Vagus nerve stimulation in refractory epilepsy: New indications and outcome assessment |
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| Affiliation: | 1. Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children''s Hospital, IRCCS, Roma, Italy;2. Epilepsy Center, San Paolo Hospital, Università degli Studi di Milano, Milano, Italy;3. Department of Neurosurgery, Fondazione Istituto Neurologico “Carlo Besta”, Milano, Italy;4. Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione Istituto Neurologico “Carlo Besta”, Milano, Italy;5. Department of Child Neurology, Fondazione Istituto Neurologico “Carlo Besta”, Milano, Italy;6. Epilepsy Surgery Center “C. Munari”, Niguarda Hospital, Milano, Italy;7. Department of Neuroscience and Neurorehabilitation, Neurology Unit, Bambino Gesù Children''s Hospital, IRCCS, Roma, Italy;8. Clinical Neurophysiology, Fondazione Istituto Neurologico “Carlo Besta”, Milano, Italy;1. Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany;2. Department of Medical Psychology and Medical Sociology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany |
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| Abstract: | Although vagus nerve stimulation (VNS) is an effective alternative option for patients with refractory epilepsy unsuitable for conventional resective surgery, predictors of a better control of seizure frequency and severity are still unavailable. This prospective study reports on 39 patients, including 4 children affected by epilepsia partialis continua (EPC), who underwent VNS for refractory epilepsy. The overall seizure frequency outcome was classified into three groups according to reduction rate: ≥ 75%, ≥ 50%, and < 50%. Engel and McHugh classifications were also used. The median follow-up period was 36 months. A seizure reduction rate ≥ 50% or EPC improvement was observed in 74% of the patients. Twenty-one out of 35 cases (60%) resulted in Engel classes II and III. Outcome, as defined by the McHugh scale, showed a responder rate of 71%.These results suggest that younger patient age and focal or multifocal epilepsy are related to a better seizure control and cognitive outcome. Vagus nerve stimulation could also be considered as an effective procedure in severe conditions, such as drug-refractory EPC. |
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