Vagus Nerve Stimulation Does Not Exacerbate Behavioral Problems in the Mentally Handicapped
Abstract number :
3.145
Submission category :
Year :
2001
Submission ID :
689
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
D.K. Chugh, MD, Neurology, MCP Hahnemann University, Philadelphia, PA; M.R.C. Lim, MD, Neurology, MCP Hahnemann University, Philadelphia, PA; M.P. Jacobson, MD, Neurology, MCP Hahnemann University, Philadelphia, PA
RATIONALE: Mentally handicapped (MH) individuals are more likely to suffer seizures than the general population. Compared to others with epilepsy, they are more likely to suffer refractory epilepsy. Concomitant neurologic disabilities may heighten anti-epileptic drug (AED) side effects such as ataxia or psychomotor slowing. Behavioral and psychiatric problems are common in this group. Behavioral disorders, mood disorders and ability to perform self-care can all decline with high dose AED[ssquote]s. We sought to assess mood and behavior in intellectually challenged individuals with epilepsy who received vagus nerve stimulation (VNS).
METHODS: We queried the VNS patient outcome registry to identify a constant cohort of mentally handicapped (MH) patients who received VNS; had data available at both 3- and 12-month follow-up; had codes of MH, Rett[scquote]s syndrome, or autism; and whose medical histories clearly specified the presence or absence of behavioral problems. We collected data on changes in mood and reductions in seizure frequency at 3- and 12-month follow-up.
RESULTS: The constant cohort comprised 356 MH patients: 139 (39%) with clearly specified, pre-existing behavioral problems and 217 (61%) without. Among patients with behavioral problems, mood was rated as better for 40% of the patients at 3 months and for 48% at 12 months, as unchanged for 49% at 3 months and for 43% at 12 months, and as worse for 12% at 3 months and for 9% at 12 months. In comparison, changes in mood among patients without behavioral problems were less pronounced: mood was rated as better for 35% at 3 months and for 40% at 12 months, and worse for 1% at 3 months and 3% at 12 months.
CONCLUSIONS: Mood and memory assessments and seizure control improved in MH subjects receiving VNS. Given the 39% incidence of behavioral and psychiatric problems in this population, the low incidence of worsening of mood, memory and achievements suggests that VNS has a positive effect on mood, as has been reported among other populations. Better screening tools are needed to assess quality of life and neuropsychiatric response to VNS in this population.
Disclosure: Honoraria - Mercedes Jacobson: Speakers Bureau GSK, Cyberonics, Novartis (none of these are [dsquote]substantial financial[dsquote] arrangements however).