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Closed-loop vagal nerve stimulation for intractable epilepsy: A single-center experience
Graham M Winston1, Sergio Guadix1, Miguel Tusa Lavieri1
1Department of Neurological Surgery, Weill-Cornell Medicine/NewYork-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, USA.
Seizure
|April 11, 2021
Summary
Closed-loop vagal nerve stimulator (VNS) devices showed improved seizure reduction in epilepsy patients compared to open-loop devices at 9 months. However, these benefits did not persist at 24 months, indicating a need for further research.
Area of Science:
- Neurology
- Biomedical Engineering
- Epilepsy Research
Background:
- Refractory epilepsy management remains challenging.
- Vagal nerve stimulation (VNS) is an established treatment.
- Closed-loop VNS aims to optimize stimulation using physiological cues.
Purpose of the Study:
- To compare the efficacy of closed-loop versus open-loop VNS devices in patients with refractory epilepsy.
- To evaluate seizure frequency reduction and clinical outcomes (Engel score) between the two VNS device types.
Main Methods:
- Retrospective chart review of VNS implantations (2004-2018).
- Bivariate and multivariable analyses comparing closed-loop and open-loop VNS.
- Assessment of early (9-month) and late (24-month) outcomes, considering various clinical covariates.
Main Results:
- Closed-loop VNS demonstrated a significantly greater seizure reduction (75%) compared to open-loop VNS (50%) at 9 months.
- Improved Engel outcomes were observed with closed-loop VNS at the early timepoint.
- These superior outcomes with closed-loop VNS did not persist at 24 months.
Conclusions:
- Closed-loop VNS may offer superior short-term seizure control and clinical benefits in refractory epilepsy.
- The long-term efficacy advantage of closed-loop VNS over open-loop VNS requires further investigation.
- Multi-center studies are needed to validate these findings and enhance generalizability.
