Predictive factors for successful vagus nerve stimulation in patients with refractory epilepsy: real-life insights from a multicenter study

Frontiers in Neuroscience

Neuroscience

Daniela Fontes Bezerra¹  Andrea Julião de Oliveira²  Lécio Figueira Pinto³  Vanessa Cristina Colares Lessa⁴  Henrique Jannuzzelli Pires do Prado⁵  Isabella D’Andrea-Meira⁵  Francisco Arruda⁶  Luciano de Paola⁷  Tayla Taynan Romão⁸  Jonadab dos Santos Silva⁹ 

[1] Department of Epilepsy, Faculdade de Medicina do ABC, São Paulo, Brazil;Department of Epilepsy, Hospital Felicio Rocho, Belo Horizonte, Brazil;Department of Epilepsy, Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, Brazil;Department of Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil;Department of Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil;Postgraduate Program in Neurology/Neurosciences, Universidade Federal Fluminense, Niterói, Brazil;Department of Epilepsy, Instituto de Neurologia de Goiânia, Goiânia, Brazil;Department of Epilepsy, Universidade Federal do Paraná, Curitiba, Brazil;Postgraduate Program in Neurology/Neurosciences, Universidade Federal Fluminense, Niterói, Brazil;Postgraduate Program in Neurology/Neurosciences, Universidade Federal Fluminense, Niterói, Brazil;Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

关键词: epilepsy;    neuromodulation;    drug-resistant epilepsy;    vagus nerve stimulation;    prediction response;   

DOI  :  10.3389/fnins.2023.1210221

 received in 2023-04-22, accepted in 2023-07-07,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionVagus nerve stimulation (VNS) therapy is an established treatment for patients with drug-resistant epilepsy that reduces seizure frequency by at least 50% in approximately half of patients; however, the characteristics of the patients with the best response have not yet been identified. Thus, it is important to identify the profile of patients who would have the best response to guide early indications and better patient selection.MethodsThis retrospective study evaluated vagus nerve stimulation (VNS) as an adjuvant therapy for patients with drug-resistant epilepsy from six epilepsy centers in Brazil. Data from 192 patients aged 2–66 years were analyzed, and all patients received at least 6 months of therapy to be included.ResultsIncluded patients were aged 2–66 years (25.6 ± 14.3), 105 (54.7%) males and 87 (45.8%) females. Median follow-up interval was 5 years (range, 2005—2018). Overall, the response rate (≥50% seizure reduction) after VNS implantation was 65.6% (126/192 patients). Most patients had 50–90% seizure reduction (60.9%) and nine patients became seizure-free. There were no serious complications associated with VNS implantation. The rate of a ≥ 50% seizure reduction response was significantly higher in patients with no history of neurosurgery. The presence of focal without generalized seizures and focal discharges on interictal EEG was associated with better response. Overall, etiological predictors of a better VNS response profile were tumors while a worse response to VNS was related to the presence of vascular malformations and Lennox–Gastaut Syndrome.DiscussionWe observed an association between a better response to VNS therapy no history of neurosurgery, focal interictal epileptiform activity, and focal seizure pattern. Additionally, it is important to highlight that age was not a determinant factor of the response, as children and adults had similar response rates. Thus, VNS therapy should be considered in both adults and children with DRE.

【 授权许可】

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Copyright © 2023 Pires do Prado, Pinto, Bezerra, de Paola, Arruda, de Oliveira, Romão, Lessa, Silva and D’Andrea-Meira.