Refractory epilepsy in tuberous sclerosis: Vagus nerve stimulation with or without subsequent resective surgery
Elliott RE, Carlson C, Kalhorn SP, Moshel YA, Weiner HL, Devinsky O, Doyle WK.
Epilepsy Behav. 2009 Nov;16(3):454-60.
https://doi.org/10.1016/j.yebeh.2009.08.018.
Let us continue on the theme of vagus nerve stimulation (#VNS) in tuberous sclerosis complex (#TSC). This retrospective study by Elliott et al. reported the efficacy of VNS in 12 drug-resistant epilepsy (#DRE) patients with TSC.
In this cohort of patients, 50% had multifocal and generalized #epilepsy, and 83% suffered from cognitive impairment according to neuropsychological testing. Furthermore, 4 patients had unsuccessfully tried ketogenic diet treatment before VNS implantation. The mean number of failed antiseizure medications was 7.1. The age of the patients at VNS implantation ranged from 2 to 44 years old (mean age: 16.2±12 years). The duration of VNS treatment ranged from 8.5 months to 9.6 years (mean value: 4.9 years).
𝐒𝐞𝐢𝐳𝐮𝐫𝐞 𝐜𝐨𝐧𝐭𝐫𝐨𝐥
The results reported that 82% of the patients experienced ≥ 67% #seizure frequency reduction. All patients experienced better seizure control (reported as 12.5%-100% seizure reduction). The number of daily seizures was significantly decreased after VNS implantation (p <0.002).
𝐐𝐮𝐚𝐥𝐢𝐭𝐲-𝐨𝐟-𝐥𝐢𝐟𝐞 (#𝐐𝐨𝐋) 𝐩𝐚𝐫𝐚𝐦𝐞𝐭𝐞𝐫𝐬
Noteworthy, 2 out of 6 children had development improvements after VNS therapy. Furthermore, one adult patient experienced cognitive improvements, and one 18-year-old man showed significant behavioural improvements.
In conclusion, this study provides evidence that VNS might be an effective and safe treatment for DRE patients with TSC. Considering the potential positive effects of VNS on on QoL (such as development, cognition, and behaviour), and the fact that TSC is usually associated with developmental delay in pediatric patients, the author suggested that VNS treatment should be considered early in the treatment course of TSC patients to obtain better seizure control and QoL.
Link to the article:
http://www.epilepsybehavior.com/article/S1525-5050(09)00453-3/fulltext
