Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery

Fernando Vale Diaz, Amir Ahmadian, A. Samy Youssef, William O. Tatum, Selim R. Benbadis

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. Methods: All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. Results: Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). Conclusion: VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.

Original languageEnglish (US)
Pages (from-to)244-248
Number of pages5
JournalSeizure
Volume20
Issue number3
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

Fingerprint

Vagus Nerve Stimulation
Vagus Nerve
Epilepsy
Seizures
Quality of Life
Therapeutics
Pharmaceutical Preparations
Outcome Assessment (Health Care)

Keywords

  • Epilepsy surgery
  • Intractable epilepsy
  • Lobectomy
  • Vagus nerve stimulator

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. / Vale Diaz, Fernando; Ahmadian, Amir; Youssef, A. Samy; Tatum, William O.; Benbadis, Selim R.

In: Seizure, Vol. 20, No. 3, 01.04.2011, p. 244-248.

Research output: Contribution to journalArticle

Vale Diaz, Fernando ; Ahmadian, Amir ; Youssef, A. Samy ; Tatum, William O. ; Benbadis, Selim R. / Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. In: Seizure. 2011 ; Vol. 20, No. 3. pp. 244-248.
@article{901d2380ca354a7da61bb85b66cbdb10,
title = "Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery",
abstract = "Objective: Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. Methods: All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. Results: Overall, 24 (64.9{\%}), 9 (24.3{\%}), 4 (10.8{\%}) patients reported less than 30{\%}, between 30{\%} and 60{\%} and greater than 60{\%} reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9{\%}) report an improvement in QoL (better or much better). Conclusion: VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.",
keywords = "Epilepsy surgery, Intractable epilepsy, Lobectomy, Vagus nerve stimulator",
author = "{Vale Diaz}, Fernando and Amir Ahmadian and Youssef, {A. Samy} and Tatum, {William O.} and Benbadis, {Selim R.}",
year = "2011",
month = "4",
day = "1",
doi = "10.1016/j.seizure.2010.12.003",
language = "English (US)",
volume = "20",
pages = "244--248",
journal = "Seizure : the journal of the British Epilepsy Association",
issn = "1059-1311",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery

AU - Vale Diaz, Fernando

AU - Ahmadian, Amir

AU - Youssef, A. Samy

AU - Tatum, William O.

AU - Benbadis, Selim R.

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Objective: Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. Methods: All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. Results: Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). Conclusion: VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.

AB - Objective: Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. Methods: All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. Results: Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). Conclusion: VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.

KW - Epilepsy surgery

KW - Intractable epilepsy

KW - Lobectomy

KW - Vagus nerve stimulator

UR - http://www.scopus.com/inward/record.url?scp=79952455690&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952455690&partnerID=8YFLogxK

U2 - 10.1016/j.seizure.2010.12.003

DO - 10.1016/j.seizure.2010.12.003

M3 - Article

VL - 20

SP - 244

EP - 248

JO - Seizure : the journal of the British Epilepsy Association

JF - Seizure : the journal of the British Epilepsy Association

SN - 1059-1311

IS - 3

ER -