Vagus Nerve Stimulation for Refractory Epilepsy in Tuberous Sclerosis
Zamponi N, Petrelli C, Passamonti C, Moavero R, Curatolo P.
Pediatr Neurol. 2010 Jul;43(1):29-34.
https://doi.org/10.1016/j.pediatrneurol.2010.03.003.
In line with our current theme - vagus nerve stimulation (#VNS) in tuberous sclerosis complex (#TSC), this retrospective study by Zamponi et al. reported the outcome of VNS in 11 TSC patients with drug-resistant epilepsy (#DRE).
The mean age of patients at VNS implantation was 14 years (range: 2-35 years). The mean baseline seizure frequency was 97 seizures per month (range: 20-300 seizures). 7 patients had partial epilepsy with polymorphic seizures. 9 patients suffered from cognitive impairment, and 8 patients had low adaptive behaviour scores. Moreover, the number of failed antiseizure medications (#ASMs) ranged between 3 to 5.
𝐒𝐞𝐢𝐳𝐮𝐫𝐞-𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬
The efficiency of VNS for seizure control appeared to improve over time. The mean number of monthly seizures gradually decreased from 59.1 ± 55.3 at 3 months to 37 ± 30 at 12 months. The responder rate at 12 months was 72%. Moreover, 3/4 patients who suffered from drop attacks before VNS implantation experienced a reduction in drop attack intensity. Noteworthy, 1 patient became seizure free.
The number of ASMs were reduced in 4 patients.
𝐍𝐞𝐮𝐫𝐨𝐩𝐬𝐲𝐜𝐡𝐨𝐥𝐨𝐠𝐢𝐜𝐚𝐥 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬
Regarding neuropsychological outcomes, all patients experienced a significant reduction in aggressive behaviours at the 1 year of follow-up. Other related improvements included significantly reduced arousal, attention and impulsivity scores (a greater amelioration was observed in patients less than 6 years old), and a slightly reduced anxiety and depression score (2 patients). Furthermore, VNS treatment led to a significantly improved parental satisfaction and quality of life (p<0.005).
In short, despite the limited number of patients in this cohort, these findings confirmed the effectiveness of VNS Therapy in TSC patients with DRE.
Link to the article:
http://www.pedneur.com/article/S0887-8994(10)00100-1/fulltext
