity, our experience with VNS with pharmacoresistant epilepsy: clinical efficacy, safety and neuropsychological effects.
Patients and methods: Since june 1999, 23 patients were implanted. We retrospectively reviewed outcome of 21. In 16 patients, it was the first surgery (VNS) and in 5 after performing other epilepsy surgery. 10 children (aged: 6-16 years) and 11 adults (aged: 17-28 years). Mean follow-up was 65 months. Parameters of stimulation: "on" and "off" periods: 30 sec/5 min; frequency: 30 Hz; pulse width: 500 μseg; intensity: 0,75-2,50 mA. We used a structured interview to monitor the progress of each patient. All patients were on polytherapy. We es- tablish a very good result if seizures decrease more than 50% in frequency and severity, good between 25-45% and without response when modifications were less than 25%. Data collection on each patient´s history, seizures, implants, device settings, adverse events. The neurocybernetic prosthesis was implanted and connected with two spiral electrodes around the left vagal nerve.
Results: 13 patients had at least a 50% reduction of seizure frequency (62%), 4 had good results with improvement in quality of life, behaviour, mood and good results on cognition and 4 showed no significant differences. We saw the best results (80%) with corpus callosotomy and vagal nerve stimulation and other epilepsy surgery in 5 patients. Complications were migration of the generator in one case and continuous stimulation in one. There were no post- operative infections. Side-effects were minor and transient the most common were voice alteration and coughing during stimulation. Generator was changed in 3 patients after 50 months. Age at implantation of the vagal nerve stimulator did not seem to correlate with patient success.
Conclusions: VNS is an appropriate strategy and a surgical option to treat drug-resistant epilepsy. The improvement in seizure severity, quality of life, behaviour, mood is very important for the patient and the family. The best result was in patients with previous surgery for epilepsy. Few side effects have been described and well tolerated. Generator replacement in epilepsy patients treated with vagal nerve stimulation is safe.
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Copyright (c) 2007 Hugo Pomata, César Petre, Marcelo Bartuluch
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