Quality of Life after Vagus Nerve Stimulation for Intractable Epilepsy: Is Seizure Control the Only Contributing Factor?

McLachlan, Richard S.; Sadler, Mark; Pillay, Neelan; Guberman, A.; Jones, Michael W.; Wiebe, Samuel; Schneiderman, Jack H

doi:10.1159/000070853

Cited by 43 publications

(40 citation statements)

References 5 publications

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“…19,20 Moreover, in previous studies, VNS-associated improvement in QOLIE-89 score and other measures of quality of life did not correlate with changes in seizure frequency. 21 Finally, our HRQoL findings do not seem to be primarily driven by an effect of VNS on mood, because no significant differences were observed between VNS + BMP and BMP groups in the two depression scales used in this study (CES-D and NDDI-E), or in the QOLIE-89 Mental Health subscale. Based on these findings, we suggest that the VNS-related improvement in HRQoL in our patients might reflect the sum of modest benefits in multiple factors rather than a single determinant.…”

Section: Discussionmentioning

confidence: 55%

The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (Open Prospective Randomized Long-term Effectiveness) trial

Ryvlin

Gilliam

Nguyen

et al. 2015

Epilepsy & Behavior

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Section: Discussionmentioning

confidence: 55%

The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (Open Prospective Randomized Long-term Effectiveness) trial

Ryvlin

Gilliam

Nguyen

et al. 2015

Epilepsy & Behavior

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“…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. 1,22,24,25,35,41 These findings suggest that consideration of VNS earlier in the course of refractory disease is warranted. 42 No randomized studies have demonstrated long-term benefits of VNS therapy on cognitive, social, or behavioral development or quality of life.…”

Section: Seizure Control and Developmentmentioning

confidence: 97%

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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“…Indeed, a 1-year prospective trial of VNS for intractable epilepsy showed significant improvement in mean overall QOL, and subjective improvement was found in 84% of the 26 patients studied. 47 After exiting the blinded portion of these trials, patients were followed for up to 18 months, all of whom received therapeutic levels of VNS, given the apparent therapeutic benefit. 15,48,49 Mean seizure frequency percent change was significant for all follow-up periods of VNS, relative to baseline.…”

mentioning

confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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Quality of Life after Vagus Nerve Stimulation for Intractable Epilepsy: Is Seizure Control the Only Contributing Factor?

Cited by 43 publications

References 5 publications

The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (Open Prospective Randomized Long-term Effectiveness) trial

The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (Open Prospective Randomized Long-term Effectiveness) trial

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

Vagus Nerve Stimulation for Epilepsy and Depression

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