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
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.
๐๐ข๐ ๐ก๐ฅ๐ข๐ ๐ก๐ญ๐ฌ
- ๐๐๐ ๐๐ก๐๐ซ๐๐ฉ๐ฒ ๐ซ๐๐ฌ๐ฎ๐ฅ๐ญ๐๐ ๐ข๐ง ๐๐ง ๐จ๐ฏ๐๐ซ๐๐ฅ๐ฅ ๐ซ๐๐ฌ๐ฉ๐จ๐ง๐๐๐ซ ๐ซ๐๐ญ๐ ๐จ๐ ๐๐.๐% ๐๐จ๐ซ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐๐.
- ๐๐ญ ๐ญ๐ก๐ ๐ฅ๐๐ฌ๐ญ ๐๐จ๐ฅ๐ฅ๐จ๐ฐ-๐ฎ๐ฉ ๐ฌ๐๐ฌ๐ฌ๐ข๐จ๐ง, ๐๐.๐% ๐จ๐ ๐ญ๐ก๐ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ก๐๐ ๐๐๐ก๐ข๐๐ฏ๐๐ ๐ฌ๐๐ข๐ณ๐ฎ๐ซ๐ ๐๐ซ๐๐๐๐จ๐ฆ.
- ๐๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ฐ๐ข๐ญ๐ก ๐๐จ๐๐๐ฅ ๐จ๐ซ ๐ฆ๐ฎ๐ฅ๐ญ๐ข๐๐จ๐๐๐ฅ ๐ข๐ง๐ญ๐๐ซ๐ข๐๐ญ๐๐ฅ ๐๐ฉ๐ข๐ฅ๐๐ฉ๐ญ๐ข๐๐จ๐ซ๐ฆ ๐๐ข๐ฌ๐๐ก๐๐ซ๐ ๐๐ฌ (#๐๐๐๐ฌ) ๐ฐ๐๐ซ๐ ๐ฆ๐จ๐ซ๐ ๐ฅ๐ข๐ค๐๐ฅ๐ฒ ๐ญ๐จ ๐๐๐๐จ๐ฆ๐ ๐๐๐ ๐ซ๐๐ฌ๐ฉ๐จ๐ง๐๐๐ซ๐ฌ (โฅ๐๐% ๐ฌ๐๐ข๐ณ๐ฎ๐ซ๐ ๐๐ซ๐๐ช๐ฎ๐๐ง๐๐ฒ ๐ซ๐๐๐ฎ๐๐ญ๐ข๐จ๐ง).
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 patientsโ 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