Authors :
Presenting Author: Cameron Beaudreault, MS – New York Medical College
Presenting Author: Steven Wolf, MD – Boston Children's Health Physicians
Sharon Chiang, MD PHD – USCF; Rob Moss, BS – Seizuretracker.com; Paige Brabant, MS – New York Medical College; Kevin Clare, BE – New York Medical College; Jessica Dorilio, MS – New York Medical College; Alexandra Naftchi, MS – New York Medical College; Bridget Nolan, BS – New York Medical College; Ariel Sacknovitz, MS – New York Medical College; Eris Spirollari, MS – New York Medical College; Richard Wang, BS – New York Medical College; David Zuckerman, MBE – New York Medical College; Patricia McGoldrick, NP, MSN, MPA – New York Medical College; carrie Mun, MD PHD – Westchester Medical Center; Vishad Sukul, MD – New York Medical College; Steven Wolf, MD – Pediatric Neurology Boston Children's He
Rationale:
Vagus nerve stimulation (VNS) may significantly decrease the frequency of disabling seizures in most patients with drug-resistant epilepsy. However, few studies have assessed impact on other aspects of quality of life such as benzodiazepine rescue medication (RM) usage. Rescue medications can prevent the need for emergency department visits and hospitalizations for extended disabling seizures but can also lead to sedation.
Methods: Using the seizure diary application SeizureTracker database, we examined trends in rescue administration frequency before and after the first recorded VNS magnet swipe in patients with drug-resistant epilepsy who had 1) At least one VNS magnet swipe recorded in the diary, and 2) Recorded usage of a benzodiazepine RM within 90 days prior to the first swipe. Wilcoxon rank-sum test was used to assess changes in RM usage frequency between 30, 60, 90, 180, and 360 day intervals beginning 30 days after first magnet swipe. Longitudinal changes in RM usage frequency were assessed with a generalized estimating equation (GEE) model with compound symmetry correlation structure and controlling for age, gender, and baseline RM administration frequency as covariates.
Results: Median baseline seizure frequency was 8.3 seizures per month, with median baseline rescue medication usage frequency of 2.1 administrations per month (SD 3.3). Significant reductions in rescue medication usage were observed in the 30 to 90 day interval after first VNS magnet swipe, at the 90 to 180 day interval, at 180 to 360 days, and at 360 to 720 days, with the magnitude of reduction increasing over time. Decreases in rescue medication usage were sustained when controlling for patients who recorded their most recent magnet swipe before the 360 to 720 day follow-up interval (n=91). Significant predictors of reductions in rescue medication included baseline frequency of rescue medication usage and time to first rescue medication after first VNS magnet swipe.
Conclusions: This retrospective analysis suggests that usage of rescue medications is reduced following the start of VNS treatment in patients with epilepsy. Patients with VNS treatment, in addition to seizure control, may have improved quality-of-life with less frequent usage of rescue medications.
Funding: Education grant from LivaNova