Abstracts

Vagal nerve stimulation(VNS) is well established as adjunctive treatment for refractory seizures in adults and children.Most of the published reports have been from university based epilepsy centers or clinical trials.There are very few reports from private practice or rural community settings.We present our initial experience with VNS in a private practice setting in rural New England.
Eighteen patients with refractory epilepsy underwent VNS implantation from October 2000 till April 2003.These included 8 males and 10 females.Ages at implantation ranged from 20-71 .All had partial seizures with 3 having atonic and 1 having secondarily generalized seizure aswell.Etiology was idiopathic in 14, while 1 patient each had encephalitis, infantile hemiplegia, traumatic brain injury and Lennox Gastaut syndrome.Three had temporal lobectomy while the rest either refused surgery or were inappropriate candidates on work up.Epilepsy duration varied from 5-50 years.
All patients were initiated with slow cycling parameters which were adjusted as tolerated.A change in antiepileptic medication was made when clinically necessary.Patients or their caregivers kept seizure records at baseline and on regular follow up.Duration of follow up was from 3-28 months. Two patients implanted within last 3 months were not included in follow up.
At 3 months follow up 11 out of 16 patients(68%) showed mean seizure reduction with 6 of 16 (37%) more than 50% and 3 of 16(18%) showing more than 75% seizure reduction.Five had less than 50% seizure reduction ,while 3 had seizure worsening and 2 had no change in seizures.
At 6 months follow up 9 of 14( 65%) showed mean seizure reduction with all of them showing more than 50% seizure reduction.Five out of these 9 ( 35%) had more than 75% seizure reduction.Three had seizure worsening while 2 had no change.
At 1 year follow up 5 of 8 (60%) had mean seizure reduction with 3 of 8 (37%) more than 50% seizure reduction and 2 of 8 ( 25%) showing more than 75% seizure reduction.Two had less than 50% seizure reduction,while 1 hadcno change and 2 had seizure worsening.
At 18 months follow up 3 of 4(75%) had mean seizure reduction with 2 patients having more than 50% and 1 more than 75% seizure reduction. One patient had no significant change in seizures.
At 2 years follow up also 3 of 4 (75%) had mean seizure reduction with 2 patients having less tahn 50% and 1 more than 75% seizure reduction. One patient continued to have no significant change in seizures.
Complications with VNS were transient and mild in 5 patients and resolved with adjustments of parameters.One patient had transient vocal cord paresis as surgical complication which improved in 5 months.One patient had skin infection over surgical wound site which resolved successfully with intravenous antibiotics.
Vagal nerve stimulation is a useful alternative for some patients with intractable seizures.It is practical and can be safely done even in a rural community setting.