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Is vagus nerve stimulation a treatment option for patients with drug-resistant idiopathic generalized epilepsy?

Authors


Hrisimir Kostov, M.D. P.b. 53, 1306 Baerum postterminal, Norway
Tel.: +47 6750 1000
Fax: +47 6754 5321
e-mail: hrisimir.kostov@epilepsy.no

Abstract

Background –  The value of vagus nerve stimulation (VNS) for treating patients with drug-resistant idiopathic generalized epilepsy (IGE) is not well documented.

Patients and methods –  Twelve patients (2 males, 10 females) with a mean age of 31 years (11–48 years) and with drug-resistant IGE had VNS implanted in the period 1995–2006. All had generalized seizures documented by video-electroencephalogram. Mean follow-up period was 23 months (9–54 months).

Results –  There was a total seizure reduction of 61% (P = 0.0002). There was 62% reduction of generalized tonic-clonic seizures (P = 0.0020), 58% of absences (P = 0.0003) and 40% of myoclonic seizures (P = 0.0156). Eight patients were considered responders (>50% seizure reduction); two of these patients became seizure-free. Five out of seven patients with juvenile myoclonic epilepsy were responders. At the last follow-up visit, the patients had reduced the anti-epileptic drug (AED) usage from an average of 2.3 to 1.7 AED per patient (P = 0.0625). Two patients are currently being treated with VNS therapy only. Nine patients reported side effects, which were mostly mild and tended to diminish over time.

Conclusion –  Our results indicate that adjunctive VNS therapy is a favourable treatment option for patients with drug-resistant IGE. Rapid cycling seems worth trying in some of the non-responders.

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