Cognitive Decline in Severe Intractable Epilepsy

Thompson, Pamela J.; Duncan, John S.

doi:10.1111/j.1528-1167.2005.00279.x

Cited by 203 publications

(138 citation statements)

References 30 publications

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“…A study in 136 patients with refractory epilepsy found that "cognitive decline was severe and occurred across a wide range of cognitive functions." 16 Favorable effects on cognition have also been reported for thalamic stimulation. A case series study 17 reported 9 patients with intractable epilepsy treated with continuous anterior nucleus of the thalamus (ANT) DBS who underwent cognitive testing before implantation and more than 1 year after surgery.…”

Section: Resultsmentioning

confidence: 99%

Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy

Salanova¹,

Witt²,

Worth³

et al. 2015

Neurology

661

617

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Objective: To report long-term efficacy and safety results of the SANTE trial investigating deep brain stimulation of the anterior nucleus of the thalamus (ANT) for treatment of localizationrelated epilepsy.Methods: This long-term follow-up is a continuation of a previously reported trial of 5-vs 0-V ANT stimulation. Long-term follow-up began 13 months after device implantation with stimulation parameters adjusted at the investigators' discretion. Seizure frequency was determined using daily seizure diaries.Results: The median percent seizure reduction from baseline at 1 year was 41%, and 69% at 5 years. The responder rate ($50% reduction in seizure frequency) at 1 year was 43%, and 68% at 5 years. In the 5 years of follow-up, 16% of subjects were seizure-free for at least 6 months. There were no reported unanticipated adverse device effects or symptomatic intracranial hemorrhages. The Liverpool Seizure Severity Scale and 31-item Quality of Life in Epilepsy measure showed statistically significant improvement over baseline by 1 year and at 5 years (p , 0.001).Conclusion: Long-term follow-up of ANT deep brain stimulation showed sustained efficacy and safety in a treatment-resistant population. Classification of evidence:This long-term follow-up provides Class IV evidence that for patients with drug-resistant partial epilepsy, anterior thalamic stimulation is associated with a 69% reduction in seizure frequency and a 34% serious device-related adverse event rate at 5 years. Approximately 3 million people in the United States have epilepsy and approximately 30% remain resistant to medical treatment. Some of these patients are candidates for resective surgery.1,2 For those who are not surgical candidates, or who continue to have seizures after surgery, neuromodulation may offer a viable therapeutic option. Several pilot studies, [3][4][5][6] and recent trials including the Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE) trial 7 and a trial of responsive cortical stimulation, 8 have demonstrated reduction in seizures. The SANTE trial in 110 subjects with localization-related epilepsy found that seizures were significantly reduced by stimulation. 7 We now report the 5-year efficacy and safety outcomes of this trial.METHODS The SANTE trial 7 utilized a design with a 3-month baseline, 1-month postoperative recovery, followed by 3 months of double-blind treatment randomized to 5 V or 0 V of stimulation, then an open-label conversion of all subjects to 5-V stimulation for 9

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Section: Resultsmentioning

confidence: 99%

Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy

Salanova¹,

Witt²,

Worth³

et al. 2015

Neurology

661

617

View full text Add to dashboard Cite

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“…When cognitive decline, recognised as particularly rare in childhood epilepsy, does occur, it is explained by pre-existing structural brain damage 22 , the adverse effect on an immature brain of early onset seizures, especially when frequent and resistant to treatment 22,23 or the side effects of antiepileptic drugs AED 24 . These children had received virtually no AED, apart from herbal remedies, and the possible adverse affects of traditional medicine or absolute lack of treatment cannot be discounted.…”

Section: Discussionmentioning

confidence: 99%

Epilepsy and its effects on children and families in rural Uganda

Mb¹

2013

Afr H. Sci.

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Background: This report aims to assess the impact of childhood epilepsy in an isolated rural area in Western Uganda, with little access to medical care, via its effect on children and families. Basic information on 440 affected children, clinically examined at 19 rural centres, was collated and data on seizure pattern and duration analysed, together with information on school attendance of older children. Objective: To publicise the consequences of undertreated illness, and to encourage improved management of this condition. Results: Distribution by seizure type was: generalised 61%, focal 33%, and miscellaneous 6%. When information on all seizure types was combined, a 'typical seizure' lasted < 1 hour, followed by coma. The typical age of onset and duration of illness approximated 2½ and 4 years respectively. Modal frequency and duration of seizures suggested that ~96 hours might be 'lost' to seizures over 4 years.Twenty four children had delayed global or motor development; a further 93 were reported to have 'poor understanding'. Information on school attendance available on 162 of 231 school aged children indicated that 92 were attending and 70 not attending school. Fifty eight percent of children >10 yrs old attending school and 68% of non-attendees, had never progressed beyond the entry class. Conclusion: The unexpected prevalence of apparent cognitive delay is discussed, together with strategies for prevention and management of epilepsy at community level.

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“…14,49 In children with treatment-resistant epilepsy, better seizure control can result in improved developmental and cognitive outcome and quality of life. 13,18,27,28,31,54 Moreover, numerous studies found that VNS can benefit attention, cognition, behavior, mood, and quality of life independent of reduced seizure burden.…”

Section: Seizure Control and Developmentmentioning

confidence: 99%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

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Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1–18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days–11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children.

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Cognitive Decline in Severe Intractable Epilepsy

Cited by 203 publications

References 30 publications

Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy

Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy

Epilepsy and its effects on children and families in rural Uganda

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

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