Long-term Outcome of Vagal Nerve Stimulator Implantation for Drug-resistant Epilepsy in Adults
Abstract number :
1.326
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204476
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Cameron Elliott, MD, PhD, FRCSC – University of Alberta, Edmonton, Alberta, Canada; Aida Kafai Golahmadi, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom; Byrone Mitchell, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom; Michelle Sae-Huang, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom; John Duncan, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom; Andrew McEvoy, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom; Anna Miserocchi, MD – National Hospital for Neurology and Neurosurgery, London, United Kingdom
Rationale: There are few large reports on the long-term outcome of vagal nerve stimulation (VNS) in the management adult drug-resistant epilepsy. The study objectives were to evaluate the long-term efficacy and safety of VNS among adult patients with drug-resistant epilepsy treated at the National Hospital for Neurology and Neurosurgery (NHNN).
Methods: Retrospective review of consecutive adult patients presenting to NHNN for surgical VNS implantation or maintenance between January 2006 and December 2021. Relevant perioperative clinical data was abstracted by review of the electronic medical record including standardized preoperative multi-disciplinary team evaluation for drug-resistant epilepsy patients including seizure charting, electroencephalography, neuroimaging and neuropsychological evaluation as well as postoperative clinical nurse specialist surveillance of VNS function. Postoperative seizure outcome was categorized according to the modified Engel Scale.
Results: A total of 303 patients (42.9 ± 12.8 years-old; 158 female) with drug-resistant epilepsy who underwent primary VNS insertion (n = 297) and/or VNS maintenance procedures (n = 185) during the study period were identified with mean postoperative follow-up of 5.3 ± 3.9 years (range, 0-18 years). The average age at index VNS insertion was 35.7 ± 12.3 years (range, 8-72 years old) with a mean duration of epilepsy prior to implantation of 27.6 ± 12.7 years (range, 2-67 years). The rate of reported adverse events was 134/303 (44%) including hardware malfunction, vocal change, throat pain, dysphagia, odynophagia, dyspnea or cough which resulted in the device being turned off in 30 (10%) and explanted in 8 (3%). Worthwhile reduction of seizure frequency was achieved in 148 of 303 patients (49%) including 132 (44%) reported to have greater than 50% reduction of seizure frequency relative to baseline and 2 patients reported to be free from disabling seizures.
Conclusions: Vagal nerve stimulation for adult drug-resistant epilepsy is safe and effective conveying worthwhile reduction in seizure frequency in 49% of patients on long-term follow up.
Funding: Not applicable
Surgery