Observations on the Use of Vagus Nerve Stimulation Earlier in the Course of Pharmacoresistant Epilepsy: Patients With Seizures for Six Years or Less
Helmers SL, Griesemer DA, Dean JC, Sanchez JD, Labar D, Murphy JV, Bettis D, Park YD, Shuman RM, Morris GL 3rd.
The Neurologist: May 2003 - Volume 9 - Issue 3 - p 160-164
http://ow.ly/upvN50J6piK
Clinical evidence suggests that #early use of vagus nerve stimulation (#VNS) Therapy can lead to better outcomes in patients with drug-resistant epilepsy (#DRE). Hence, for our next theme, we would like to put emphasis on publications evaluating VNS-related outcomes following early implantation:
In May 2003, Helmers et al. published an article examining seizure-related outcomes of early VNS implantation in patients with DRE (n=405).
The early treatment group (duration between seizure onset and VNS implantation: ≤ 6 years ) consisted of 51 patients, while 354 patients were included in the late treatment group (>6 years of duration). The statistical differences in the demographics of patients in those two groups are listed in Table 1.
Patients in the early and late treatment groups had similar outcomes for #seizure frequency reduction at 3 months and 12 months post-VNS Therapy. However, the early treatment group had a higher likelihood of becoming #seizure-free; after three months, 7.8% of the patients in the early treatment group became seizure-free, while the corresponding value was 3.7% for the late implantation group. Noteworthy, after one year, the seizure freedom rate was 11.8% for patients in the early treatment group, which was more than twice that of the late implantation group (4.5%, P = 0.033).
The observed difference in treatment effect between the two implantation groups was related to the difference in epilepsy durations. However, different seizure loads between groups may have influenced the results, as seizure load may contribute to neurologic morbidity. Hence, patients with low seizure load, such as some pediatric patients, elderly patients with newly onset seizures, and patients with rarely occurring seizures, might benefit from early implantation of VNS in regards to seizure-freedom.
The findings in this study support early implantation of VNS in patients with DRE and suggest avoiding unnecessary delays in the treatment pathway.
Table 1. Statistical differences in demographics between patients in the early and late treatment groups.
Table created by Go North Medical based on data included in Helmers SL, Griesemer DA, Dean JC, Sanchez JD, Labar D, Murphy JV, Bettis D, Park YD, Shuman RM, Morris GL 3rd. Observations on the use of vagus nerve stimulation earlier in the course of pharmacoresistant epilepsy: patients with seizures for six years or less. Neurologist. 2003 May;9(3):160-4. doi: 10.1097/00127893-200305000-00004. PMID: 12808412.