Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2011;7(1):1-5.
Published online June 30, 2011.
Clinical Outcomes of Vagus Nerve Stimulation in Patients with Intractable Epilepsy
Min Seok Byun, Yong Soon Hwang, Jun Jae Shin, Tae Hong Kim, Hyung Shik Shin, Sang Keun Park
Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea
: The authors intend to assess the efficacy and side effects of vagus nerve stimulation (VNS) in patients with intractable epilepsy, and add our experiences to the formerly reported results of VNS. Materials and Methods : Twenty-two patients underwent implantation of VNS system from 1999 to 2007 at our Epilepsy Center ; a typical high-stimulation protocol with some variation was applied to all patients. There were 12 male and 10 female patients. The age distribution was 3 to 21 years (mean 9.7 years). Sixteen patients had Lennox-Gastuat syndrome (LGS). The remaining six patients had partial seizures with the following diagnoses : localization-related epilepsies [LREs, four cases ; two cases of cortical dysplasia (CD), and two cases of tuberous sclerosis complex (TSC)], a complex partial seizure (CPS), and a gelastic seizure (GS) due to hypothalamic hamartoma (HH). The mean follow-up period was 5.2 years (range, 2 to 10 years). After review of the patients’ medical records and radiological studies, we determined seizure related outcomes at the last followup and satisfaction of patients’ parents with this relatively expensive treatment modality.
: Out of 22 patients, 12 patients (54.5%) responded to VNS and 10 patients (45.5%) did not. The Response Group included nine LGSs, two LREs (one CD and one TSC), and a CPS patient. The No Response Group included seven LGSs, two LREs (one CD and one TSC), and a GS patient. Among the 12 patients in the Response Group, three patients demonstrated a reduction in seizure rate of >75% with the remainder (nine patients) demonstrating a reduction in seizure rate of >50% at last follow-up. Of the nine patients in the latter group, the parents of three patients (33%) did not satisfied to the results of VNS and were uncertain at the time of writing as to whether they would exchange the device for another when the battery was depleted. A significant side effect was noted in only one case, with resulting throat pain and voice vibration during stimulation.
: Our result shows about half of the patients had benefits from VNS irrespective of their seizure type and etiology, and this is similar to the results of other reports. So, we recognized again the unpredictability of outcomes of VNS and further studies will be needed to elucidate the prognostic factors for VNS implantation. However, we think VNS is still a valuable alternative as a last measure in otherwise hopeless intractable epilepsy.
Key Words: Vagus nerve stimulation, Epilepsy, Treatment, Outcome, Lennox-Gastaut syndrome.

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