Vagus nerve stimulation for refractory posttraumatic epilepsy: Efficacy and predictors of seizure outcome

Guo M, Wang J, Tang C, Deng J, Zhang J, Xiong Z, Liu S, Guan Y, Zhou J, Zhai F, Luan G, Li T

Front Neurol. 2022 Jul 28;13:954509
https://doi.org/10.3389/fneur.2022.954509

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The severity of traumatic brain injury (#TBI) is closely related to the relative risk of developing posttraumatic epilepsy (#PTE) [1]. PTE patients are severely drug-resistant, and it is generally difficult to achieve seizure control with brain surgery [2]. 

This new publication by Guo et al. 2022 aimed to examine treatment outcomes of VNS Therapy in patients with drug-resistant PTE.

𝐇𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬

 - 𝐕𝐍𝐒 𝐓𝐡𝐞𝐫𝐚𝐩𝐲 𝐫𝐞𝐬𝐮𝐥𝐭𝐞𝐝 𝐢𝐧 𝐚𝐧 𝐨𝐯𝐞𝐫𝐚𝐥𝐥 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐫 𝐫𝐚𝐭𝐞 𝐨𝐟 𝟔𝟒.𝟒% 𝐟𝐨𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐢𝐭𝐡 𝐏𝐓𝐄.

- 𝐀𝐭 𝐭𝐡𝐞 𝐥𝐚𝐬𝐭 𝐟𝐨𝐥𝐥𝐨𝐰-𝐮𝐩 𝐬𝐞𝐬𝐬𝐢𝐨𝐧, 𝟏𝟓.𝟔% 𝐨𝐟 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐡𝐚𝐝 𝐚𝐜𝐡𝐢𝐞𝐯𝐞𝐝 𝐬𝐞𝐢𝐳𝐮𝐫𝐞 𝐟𝐫𝐞𝐞𝐝𝐨𝐦.

- 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐢𝐭𝐡 𝐟𝐨𝐜𝐚𝐥 𝐨𝐫 𝐦𝐮𝐥𝐭𝐢𝐟𝐨𝐜𝐚𝐥 𝐢𝐧𝐭𝐞𝐫𝐢𝐜𝐭𝐚𝐥 𝐞𝐩𝐢𝐥𝐞𝐩𝐭𝐢𝐟𝐨𝐫𝐦 𝐝𝐢𝐬𝐜𝐡𝐚𝐫𝐠𝐞𝐬 (#𝐈𝐄𝐃𝐬) 𝐰𝐞𝐫𝐞 𝐦𝐨𝐫𝐞 𝐥𝐢𝐤𝐞𝐥𝐲 𝐭𝐨 𝐛𝐞𝐜𝐨𝐦𝐞 𝐕𝐍𝐒 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐫𝐬 (≥𝟓𝟎% 𝐬𝐞𝐢𝐳𝐮𝐫𝐞 𝐟𝐫𝐞𝐪𝐮𝐞𝐧𝐜𝐲 𝐫𝐞𝐝𝐮𝐜𝐭𝐢𝐨𝐧).

The medical records of 45 patients (median age at implantation: 22.2 years, IQR: 14.3-33.5 years) with PTE who were treated with VNS Therapy for at least 12 months were retrospectively analyzed in terms of seizure frequency reduction and potential predictive factors of VNS efficiency.

After a median follow-up duration of 3 (IQR: 2.0-4.5) years, a responder rate of 64.4% was observed. 15.6% of the patients were reported to be seizure-free at the last follow-up session. Noteworthy, the responder rate appeared to be time-dependent, increasing from 37.8% at the 3-month follow-up to 44.4%, 60% and 67.6% at the 6-, 12- and 24-month follow up sessions, respectively. Generalized IEDs were associated with worse treatment outcomes.

This study would benefit from the inclusion of treatment outcomes related to the patients’ quality of life as this is an important factor in the overall efficiency of VNS Therapy. Furthermore, the authors note that they could not include data on TBI #severity due to insufficient information. This is unfortunate but is stated to be included in future studies. Despite the study limitations, the results indicate a beneficial effect of VNS Therapy in patients with drug-resistant PTE, especially for patients without generalized IEDs.

References

1. DOI: http://ow.ly/fQKW50KWSNx

2. DOI: http://ow.ly/mnrJ50KWSNC