J Neurol Surg A Cent Eur Neurosurg 2018; 79(02): 152-158
DOI: 10.1055/s-0037-1607396
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Older Age and Longer Epilepsy Duration Do Not Predict Worse Seizure Reduction Outcome after Vagus Nerve Stimulation

Jan Chrastina
1   Department of Neurosurgery, Masaryk University Medical Faculty, Faculty Hospital St. Anne's, Brno, Czech Republic
,
Jitka Kocvarova
2   First Department of Neurology, Faculty Hospital St. Anne's, Masaryk University Medical Faculty, St. Anne's Hospital Brno, Brno, Czech Republic
,
Zdenek Novak
1   Department of Neurosurgery, Masaryk University Medical Faculty, Faculty Hospital St. Anne's, Brno, Czech Republic
,
Irena Dolezalova
2   First Department of Neurology, Faculty Hospital St. Anne's, Masaryk University Medical Faculty, St. Anne's Hospital Brno, Brno, Czech Republic
,
Michal Svoboda
3   Institute of Biostatistics and Analyses, Medical Faculty Masaryk University, Brno, Czech Republic
,
Milan Brazdil
2   First Department of Neurology, Faculty Hospital St. Anne's, Masaryk University Medical Faculty, St. Anne's Hospital Brno, Brno, Czech Republic
4   Central European Institute of Technology (CEITEC), Masaryk University, Brno, Brno, Czech Republic
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Publikationsverlauf

09. Januar 2017

02. August 2017

Publikationsdatum:
27. November 2017 (online)

Abstract

Introduction We analyzed the results of vagus nerve stimulation (VNS) on older patients and patients with long-lasting epilepsy and included severely intellectually disabled patients.

Patients and Methods A total of 103 adults with VNS implanted from 2005 to 2014 were studied. The responder rates, that is, the percentage of VNS patients who responded to VNS, classified as seizure reduction ≥ 50% (50R) and seizure reduction ≥ 90% (90R), were compared in defined age groups (< 40 and ≥ 40 years, and < 50 and ≥ 50 years) and epilepsy duration groups (< 20 and ≥ 20 years, < 30 and ≥ 30 years, and < 40 and ≥ 40 years) at the 1-year follow-up visit and the last follow-up visit (at least 2 years after surgery). The age distributions and responder rates were also studied in patients with an intellectual disability.

Results The analysis did not confirm a significantly lower 50R or 90R rate in patients ≥ 40, ≥ 50, or ≥ 60 years when compared with their younger counterparts, but the 50R rate increase during follow-up care was the lowest in patients ≥ 50 and ≥ 60 years. The highest percentage of patients with an intellectual disability in the group < 40 years of age did not adversely affect the 50R rate. Longer epilepsy duration was not confirmed as a negative predictor of VNS outcome. There was a significantly higher 50R rate in patients with epilepsy duration ≥ 20 years (at the last follow-up visit) and a higher 90R rate in patients with epilepsy duration ≥ 30 years (at the 1-year follow-up visit). The increase in the 50R rate during follow-up care was lower in patients with epilepsy durations ≥ 30 and ≥ 40 years.

Conclusions The study did not find worse VNS outcomes, as defined by the 50R or 90R rate, in older adult patients or in patients with a longer epilepsy duration. The increasing stimulation effect over time is less marked in older patients and in patients with longer epilepsy duration.

