Efficacy of VNS for Drug-Resistant Epilepsy in Structural Brain Lesions

Hanin Al-Gethami,Ashwaq Alshahrani,Majed Alhameed,Mubarak Aldosari

doi:10.2174/1874205x02014010085

Abstract

Background: Vagus nerve stimulation (VNS) has been used for the treatment of drug-resistant epilepsy, especially in patients who are not candidates for surgical intervention. In fact, it was approved by the US FDA in 1997 as an adjunctive treatment for medically intractable epilepsy. Objective: In this study, we investigated the efficacy of VNS in drug-resistant epilepsy associated with structural brain lesions (SBLs). Methods: We retrospectively analyzed the effect of VNS on 25 patients diagnosed with intractable epilepsy-associated SBL, and compared the results to 19 patients with intractable epilepsy and normal neuroimaging. All patients underwent VNS insertion at the National Neurosciences Institute, King Fahad Medical City (Riyadh, Saudi Arabia) between 2008 and 2018. Results: The response rate (RR) for patients with drug-resistant epilepsy-associated SBL was 24% after 3 months, 36% after 6 months, and 48% after 1 year, reaching 76% over time. The mean follow-up period was 63.3 months. For non-SBL patients, the RR was 10.5% after 3 months, 36.8% after 6 months, and 47.4% after 1 year, reaching 73.7% over time. The mean follow-up period was 59.2 months. There was no statistically significant difference between the two groups regarding RR, VNS settings, and other parameters, including anti-epileptic drug use and demographics data. Conclusion: VNS is strongly considered for intractable epilepsy in SBL patients, especially if they are not candidates for surgical intervention. Over time, those patients will receive increased benefits from VNS therapy.

Highlights

Epilepsy is one of the most common and disabling neurological diseases, affecting about 50 million people worldwide [1], with a prevalence of 6.54 per 1000 in Saudi Arabia [2].It was proposed by the International League Against Epilepsy and International Bureau for Epilepsy in 2005, as a brain disorder characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition [3]; a new practical clinical definition of epilepsy has been agreed upon
Vagus nerve stimulation (VNS) is strongly considered for intractable epilepsy in structural brain lesions (SBLs) patients, especially if they are not candidates for surgical intervention
VNS has shown a favorable outcome for intractable focal, focal-to-bilateral tonic-clonic epilepsy, and generalized onset epilepsy, including atonic seizures in adults [13 - 16], and compared to them, VNS has shown similar efficacy and safety outcomes in children [17 - 20]

Summary

Introduction

Epilepsy is one of the most common and disabling neurological diseases, affecting about 50 million people worldwide [1], with a prevalence of 6.54 per 1000 in Saudi Arabia [2] It was proposed by the International League Against Epilepsy and International Bureau for Epilepsy in 2005, as a brain disorder characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition [3]; a new practical clinical definition of epilepsy has been agreed upon. Vagus nerve stimulation (VNS) has been used for the treatment of drug-resistant epilepsy, especially in patients who are not candidates for surgical intervention It was approved by the US FDA in 1997 as an adjunctive treatment for medically intractable epilepsy

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Discussion

Conclusion