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Long-Term Seizure Outcome With or Without Vagal Nerve Stimulation Therapy.
Sonia Gill1, Kathryn N Devlin1, Hsiangkuo Yuan1
1Jefferson Comprehensive Epilepsy Center (SG, SM, CS, MRS, MN), Department of Neurology, Thomas Jefferson University Hospital; Department of Psychological and Brain Sciences (KND), Drexel University; Jefferson Headache Center (HY), Department of Neurology, Thomas Jefferson University Hospital; Department of Neurosurgery (CW), Thomas Jefferson University Hospital, Philadelphia, PA; and Inova Medical Group - Neurology (SG), Fairfax, VA.
Long-term outcomes for epilepsy patients using vagal nerve stimulator (VNS) therapy were similar whether they continued VNS or discontinued it. This suggests other factors, like disease progression or medication, significantly influence seizure control over time.
Area of Science:
- Epilepsy Research
- Neuromodulation
- Long-term Clinical Outcomes
Background:
- Refractory epilepsy management often involves Vagal Nerve Stimulation (VNS) therapy.
- Understanding long-term efficacy of VNS is crucial for treatment decisions.
- Comparison between continuous VNS use and discontinuation after prolonged treatment is needed.
Purpose of the Study:
- To compare long-term seizure control in patients with continuous VNS (VNS-on) versus those who discontinued VNS after more than 3 years (VNS-off).
- To evaluate responder rates and changes in seizure frequency between the two groups.
Main Methods:
- Retrospective analysis of patients with refractory epilepsy treated with VNS for over 3 years.
- Comparison of VNS-on group with VNS-off group (requiring >2 years follow-up post-discontinuation).
- Exclusion of patients with brain surgery within 3 years of VNS initiation.
- Assessment of ≥50% seizure reduction (responder rate) and seizure frequency changes.
Main Results:
- Similar 50% responder rates were observed between VNS-on (54.5%) and VNS-off groups (37.5% at last-on, 62.5% at last follow-up).
- Both groups showed significant long-term seizure reduction compared to baseline.
- Seizure frequency changes were comparable between VNS-on and VNS-off groups at various follow-up points.
Conclusions:
- Discontinuation of VNS therapy after prolonged use did not negatively impact long-term seizure control compared to continuous use.
- Long-term outcomes appear to be influenced by factors beyond VNS therapy, such as the natural course of epilepsy and concomitant medication.
- These findings suggest a potentially similar long-term prognosis regardless of continued VNS use in selected patient populations.
