Quality of Life Metrics with Vagus Nerve Stimulation for Epilepsy from Provider Survey Data
Abstract number :
2.328
Submission category :
16. Epidemiology
Year :
2016
Submission ID :
193931
Source :
www.aesnet.org
Presentation date :
12/4/2016 12:00:00 AM
Published date :
Nov 21, 2016, 18:00 PM
Authors :
Kevin Hassnain, LivaNova, INC.; Stephen Harward, Duke University Hospital; and Dario Englot, Vanderbilt University Medical Center
Rationale: Drug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many patients, but not all individuals are candidates for resection. In these cases, neuromodulation-based therapies such as vagus nerve stimulation (VNS) are often used, but most VNS studies focus exclusively on the reduction of seizure frequency. QOL changes and predictors with VNS remain poorly understood. Methods: Using the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5,000 patients (including over 3,000 with ?- 12 months follow-up), as subjectively assessed by treating physicians. Trends and predictors of QOL changes were examined and related to post-operative seizure outcome and likelihood of VNS generator replacement. Results: After VNS therapy, physicians reported patient improvement in alertness (58-63%), post-ictal state (55-62%), cluster seizures (48-56%), mood change (43-49%), verbal communication (38-45%), school/professional achievements (29-39%), and memory (29-38%). Predictors of net QOL improvement included shorter time to implant (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6), generalized seizure type (OR, 1.2; 95% CI, 1.0-1.4), female gender (OR, 1.2; 95% CI, 1.0-1.4), and Caucasian ethnicity (OR, 1.3; 95% CI, 1.0-1.5). No significant trends were observed over time. Patients with net QOL improvement were more likely to have favorable seizure outcomes (chi square [?2] = 148.1, p < 0.001) and more likely to undergo VNS generator replacement (?2 = 68.9, p < 0.001) than those with worsened/unchanged QOL. Conclusions: VNS for drug-resistant epilepsy is associated with improvement on various QOL metrics subjectively rated by physicians. QOL improvement is associated with favorable seizure outcome and a higher likelihood of generator replacement, suggesting satisfaction with therapy. In addition to reduction of seizure frequency, it is important to focus on QOL metrics in neuromodulation for epilepsy, given the deleterious effects of seizures on patient QOL. Funding: N/A
Epidemiology