Abstract | OBJECTIVE: METHODS: A retrospective review was performed on 19 patients with refractory epilepsy and TSC who underwent vagus nerve stimulator (VNS) implantation. There were 11 (58%) females and 8 (42%) males aged 2 to 44 years when the VNS was implanted (mean: 14.7+/-12 years). Twelve patients underwent primary VNS implantation after having failed a mean of 7.1 antiepileptic drugs. Two patients (17%) had generalized epilepsy, one had a single seizure focus, three (25%) had multifocal epilepsy, and six (50%) had multifocal and generalized epilepsy. Seven patients were referred for device removal and evaluation for intracranial procedures. One patient in the primary implantation group was lost to follow-up and excluded from outcome analysis. RESULTS: All implantations and removals were performed without permanent complications. The duration of treatment for primary VNS implants varied from 8.5 months to 9.6 years (mean: 4.9 years). Mean seizure frequency significantly improved following VNS implantation (mean reduction: 72%, P<0.002). Two patients had Engel Class I (18%), one had Class II (9%), seven had Class III (64%), and one had Class IV (9%) outcome. Three patients with poor response to vagus nerve stimulation therapy at our center underwent resection of one or more seizure foci (Engel Class I, two patients; Engel Class III, one patient). Seven patients referred to our center for VNS removal and craniotomy underwent seizure focus resection (6) or corpus callosotomy (1) (Engel Class II: 2, Engel III: 2; Engel IV: 3). In total, 8 of 10 (80%) patients experienced improved seizure control following intracranial surgery (mean reduction: 65%, range: 0-100%, P<0.05). CONCLUSIONS:
|
Authors | Robert E Elliott, Chad Carlson, Stephen P Kalhorn, Yaron A Moshel, Howard L Weiner, Orrin Devinsky, Werner K Doyle |
Journal | Epilepsy & behavior : E&B
(Epilepsy Behav)
Vol. 16
Issue 3
Pg. 454-60
(Nov 2009)
ISSN: 1525-5069 [Electronic] United States |
PMID | 19767244
(Publication Type: Clinical Trial, Comparative Study, Journal Article)
|
Topics |
- Adolescent
- Adult
- Child
- Child, Preschool
- Electroencephalography
- Epilepsy
(etiology, therapy)
- Female
- Humans
- Male
- Neurosurgery
(methods)
- Outcome Assessment, Health Care
- Retrospective Studies
- Tuberous Sclerosis
(complications, therapy)
- Vagus Nerve Stimulation
(methods)
- Young Adult
|