Abstracts

Rationale: This manuscript describes our findings while treating patients with refractory generalized epilepsy with combined VNS and centro-median DBS. _x000D_  _x000D_ Methods: Eleven consecutive patients with refractory generalized epilepsy previously submitted to VNS and who subsequently underwent centro-median DBS (CMDBS) were studied. All patients had daily seizures. Atypical absences were noted in 8 patients, tonic seizures in 7, bilateral tonic-clonic seizures in 4, atonic seizures in 3 and myoclonic seizures in 2 patients. VNS final parameters were 2-2.5mA, 30Hz and 500usec, cycling mode, 30 sec “on” and 5 min “off” for all patients. CMDBS final parameters were 4-5V, 130Hz and 300usec, bipolar, continuous stimulation, in all patients._x000D_  _x000D_ Results: There were 8 males. Age ranged from 8 to 49 years (mean 19 years). Follow-up time after VNS ranged from 18 to 132 months (mean 52 months) and from additional 18 to 164 months (mean 42 months) during combined VNS-CMDBS. Four patients were initially considered responders to VNS. All these patients also got additional >50% seizure frequency reduction during combined VNS-CMDBS. Seven patients were not responders to VNS and among those, 4 got additional >50% seizure frequency reduction during combined VNS-CMDBS. Eight patients got additional >50% reduction in seizure frequency when moved from VNS alone to VNS-CMDBS therapy. There were 2 non-responders during combined VNS-CMDBS therapy, and both were not responders to VNS alone either. Nine patients were considered responders during VNS-CMDBS combined therapy compared to baseline. _x000D_  _x000D_ Conclusions: This study showed that combined VNS-CMDBS therapy was able to double the number of responders in a cohort of patients with refractory generalized epilepsy. These data represent the first evidence that combined neuromodulation might be useful in this quite homogeneous patient population._x000D_  _x000D_ Funding: None