Practice trends and the outcome of neuromodulation therapies in epilepsy: A single‐center study

Abstract

Neuromodulation therapies (VNS, RNS, and DBS) can improve seizure control in persons with epilepsy. However, there is a significant service gap in integrating these therapies in clinical care. Our epilepsy center has established an epilepsy neuromodulation clinic to improve access to patients, communication with referring physicians, track outcome and train future providers in programming neuromodulation devices. We report the (a) treatment outcome of the available neuromodulation therapies (ie, reduction in seizure frequency over 6‐12 months follow‐up); and (b) demonstrate the benefit of the specialized clinic (rapid titration, continuity of care, superior access for patient and vendors). In this single‐center, retrospective study, forty‐three adults (VNS = 27; RNS = 16) with drug‐resistant epilepsy were followed in the clinic during the 19 months study period. About 44‐69% of patients reported > 60% decrease in seizure. All patients were scheduled in the clinic within 2‐4 weeks, and stimulations were optimized rapidly. About 40% of patients participated in research while 28% were referred for additional diagnostic studies. Nineteen students and fellows were trained in programming neurostimulator. Epilepsy neuromodulation clinic can serve as an optimal solution for patients as well as providers due to rapid access, better continuity of care, higher recruitment for research studies, and training health professionals.

Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis

“…A single RCT study (with two linked publications; see Supplementary Materials Table 1) was excluded due to unclear reporting of the enrolled population (i.e., proportion of adults) [48,49]. A total of 12 adult comparative observational study publications were excluded for the following reasons: no comparator (n = 4) [50][51][52][53], population of interest (n = 2) [54,55], reported no outcomes of interest (n = 5) [56][57][58][59][60] and superseded by a linked primary publication (n = 1) [61].…”

Altered amplitude of low‐frequency fluctuations and regional homogeneity in drug‐resistant epilepsy patients with vagal nerve stimulators under different current intensity

“…As an adjunctive therapy, numerous studies have reported that VNS can effectively reduce seizure frequency 4 . After either two or three‐five years of stimulation, approximately 50% and 60% of epilepsy patients, respectively, were reported to achieve a ≥50% seizure reduction 5,6 . Commonly employed stimulation parameters are as follows: between 1.5 and 2.25 mA, 20‐30 Hz, 250‐500 μs, on time 30 s, off time 3‐5 min, which mainly based on doctors’ experience 7 .…”

Efficacy and Safety of VNS Therapy or Continued Medication Management for Treatment of Adults with Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis

“…proportion of adults) [48,49]. A total of 12 adult comparative observational study publications were excluded for the following reasons: no comparator (n=4) [50][51][52][53], population of interest (n=2) [54,55], reported no outcomes of interest (n=5) [56][57][58][59][60] and superseded by a linked primary publication (n=1) [61].…”