Early Vagus Nerve Stimulation (VNS) Intervention Improves Therapeutic Efficacy: A Single-centerExperience
Abstract number :
89
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2020
Submission ID :
2422437
Source :
www.aesnet.org
Presentation date :
12/5/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Mohankumar Kurukumbi, Inova Epilepsy Center, Inova Fairfax Hospital; Divya Sahajwalla - Virginia Commonwealth University; Laura Coonfield - Inova Neurosciences Research; Christa Zachariah - LivaNova; Glenn Watson - LivaNova;;
Rationale:
Anti-epileptic neuromodulation therapies are traditionally introduced later in a patient’s epilepsy treatment journey, coinciding with a failure of two or more anti-epileptic drugs (AEDs). Interestingly, few studies have examined the impact of introducing neuromodulation earlier in this journey; possibly before patients are classically defined as ‘drug-resistant.’ Early intervention of vagus nerve stimulation (VNS) is shown to significantly decrease seizure burden in patients within five years of their epilepsy diagnosis, or who had tried four or fewer AEDs compared to patients that were intervened later.
Method:
To gain a better understanding of introducing VNS earlier on seizure burden and treatment management, this single-center retrospective study compared the therapeutic efficacy of early vs. late introduction of VNS therapy and impact on subsequent AED management. This study retrospectively reviewed epilepsy monitoring unit and follow-up data from adult patients with VNS at Inova Fairfax Hospital from January 2016- June 2019. We identified two patient groups: a) “early VNS” intervention (≤2 failed AEDs) and b) “late VNS” intervention ( >2 failed AEDs). Follow-up data was taken at 6-18 months. The primary outcome measure was seizure control and secondary outcome measures were complication rate and frequency of AED management change.
Results:
The “early VNS” patients were shown to have a significant reduction in seizure frequency compared to “late VNS” patients. Furthermore, significantly more “early VNS” patients (≤2 failed AEDs) reported having no seizures at 6-18 months follow-up. No significant difference in complication rates between the two groups was found.
Conclusion:
This is the first study to demonstrate that earlier intervention with VNS after only ≤2 failed AEDs yields significant therapeutic benefit. Collectively, these results challenge the use of VNS only as a ‘second-line’ therapeutic intervention and therefore should be considered a promising treatment option when introduced earlier in a patient’s epilepsy journey.
Funding:
:none
Clinical Epilepsy