Abstracts

Rationale: For patients suffering from pharmacoresistance which cannot be treated by resective epilepsy surgery further alternatives for treatment are invasive deep brain stimulation or vagus nerve stimulation. In the following feasability study t-VNS was applied in order to elucidate whether this noninvasive stimulation may be an alternative treatment option in pharmacoresistant epilepsies. Methods: t-VNS was applied in 8 patients with focal and 2 patients with generalized epilepsies. Electrical stimulation of the left auricular branch of the vagus nerve was applied three hours a day for a period of nine months. Subjective patient report was documented by a patients` seizure diary. In addition a prolonged out-patient video EEG monitoring has been performed. Comfort of portable t-VNS stimulator and side effects as well as seizure frequency prior and during this nine months treatment were investigated.Results: Overall practicability was reported as good and sufficient. No severe side effects occurred. According to patients` reports seizure frequency was reduced in 5 out of 7 patients who participated in the complete treatment phase. Results of computer assisted analysis of seizure frequency documented in the continuous long-term video EEG and cognitive as well as emotional testing were additonally analysed. Conclusions: Treatment by means of transcutaneous vagus nerve stimulator during a daily use of nine months from a technical point in most patients turned out as easily and safely to handle. First data point to an anticonvulsive effect of t-VNS in pharmacoresistant epilepsy. For further efficacy evaluation randomized controlled studies have to be performed.