Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy

Ana Suller Marti; Seyed Mohammad Mirsattari; Keith MacDougall; David Andrew Steven; Andrew Parrent; Sandrine de Ribaupierre; Andrea Andrade; David Diosy; Richard Scott McLachlan; Jorge Guillermo Burneo

doi:10.1016/j.yebeh.2020.107253

Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy

Epilepsy Behav. 2020 Oct:111:107253. doi: 10.1016/j.yebeh.2020.107253. Epub 2020 Jun 29.

Affiliations

¹ Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: [email protected].
² Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
³ Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁴ Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Neuroepidemiology Unit, Schulich School of Medicine, Western University, London, ON, Canada.

PMID: 32615417
DOI: 10.1016/j.yebeh.2020.107253

Abstract

Background: For patients with generalized epilepsy who do not respond to antiseizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy-resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox-Gastaut Syndrome (LGS) and genetic generalized epilepsy (GGE).

Methods: We identified patients with a diagnosis of generalized epilepsy (including LGS and GGE), who underwent VNS implantation at the London Health Sciences Centre and Western University, London, Ontario, since this treatment became available in Canada in 1997 until July 2018. We assessed response to the treatment, including admissions to hospital and complications.

Results: A total of 46 patients were included in this study with a history of therapy-resistant generalized epilepsy. The mean age at implantation was 24 years (interquartile range [IQR] = 17.8-31 years), significantly younger in the LGS group (p = 0.02) and 50% (n = 23) were female. The most common etiologies were GGE in 37% (n = 17) and LGS in 63% (n = 29). Median follow-up since VNS implantation was 63 months (IQR: 31-112.8 months). Of the LGS group 41.7% (n = 12) of patients had an overall seizure reduction of 50% or more, and 64.7% (n = 11) in the GGE group without statistical significance between the groups. The best response in seizure reduction was seen in generalized tonic-clonic seizures, with a significant reduction in the GGE group (p = 0.043). There was a reduction of seizure-related hospital admissions from 91.3% (N = 42) preimplantation, to 43.5% (N = 20) postimplantation (p < 0.05). The frequency of side effects due to the stimulation was almost equal in both groups (62.1% in LGS and 64.7% in GGE).

Conclusions: Vagus nerve stimulation should be considered as a treatment in patients with therapy-resistant generalized epilepsy, especially in cases with GGE.

Keywords: Epilepsy; Generalized tonic–clonic; Seizures; Vagus nerve stimulation.

Publication types

Observational Study

MeSH terms

Adolescent
Adult
Drug Resistant Epilepsy / epidemiology*
Drug Resistant Epilepsy / physiopathology
Drug Resistant Epilepsy / therapy*
Electrodes, Implanted*
Epilepsy, Generalized / epidemiology*
Epilepsy, Generalized / physiopathology
Epilepsy, Generalized / therapy*
Female
Hospitalization / trends
Humans
Male
Middle Aged
Ontario / epidemiology
Retrospective Studies
Treatment Outcome
Vagus Nerve Stimulation / instrumentation
Vagus Nerve Stimulation / methods*
Young Adult