Abstract Details

Title Vagus Nerve Stimulation: Seizure Reduction in Medically Refractory Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P12 - Poster Session 12 (12:00 PM-1:00 PM)

Poster/Presentation
Number 12-011

Objective

The aim of this study is to define seizure response, seizure reduction rates and possible factors associated with a good outcome.

Background Vagus Nerve Stimulation (VNS) is a device approved for seizure management in patients with refractory focal epilepsy. Many studies were conducted with a variability of responses in seizure reduction.

Design/Methods

We interrogated the database of the epilepsy program at the London Health Science Centre, searching for VNS implantations in patients with medically resistant epilepsy since the VNS was available in Canada (1997) to September 2018.

Results A total of 114 patients were included. The median age of VNS implantation was 34.4 years old (IQR=1.5-64) and the age of implantation was 26.5(IQR=20-34). 56.1%(N=64) of patients were male. 27%(N=31) had generalized epilepsy and the most common etiology was unknown in 27%(N=31). The number of antiseizure medications at the time of the implantation was 3(IQR=2-3) and the frequency of seizures was 25(IQR=8.7-60). The median follow-up period was 46 months after the implantation. The seizure rate reduction was -68.2%(IQR=(-92.6%)–(-37.1%)) after the VNS was implanted and 56%(N=41) had a seizure reduction equal or higher than 50%. The type of seizures with a significant seizure reduction (p<0.005) were generalized tonic-clonic, bilateral tonic-clonic and focal with impairment of awareness. The etiology with the best response was genetic generalized epilepsy (p<0.02) and the best models were 103, 102, 105 and 106. Complications were detected in 5.3%(N=6). Side effects were found in 63.2%(N=72) and the most common side effects were hoarseness, voice change and pain in the neck that improved over time.

Conclusions

VNS is a relatively safe therapy as an adjutant therapy in patients with medically resistant epilepsy, with a good response in more than a half of the patients. The patients with generalized and bilateral tonic-clonic seizures show the greatest improvement from VNS.

Authors/Disclosures
Ana Suller Marti, MD (University Hospital London Ontario) PRESENTER	Dr. Suller Marti has nothing to disclose.
Richard McLachlan, MD	No disclosure on file
Seyed M. Mirsattari, MD, PhD, FRCPC (Mayo Clinic)	Dr. Mirsattari has nothing to disclose.
	No disclosure on file
	No disclosure on file
Andrea Andrade, MD	No disclosure on file
	No disclosure on file
David C. Diosy, MD	Dr. Diosy has nothing to disclose.
	No disclosure on file
Jorge G. Burneo, MD, MSPH, F�鶹��ýӳ�� (University of Western Ontario)	Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, Clinical Neurology and Neurosurgery Journal. Dr. Burneo has received research support from The Jack Cowin Endowed Chair in Epilepsy Research. Dr. Burneo has received publishing royalties from a publication relating to health care. Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Jazz Pharmaceuticals.

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