Vagus nerve stimulation therapy after failed cranial surgery for intractable epilepsy: Results from the vagus nerve stimulation therapy patient outcome registry

被引:75
作者
Amar, AP
Apuzzo, MLJ
Liu, CY
机构
[1] Yale Univ, Dept Neurosurg, Sch Med, New Haven, CT USA
[2] Univ So Calif, Dept Neurosurg, Keck Sch Med, Los Angeles, CA USA
关键词
callosotomy; epilepsy; epilepsy surgery; failure; lobectomy; seizure; vagus nerve stimulation therapy;
D O I
10.1227/01.NEU.0000141073.08427.76
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: To determine the effectiveness of vagus nerve stimulation (VNS) therapy among patients with persistent or recurrent seizures after lobar resection, callosotomy, and other cranial operations for intractable epilepsy. METHODS: Data were obtained from the VNS therapy patient outcome registry, which was established after United State's Food and Drug Administration approval of the VNS device in 1997 as a means, of capturing open-label clinical data, outside of protocol. The integrity of the systems for collecting and processing registry data was authenticated by an independent auditing agency. The effect of potential selection bias, however, remains uncertain. RESULTS:Two nonconsecutive cohorts were compared: patients tracked in the registry who had previously undergone cranial surgery for epilepsy (CS group, n = 921) and those who had not (non-CS group, n 3822). For the'CS group, the median reduction in seizure frequency was 42.5% after 3 months of VNS therapy, 42.9% at 6 months, 45.7% at 12 months, 52.0% at 18 months, and 50.5% at 24 months. For the non-CS group, analogous rates were 47.0%, 52'9%, 60.0%, 62.7%, and 66.7% respectively. In the CS group, seizures were reduced by at least 50% in 55.1% of patients, at least 75% in 31.4% of patients, at least 90% in 17.3% of patients, and 100% in 5.1% of patients after 124 months of VNS therapy. Response rates were more pronounced in the non-CS group: at least 50% in 62.2% of patients, at least 75% in 43.7% of patients, at least 90% in 26.8% of patients, and 100% in 8.3% of patients. Patients,in both groups experienced marked, improvements in quality of life parameters. CONCLUSION: The effectiveness of VNS is maintained during prolonged stimulation, and, overall seizure control continues to improve with time. Patients in whom prior Cranial surgery had failed did not respond as favorably as all other patients receiving VNS therapy. Nonetheless, many of the former group improved substantially. Thus, on the basis of these open-libel data, VNS therapy represents a potentially palliative treatment option for patients with-refractory seizures after failed cranial surgery.
引用
收藏
页码:1086 / 1092
页数:7
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