Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy

Englot, Dario J.; Rolston, John D.; Wright, Clinton W.; Hassnain, Kevin H.; Chang, Edward F.

doi:10.1227/neu.0000000000001165

Cited by 228 publications

(247 citation statements)

References 112 publications

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“…Furthermore, while greater QOL improvement was observed in patients of female gender or Caucasian ethnicity in this study, these are not typical predictors of seizure response in VNS studies. However, a predominantly generalized seizure type predicted favorable QOL outcome in the present study, and has also been shown to predict a better seizure outcome in prior VNS studies [16, 19]. This is an important consideration, as patients with primary generalized epilepsy are unlikely to be candidates for surgical resection or ablation.…”

Section: Discussionsupporting

confidence: 53%

“…Complete freedom from seizures is significantly more likely with resective or ablative epilepsy surgery, reported in 50-80% of surgical cases [31], than with VNS, observed in approximately 8% of patients after > 24 months of therapy [19]. With VNS, approximately 50-60% of epilepsy patients achieve ≥ 50% reduction in seizure frequency after 12-24 months of treatment [16], and similar seizure outcomes have been reported with other neurostimulation therapies for epilepsy [13].…”

Section: Discussionmentioning

confidence: 99%

“…Overall, data were prospectively collected by 1,285 prescribing physicians from 978 centers (911 within the USA and Canada and 67 international) at patients’ baseline before implantation and at various intervals during therapy. Previous studies have authenticated the integrity of the systems for collecting and processing data in the VNS registry using an independent auditing agency [18], and registry outcomes have been compared to and corroborated by outcomes reported across the independent literature [19]. The registry was IRB approved and individual patients provided consent.…”

Section: Methodsmentioning

confidence: 99%

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Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data

Englot

Hassnain

Rolston

et al. 2017

Epilepsy & Behavior

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Objective Drug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many epilepsy patients, but not all individuals are candidates for resection. In these cases, neuromodulation-based therapies such as vagus nerve stimulation (VNS) are often used, but most VNS studies focus exclusively on reduction of seizure frequency. QOL changes and predictors with VNS remain poorly understood. Method Using the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5,000 patients (including over 3,000 with ≥ 12 months follow-up), as subjectively assessed by treating physicians. Trends and predictors of QOL changes were examined and related to post-operative seizure outcome and likelihood of VNS generator replacement. Results After VNS therapy, physicians reported patient improvement in alertness (58-63%, range over follow-up period), post-ictal state (55-62%), cluster seizures (48-56%), mood change (43-49%), verbal communication (38-45%), school/professional achievements (29-39%), and memory (29-38%). Predictors of net QOL improvement included shorter time to implant (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6), generalized seizure type (OR, 1.2; 95% CI, 1.0-1.4), female gender (OR, 1.2; 95% CI, 1.0-1.4), and Caucasian ethnicity (OR, 1.3; 95% CI, 1.0-1.5). No significant trends were observed over time. Patients with net QOL improvement were more likely to have favorable seizure outcomes (chi square [χ2] = 148.1, p < 0.001) and more likely to undergo VNS generator replacement (χ2 = 68.9, p < 0.001) than those with worsened/unchanged QOL. Significance VNS for drug-resistant epilepsy is associated with improvement on various QOL metrics subjectively rated by physicians. QOL improvement is associated with favorable seizure outcome and a higher likelihood of generator replacement, suggesting satisfaction with therapy. It is important to consider QOL metrics in neuromodulation for epilepsy, given the deleterious effects of seizures on patient QOL.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data

Englot

Hassnain

Rolston

et al. 2017

Epilepsy & Behavior

Self Cite

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“…Finally, while complete seizure freedom is relatively rare with VNS, seizure freedom rates and predictors were recently examined across 5,554 patients in the VNS Therapy Patient Outcome Registry, and in a systematic literature review of 78 studies including 2,869 patients [52]. Overall, seizure-freedom rates ranged from 3% after zero to four months of treatment to 8% after more than two years of therapy.…”

Section: Neurostimulation Proceduresmentioning

confidence: 99%

“…Overall, seizure-freedom rates ranged from 3% after zero to four months of treatment to 8% after more than two years of therapy. Predictors of seizure freedom included age of epilepsy onset of greater than 12 years and a predominantly generalized seizure type [52]. Overall, when resective epilepsy surgery is not a viable treatment option, or in individuals who have failed open surgery, VNS may represent worthwhile palliative therapy for pharmacoresistant epilepsy.…”

Section: Neurostimulation Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

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