Abstracts

RATIONALE: We wanted to share our recent clinical experiences treating medication-resistant typical absence seizures with vagus nerve stimulation (VNS).
METHODS: Three patients, ages 45, 39 and 21 years, with medication-resistant typical absence seizures were treated with VNS. In all cases antiepileptic drug (AED) choices and dosing were limited by drug intolerance or allergy. Two patients had prior histories of generalized convulsive seizures, and one also was experiencing myoclonic jerks. All three patients had generalized 3/second EEG spike-waves. Absence seizure rates were measured in the following months: baseline before VNS, and 3,6,12, and 18 after VNS.
RESULTS: Patient 1 had 60 seizures in the baseline month, and no seizures in months 3-18 of VNS. She stopped topirimate by month 3, and reduced her daily primidone dose from 750 mg to 125 mg by month 18. Patient 2 had a 20 seizure/month baseline, no seizures in months 3 and 12, and one seizure in months 6 and 18. Her clonazepam dose was unchanged. Patient 3 had a 2000 seizure/month baseline, 600 seizures in month 1, 50 seizures in month 2, five seizures in month 12 and eight seizures in month 18. She was not on an AED.
CONCLUSIONS: Most typical absence seizures are controlled easily with AEDs. In rare circumstances, however, these seizures may be AED-resistant, or the patient may be multi-drug intolerant or allergic. While we hesitate to draw general conclusions from only three cases, the very dramatic improvements in our patients do raise the possibility that VNS may represent an effective alternative for typical absence seizures when AEDs are problematic.
Disclosure: Honoraria - Drs. Labar and Li have received honoraria for speaking for Cyberonics, manufacturer of the VNS.