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Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation.
MedLine Citation:
PMID:  21558973     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Robert E Elliott; Amr Morsi; Eric B Geller; Chad C Carlson; Orrin Devinsky; Werner K Doyle
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-06
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
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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