| Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation. | |
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MedLine Citation:
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PMID: 21558973 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: Using the Cyberonics registry, Amar and colleagues (2004) reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES). OBJECTIVE:: To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE). METHODS:: We retrospectively reviewed 376 patients (188 females; 265 adults; mean age of 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed one or more prior craniotomies for TRE and 266 (70.7%) had no history of IES. RESULTS:: The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types and more commonly had focal or multifocal versus generalized seizures (P<0.05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs. 56.5%, P=0.42). There was no correlation between type of failed IES (callosotomy versus resection) and seizure reduction with VNS therapy. CONCLUSION:: Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. VNS should be considered a palliative treatment option for patients with TRE, including patients who failed cranial epilepsy surgeries. |
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Authors:
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Robert E Elliott; Amr Morsi; Eric B Geller; Chad C Carlson; Orrin Devinsky; Werner K Doyle |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-06 |
Journal Detail:
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Title: Neurosurgery Volume: - ISSN: 1524-4040 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Neurosurgery, New York University Langone Medical Center, New York, NY; Department of Neurosurgery, New York University Langone Medical Center, New York, NY; Department of Neurology, Saint Barnabas Medical Center Livingston, NJ; Department of Neurology, New York University Langone Medical Center, New York, NY; Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, NY; Department of Neurosurgery, New York University Langone Medical Center, New York, NY. |
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