 
  • References

  • 1 The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 1995; 45 (02) 224-230
  • 2 Handforth A, DeGiorgio CM, Schachter SC. , et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 1998; 51 (01) 48-55
  • 3 Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg 2011; 115 (06) 1248-1255
  • 4 Elliott RE, Morsi A, Kalhorn SP. , et al. Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy Behav 2011; 20 (01) 57-63
  • 5 Cukiert A. Vagus nerve stimulation for epilepsy: an evidence-based approach. Prog Neurol Surg 2015; 29: 39-52
  • 6 Amar AP, DeGiorgio CM, Tarver WB, Apuzzo ML. Long-term multicenter experience with vagus nerve stimulation for intractable partial seizures: results of the XE5 trial. Stereotact Funct Neurosurg 1999; 73 (1-4): 104-108
  • 7 Labar D, Murphy J, Tecoma E. Vagus nerve stimulation for medication-resistant generalized epilepsy. E04 VNS Study Group. Neurology 1999; 52 (07) 1510-1512
  • 8 Frost M, Gates J, Helmers SL. , et al. Vagus nerve stimulation in children with refractory seizures associated with Lennox-Gastaut syndrome. Epilepsia 2001; 42 (09) 1148-1152
  • 9 Helmers SL, Wheless JW, Frost M. , et al. Vagus nerve stimulation therapy in pediatric patients with refractory epilepsy: retrospective study. J Child Neurol 2001; 16 (11) 843-848
  • 10 Zamponi N, Rychlicki F, Corpaci L, Cesaroni E, Trignani R. Vagus nerve stimulation (VNS) is effective in treating catastrophic 1 epilepsy in very young children. Neurosurg Rev 2008; 31 (03) 291-297
  • 11 Morrell F. Varieties of human secondary epileptogenesis. J Clin Neurophysiol 1989; 6 (03) 227-275
  • 12 Danielsson S, Viggedal G, Gillberg C, Olsson I. Lack of effects of vagus nerve stimulation on drug-resistant epilepsy in eight pediatric patients with autism spectrum disorders: a prospective 2-year follow-up study. Epilepsy Behav 2008; 12 (02) 298-304
  • 13 Andriola MR, Vitale SA. Vagus nerve stimulation in the developmentally disabled. Epilepsy Behav 2001; 2 (02) 129-134
  • 14 Janszky J, Hoppe M, Behne F, Tuxhorn I, Pannek HW, Ebner A. Vagus nerve stimulation: predictors of seizure freedom. J Neurol Neurosurg Psychiatry 2005; 76 (03) 384-389
  • 15 Arcos A, Romero L, Gelabert M. , et al. Can we predict the response in the treatment of epilepsy with vagus nerve stimulation?. Neurosurg Rev 2014; 37 (04) 661-668
  • 16 Cukiert A. Commentary: Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy. Neurosurgery 2016; 79 (03) 354-355
  • 17 Lagae L, Verstrepen A, Nada A. , et al. Vagus nerve stimulation in children with drug-resistant epilepsy: age at implantation and shorter duration of epilepsy as predictors of better efficacy?. Epileptic Disord 2015; 17 (03) 308-314
  • 18 Fernández-Guardiola A, Martínez A, Valdés-Cruz A, Magdaleno-Madrigal VM, Martínez D, Fernández-Mas R. Vagus nerve prolonged stimulation in cats: effects on epileptogenesis (amygdala electrical kindling): behavioral and electrographic changes. Epilepsia 1999; 40 (07) 822-829
  • 19 Alexopoulos AV, Kotagal P, Loddenkemper T, Hammel J, Bingaman WE. Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure 2006; 15 (07) 491-503
  • 20 Meng FG, Jia FM, Ren XH. , et al. Vagus nerve stimulation for pediatric and adult patients with pharmaco-resistant epilepsy. Chin Med J (Engl) 2015; 128 (19) 2599-2604
  • 21 Wheless JW, Maggio V. Vagus nerve stimulation therapy in patients younger than 18 years. Neurology 2002; 59 (06) (Suppl. 04) S21-S25
  • 22 Thompson EM, Wozniak SE, Roberts CM, Kao A, Anderson VC, Selden NR. Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence. J Neurosurg Pediatr 2012; 10 (03) 200-205
  • 23 Kuba R, Brázdil M, Kalina M. , et al. Vagus nerve stimulation: longitudinal follow-up of patients treated for 5 years. Seizure 2009; 18 (04) 269-274
  • 24 Menascu S, Kremer U, Schiller Y. , et al. The Israeli retrospective multicenter open-label study evaluating vagus nerve stimulation efficacy in children and adults. Isr Med Assoc J 2013; 15 (11) 673-677
  • 25 Wheeler M, De Herdt V, Vonck K. , et al. Efficacy of vagus nerve stimulation for refractory epilepsy among patient subgroups: a re-analysis using the Engel classification. Seizure 2011; 20 (04) 331-335
  • 26 Sirven JI, Sperling M, Naritoku D. , et al. Vagus nerve stimulation therapy for epilepsy in older adults. Neurology 2000; 54 (05) 1179-1182
  • 27 Englot DJ, Rolston JD, Wright CW, Hassnain KH, Chang EF. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy. Neurosurgery 2016; 79 (03) 345-353
  • 28 Helmers SL, Griesemer DA, Dean JC. , et al. Observations on the use of vagus nerve stimulation earlier in the course of pharmacoresistant epilepsy: patients with seizures for six years or less. Neurologist 2003; 9 (03) 160-164
  • 29 Renfroe JB, Wheless JW. Earlier use of adjunctive vagus nerve stimulation therapy for refractory epilepsy. Neurology 2002; 59 (06) (Suppl. 04) S26-S30
  • 30 Colicchio G, Policicchio D, Barbati G. , et al. Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration. Childs Nerv Syst 2010; 26 (06) 811-819
  • 31 Rocha L. Interaction between electrical modulation of the brain and pharmacotherapy to control pharmacoresistant epilepsy. Pharmacol Ther 2013; 138 (02) 211-228
  • 32 Walker BR, Easton A, Gale K. Regulation of limbic motor seizures by GABA and glutamate transmission in nucleus tractus solitarius. Epilepsia 1999; 40 (08) 1051-1057
  • 33 Shen H, Fuchino Y, Miyamoto D, Nomura H, Matsuki N. Vagus nerve stimulation enhances perforant path-CA3 synaptic transmission via the activation of β-adrenergic receptors and the locus coeruleus. Int J Neuropsychopharmacol 2012; 15 (04) 523-530