Effect of vagus nerve stimulation against generalized seizure and status epilepticus recurrence

Frontiers in Neurology

Neurology

Kazuki Nishioka¹  Takumi Mitsuhashi¹  Kou Horikoshi¹  Akihide Kondo¹  Hiroharu Suzuki¹  Yasushi Iimura¹  Kazuki Nomura¹  Tetsuya Ueda¹  Hidenori Sugano² 

[1] Department of Neurosurgery, Juntendo University, Tokyo, Japan;Epilepsy Center, Juntendo University Hospital, Tokyo, Japan;Department of Neurosurgery, Juntendo University, Tokyo, Japan;Epilepsy Center, Juntendo University Hospital, Tokyo, Japan;Sugano Neurosurgery Clinic, Tokyo, Japan;

关键词: vagus nerve stimulation;    generalized seizure;    status epilepticus;    drug-resistant epilepsy;    response rate;   

DOI  :  10.3389/fneur.2023.1258854

 received in 2023-07-14, accepted in 2023-08-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveVagus nerve stimulation (VNS) is a palliative surgery for drug-resistant epilepsy. The two objectives of this study were to (1) determine the seizure type most responsive to VNS and (2) investigate the preventive effect on status epilepticus (SE) recurrence.MethodsWe retrospectively reviewed 136 patients with drug-resistant epilepsy who underwent VNS implantation. We examined seizure outcomes at 6, 12, and 24 months following implantation of VNS as well as at the last visit to the Juntendo Epilepsy Center. Univariate analysis and multivariate logistic regression models were used to estimate the prognostic factors.Results125 patients were followed up for at least 1 year after VNS implantation. The percentage of patients with at least a 50% reduction in seizure frequency compared with prior to VNS implantation increased over time at 6, 12, and 24 months after VNS implantation: 28, 41, and 52%, respectively. Regarding overall seizure outcomes, 70 (56%) patients responded to VNS. Of the 40 patients with a history of SE prior to VNS implantation, 27 (67%) showed no recurrence of SE. The duration of epilepsy, history of SE prior to VNS implantation and seizure type were correlated with seizure outcomes after VNS implantation in univariate analysis (p = 0.05, p < 0.01, and p = 0.03, respectively). In multivariate logistic regression analysis, generalized seizure was associated with VNS response [odds ratio (OR): 4.18, 95% CI: 1.13–15.5, p = 0.03]. A history of SE prior to VNS implantation was associated with VNS non-responders [(OR): 0.221, 95% CI: 0.097–0.503, p < 0.01]. The duration of epilepsy, focal to bilateral tonic–clonic seizure and epileptic spasms were not significantly associated with VNS responders (p = 0.07, p = 0.71, and p = 0.11, respectively).ConclusionFollowing 125 patients with drug-resistant epilepsy for an average of 69 months, 56% showed at least 50% reduction in seizure frequency after VNS implantation. This study suggests that generalized seizure is the most responsive to VNS, and that VNS may reduce the risk of recurrence of SE. VNS was shown to be effective against generalized seizure and also may potentially influence the risk of further events of SE, two marker of disease treatment that can lead to improved quality of life.

【 授权许可】

Unknown   
Copyright © 2023 Iimura, Suzuki, Mitsuhashi, Ueda, Nishioka, Horikoshi, Nomura, Sugano and Kondo.