Prospective Long-Term Study of Vagus Nerve Stimulation for the Treatment of Refractory Seizures

Authors


  • Presented at the 1999 American Academy of Neurology Annual Meeting, Toronto, Canada.

Address correspondence and reprint requests to Dr. Christopher M. DeGiorgio, UCLA Department of Neurology, Olive View/UCLA Medical Center, North Annex, Sylmar, CA 91342, U.S.A. E-mail: cmd@ucla.edu

Abstract

Summary: Purpose: To determine the long-term efficacy of vagus nerve stimulation (VNS) for refractory seizures. VNS is a new treatment for refractory epilepsy. Two short-term double-blind trials have demonstrated its safety and efficacy, and one long-term study in 114 patients has demonstrated a cumulative improvement in efficacy at 1 year. We report the largest prospective long-term study of VNS to date.

Methods: Patients with six or more complex partial or generalized tonic-clonic seizures enrolled in the pivotal EOS study were prospectively evaluated for 12 months. The primary outcome variable was the percentage reduction in total seizure frequency at 3 and 12 months after completion of the acute EO5 trial, compared with the preimplantation baseline. Subjects originally randomized to low stimulation (active-control group) were crossed over to therapeutic stimulation settings for the first time. Subjects initially randomized to high settings were maintained on high settings throughout the 12-month study.

Results: The median reduction at 12 months after completion of the initial double-blind study was 45%. At 12 months, 35% of 195 subjects had a >50% reduction in seizures, and 20% of 195 had a >75% reduction in seizures.

Conclusions: The efficacy of VNS improves during 12 months, and many subjects sustain >75% reductions in seizures.

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