Efficacy and Tolerability of Ultra Rapid Duty Cycling Vagus Nerve Stimulation for Medically Refractory Absence Seizures
Abstract number :
1.22
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2203958
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Lalit Bansal, MD – Children's Mercy Hospital; Laith Haddad, MD – Children's Mercy Hospital; Ahmed Abdelmoity, MD – Professor, Neurology, Children's Mercy Hospital; Mirza Waseem Baig, MD – Assistant Professor, Neurology, Children's Mercy Hospital; Saru Bansal, MDS – Research Student, Neurology, Children's Mercy Hospital; Grace Dunker, - – Research Student, Neurology, Children's Mercy Hospital; Ara Hall, MD – Associate Professor, Neurology, Children's Mercy Hospital; Carina Harrison, MS – Research Student, Neurology, Children's Mercy Hospital; Kailash Pawar, MD – Assistant Professor, Neurology, Children's Mercy Hospital; Lines Vargas Collado, MD – Assistant Professor, Neurology, Children's Mercy Hospital
Rationale: Significant knowledge gap exists on Vagal nerve stimulator (VNS) efficacy and tolerability in medically refractory absence seizures (MRAS). This retrospective review of patients with MRAS aims to narrow this knowledge gap by comparing, Ultra rapid duty cycling (URDC, ON-time 7 sec, OFF-time 0.2 min) to less frequent stimulations of rapid duty cycling (RDC) and normal duty cycling (NDC, OFF time ≥ 1.1 minute) and evaluating any possible effects on multiple outcomes.
Methods: MRAS patients age < 21 years who underwent VNS implantation between January 2016-December 2020 were identified. Details of patient demographics, antiepileptic medications, seizure types, seizure frequency, VNS parameters, side effects, and outcomes of seizure reduction rate (SRR), seizure freedom, academic performance, attention, and developmental gains, were extracted and compared among NDC, RDC, and URDC patient cohort.
Results: Thirty-six patients with MRAS with an adequate follow-up period of at least 12 months from VNS implantation were identified. The mean antiepileptics failed before VNS implantation was 4.5. After a mean follow-up of 32.6 months, responder rate (RR, SRR ≥ 50%) for URDC was 80% for absence seizures and 80% for all seizure types vs. 66.67% & 66.77 % for NDC and 78.57% & 57.14% for RDC, respectively. Six out of 10 patients (60%) on URDC achieved complete seizure freedom; 5 of the 6 patients had multiple seizure types. A higher rate of subjective improvement in academic performance, attention, and developmental gain was noted in the URDC group. URDC patients tolerated higher output current (mean 3.025 mA) with minimal side effects, however required a sooner battery change.
Conclusions: VNS is safe and effective nonpharmacological management choice in patients with MRAS. Combination of URDC and high output current have shown promising results with better RR and seizure freedom. Apart from a reduced battery life, this parameter modality seems to be well-tolerated.
Funding: None
Clinical Epilepsy