Abstracts

VNS-therapy for treatment of patients with medically refractory epilepsy in the Netherlands is part of a continuous quality improvement system. This encompasses the organisatory structure, responsibilities, processes and facilities for carrying out quality care. One of the basic and core elements of a quality system is the systematic monitoring of the process of care via the quality circle. The first outcome results of VNS-therapy in patients with epilepsy within this setting in the Netherlands are presented., The quality system was developed in a close collaboration with medical specialists from 5 neurosurgery and 5 epilepsy centers. Monitoring of the VNS-quality system is performed in three phases (intake, implant, and follow-up). The main indicators are reduction of epileptic seizures and changes in seizure severity, quality of life (QOLIE-89) and adverse events. The effect of VNS during follow-up was recorded after 1, 3, 6, 9 and 12 months., Between 2002 and 2006, 122 patients were included following the national protocol for VNS-therapy. During the first 2 years patient referral was low ([sim]12 patients p.y.). Thereafter [sim]30 patients per year were included. Of these patients 9 were excluded. Of the remaining patients, at the time of analysis, seventy had received an implant, 22 were on the waiting list for implantation and 21 were in the intake phase.
The mean age at intake was 40 y (SE 1.5 y). The onset of epilepsy in these patients was at 12.7 y (SE 1.1 y), and had a history with medically refractory epilepsy of 27.7 y (SE 1.5 y). They had 60.0 (SE 11.1) epileptic seizures per month. Most patients had localized partial epilepsy (59% symptomatic and 31 % cryptogenic).
A medically significant ([gt]40%) decrease on seizure frequency during VNS was observed in 35% of patients after 1 month, and 49%, 61%, 42% and 64%, after respectively 3, 6, 9 and 12 months. Seizure severity was markedly reduced in 46%, 46%, 52%, 62% and 55% of patients after respectively 1, 3, 6, 9 and 12 months. About 80% of patients used [apos]magnet activation[apos] to prevent or halt a seizure. 52% of patients experience a better or much better post-ictal recovery period with VNS. Side-effects were mainly voice related (hoarseness: 68%) and throat pain (32%). Quality of life showed statistically significant improvement in [ldquo]change in health[rdquo] and [ldquo]general health[rdquo]., Monitoring the effect of VNS-therapy in a national quality-system setting guaranties high quality care. Moreover it provides an effective means to review the outcome results of the participating centers. This national data-base may eventually help identify response predictors to further improve the effectiveness of VNS-therapy, which will subsequently be implemented in the national VNS-therapy protocol.,