Background: Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. Methods: We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Results: Thirty patients (females, 18; males, 12; age, 35.1 ± 13.3 years) were included. After 6, 12, 24, and 36 months of followup, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Conclusions: Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.RÉSUMÉ: Efficacité de la stimulation du nerf vague pour traiter l'épilepsie réfractaire. Contexte : La stimulation du nerf vague (SNV) est une alternative au traitement bien établi dans le traitement de l'épilepsie réfractaire, quoique la modification de la médication antiépileptique (MAE) pendant le traitement par SNV puisse expliquer l'amélioration constatée chez les patients. Méthodologie : Nous avons évalué rétrospectivement l'efficacité de la SNV chez 30 adultes atteints d'épilepsie traités par SNV et suivis pendant plus de 6 mois. Les critères pour l'implantation étaient les suivants : (1) ne pas être un candidat à la résection chirurgicale ; (2) être atteint d'une épilepsie réfractaire au traitement ; (3) présenter une altération de la qualité de vie ; (4) n'avoir aucune autre option de traitement et (5) être atteint d'épilepsie généralisée idiopathique qui n'est pas contrôlée par une MAE appropriée. Nous avons évalué les caractéristiques sociodémographiques, l'étiologie des crises, la classification des crises et la MAE utilisée pendant le traitement par la SNV. Nous en avons évalué les effets indésirables et l'efficacité. Le statut de répondeur a été défini comme étant un patient présentant une amélioration de plus de 50% des crises par rapport à la période précédant la SNV. Résultats : Trente patients (18 femmes et 12 hommes dont l'âge moyen était de 35,1 ± 13,3 ans) ont été inclus dans l'étude. Après un suivi de 6, 12, 24 et 36 ...

Background: Jacklin et al. (2013) described a rising incidence and a younger onset of dementia in Albertan First Nations compared to non-First Nations patients. Canadian research is limited in Indigenous patients with dementia, leaving it difficult to understand factors contributing to the differences in incidence and prevalence. Methods: 375 patients (41 Indigenous) was seen at the clinic. The questionnaire given during initial assessments were reviewed and differences between groups (non-Indigenous patients versus Indigenous) were assessed. Results: Compared to the non-Indigenous patient, Indigenous patients were younger (p=0.007), were more likely to be female (p=0.033) and had less education (p=0.055). They were less likely to live solely with a partner (p<0.001) and more likely to have a daughter as caregiver (p=0.004). The Indigenous patients were more likely to smoke (p<0.001). Although no differences in diagnosis of mental health disorders were seen (p=0.735), the Indigenous patients scored significantly higher on the CES-D (p<0.0001). Conclusions: This comparison highlights differences potentially affecting the health of Indigenous patients. Acknowledging these differences is critical to individualized patient care. Further research is required to explore how these factors affect dementia disease course and treatment, and how these factors play a role in the differences in incidence and prevalence demonstrated in previous studies.

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Vagus Nerve Stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug resistant epilepsy (DRE), although modification of AEDs during VNS treatment could explain improvement in patients. We retrospectively assessed the efficacy of VNS in 30 adult epileptic patients treated with > 6 months follow-up. The criteria for implantation were the following: a) not candidate for resective epilepsy surgery, b) DRE, c) impairment of quality of life, d) no other option of treatment. We assessed socio-demographics, seizure etiology, seizure classification and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50 seizure improvement from baseline, Thirty patients (females-18, males-12; age 35.1+13.3) were included. After 6 months, 12 months, 24 months and 36 months, the response rate was as follows: 13/30(43%), 13/27 (48%), 9/22(41%) and 16/8 (50%), none of them were seizure free. Changes of AEDs were done in 57% of patients at 6 months, 43% at 12, 43% at 24, 43% at 24 months. Other outcomes will be discussed. Our study shows that VNS is an effective therapy although significant changes in medications were done along the therapy, therefore the real effect of VNS could be controversial