Long-term effect of vagus nerve stimulation on interictal epileptiform discharges in refractory epilepsy

Background: Vagus nerve stimulation (VNS) therapy has been widely recognized as an effective alternative for the treatment of refractory epilepsy. However, the precise mechanism of VNS is poorly understood. The purpose of this study was to observe the long-term interictal EEG changes induced by VNS, and to investigate the probable mechanism of action of VNS in achieving seizure control. Methods: Eight patients with VNS were selected from two epilepsy centers in China (Harbin and Shanghai) between 2001 and 2004. We studied the clinical efficacy by long-term follow-up, ranging from 37 to 81 months (mean 55.8 months). Moreover, serial EEGs were performed at the different time (preoperative baseline, 3, 6, 12, and 24 months after VNS initiation) and the different states of VNS stimulator ("activation", "deactivation" and "reactivation"). Results: A >= 50% seizure reduction was achieved in 12.5%, 62.5%, 75%, 62.5% and 75% of the total patients (n = 8) at 6, 12, 18, 24 and 36 months of post-VNS, respectively. The results revealed a statistically significant progressive decrease in the number of IEDs (interictal epileptiform discharges) on EEG with time (P < 0.01). Significant correlation had been highlighted after 6 months of VNS stimulation, between the reduction of seizure frequency and the decreasing of IEDs (P < 0.01). Furthermore, statistically significant difference of IEDs was seen when comparing the state of "deactivation" with the states of "activation" and "reactivation", respectively (P < 0.01). However, there was no significant difference in IEDs between "activation" and "reactivation" (P > 0.05). Conclusions: VNS is an efficient, well-tolerated therapy for refractory epilepsy. It can induce progressive electrophysiological effect on epileptiform activity over time. This may reflect the mechanism of chronic action of VNS with desynchronization of EEG in achieving seizure control. (C) 2009 Elsevier B. V. All rights reserved.