Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy
Abstract Background Vagus nerve stimulation (VNS) is an effective treatment for patients with refractory epilepsy, yet with varied predictive factors and heterogeneous long-term outcomes. Adjustment of VNS parameters is critical for obtaining favorable efficacy. In this study, we aimed to investigat...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | Acta Epileptologica |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42494-022-00109-w |
| _version_ | 1811201214162927616 |
|---|---|
| author | Cuiping Xu Hua Lin Jiwen Xu Xiaohua Zhang Guiliang Hao Qiang Qiang Liu Chengyun Ding Shan Wang Quanjun Zhao Xiaojun Bai Kui Chen Duanyu Ni Yongjie Li Tao Yu Yuping Wang |
| author_facet | Cuiping Xu Hua Lin Jiwen Xu Xiaohua Zhang Guiliang Hao Qiang Qiang Liu Chengyun Ding Shan Wang Quanjun Zhao Xiaojun Bai Kui Chen Duanyu Ni Yongjie Li Tao Yu Yuping Wang |
| author_sort | Cuiping Xu |
| collection | DOAJ |
| description | Abstract Background Vagus nerve stimulation (VNS) is an effective treatment for patients with refractory epilepsy, yet with varied predictive factors and heterogeneous long-term outcomes. Adjustment of VNS parameters is critical for obtaining favorable efficacy. In this study, we aimed to investigate the long-term outcomes and the possible predictive factors of VNS in patients with refractory epilepsy. Methods Eighty-six patients (59 males and 27 females) who underwent VNS implantation for treatment of refractory epilepsy between May 2016 and May 2017 at five Epilepsy Centers were enrolled. The clinical data, including sex, age at epilepsy onset, VNS implantation, epilepsy duration, seizure type, MRI findings, history of neurosurgical operations, and responder rate (responders were those with ≥50% seizure reduction), were analyzed. Results Four-year follow-up data were available for 76 patients (53 males and 23 females). The mean current intensity at the last follow-up was 1.8 ± 0.3 mA (range: 0.75–2.5 mA). The mean seizure reduction was 36.2% at 6 months, 38.5% at 1 year, 69.4% at 3 years, and 56.7% at 4 years. A favorable outcome of ≥50% reduction in seizure frequency occurred in 40.0% of the patients at 6 months, 55.9% at 1 year with 4 patients being seizure-free, 63.2% at 3 years with 5 patients being seizure-free, and 68.4% at 4 years with 5 patients being seizure-free. Earlier onset age (P < 0.001) and shorter duration (P = 0.042) were associated with favorable prognosis. Compared with generalized tonic-clonic seizures, tonic seizures had a favorable outcome (P = 0.026). Twenty-three patients underwent neurosurgical operations before VNS implantation, and the responder rate was 60.9% at the last follow-up. Conclusions VNS is an adjunctive and effective treatment for patients with refractory epilepsy who are not good candidates for surgical resection or have failed to respond to surgical treatment. The stimulation efficacy increases over time after implantation, and earlier exposure to VNS improves the prognosis. |
| first_indexed | 2024-04-12T02:18:23Z |
| format | Article |
| id | doaj.art-d8e657e838ea4fd79f0014183f4c3dcc |
| institution | Directory Open Access Journal |
| issn | 2524-4434 |
| language | English |
| last_indexed | 2024-04-12T02:18:23Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Acta Epileptologica |
| spelling | doaj.art-d8e657e838ea4fd79f0014183f4c3dcc2022-12-22T03:52:12ZengBMCActa Epileptologica2524-44342022-09-01411710.1186/s42494-022-00109-wLong-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsyCuiping Xu0Hua Lin1Jiwen Xu2Xiaohua Zhang3Guiliang Hao4Qiang Qiang Liu5Chengyun Ding6Shan Wang7Quanjun Zhao8Xiaojun Bai9Kui Chen10Duanyu Ni11Yongjie Li12Tao Yu13Yuping Wang14Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversityDepartment of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Epilepsy, First Affiliated Hospital, General Hospital of People’s Liberation ArmyDepartment of Epilepsy, First Affiliated Hospital, General Hospital of People’s Liberation ArmyDepartment of Neurosurgery, The 306th Hospital of PLADepartment of Neurosurgery, The 306th Hospital of PLADepartment of Neurology, Beijing Friendship HospitalDepartment of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Functional Neurosurgery, Xuanwu Hospital, Capital Medical UniversityDepartment of Neurology, Xuanwu Hospital, Capital Medical UniversityAbstract Background Vagus nerve stimulation (VNS) is an effective treatment for patients with refractory epilepsy, yet with varied predictive factors and heterogeneous long-term outcomes. Adjustment of VNS parameters is critical for obtaining favorable efficacy. In this study, we aimed to investigate the long-term outcomes and the possible predictive factors of VNS in patients with refractory epilepsy. Methods Eighty-six patients (59 males and 27 females) who underwent VNS implantation for treatment of refractory epilepsy between May 2016 and May 2017 at five Epilepsy Centers were enrolled. The clinical data, including sex, age at epilepsy onset, VNS implantation, epilepsy duration, seizure type, MRI findings, history of neurosurgical operations, and responder rate (responders were those with ≥50% seizure reduction), were analyzed. Results Four-year follow-up data were available for 76 patients (53 males and 23 females). The mean current intensity at the last follow-up was 1.8 ± 0.3 mA (range: 0.75–2.5 mA). The mean seizure reduction was 36.2% at 6 months, 38.5% at 1 year, 69.4% at 3 years, and 56.7% at 4 years. A favorable outcome of ≥50% reduction in seizure frequency occurred in 40.0% of the patients at 6 months, 55.9% at 1 year with 4 patients being seizure-free, 63.2% at 3 years with 5 patients being seizure-free, and 68.4% at 4 years with 5 patients being seizure-free. Earlier onset age (P < 0.001) and shorter duration (P = 0.042) were associated with favorable prognosis. Compared with generalized tonic-clonic seizures, tonic seizures had a favorable outcome (P = 0.026). Twenty-three patients underwent neurosurgical operations before VNS implantation, and the responder rate was 60.9% at the last follow-up. Conclusions VNS is an adjunctive and effective treatment for patients with refractory epilepsy who are not good candidates for surgical resection or have failed to respond to surgical treatment. The stimulation efficacy increases over time after implantation, and earlier exposure to VNS improves the prognosis.https://doi.org/10.1186/s42494-022-00109-wRefractory epilepsyVagus nerve stimulationGeneralized seizuresLong-term efficacy |
| spellingShingle | Cuiping Xu Hua Lin Jiwen Xu Xiaohua Zhang Guiliang Hao Qiang Qiang Liu Chengyun Ding Shan Wang Quanjun Zhao Xiaojun Bai Kui Chen Duanyu Ni Yongjie Li Tao Yu Yuping Wang Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy Acta Epileptologica Refractory epilepsy Vagus nerve stimulation Generalized seizures Long-term efficacy |
| title | Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| title_full | Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| title_fullStr | Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| title_full_unstemmed | Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| title_short | Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| title_sort | long term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy |
| topic | Refractory epilepsy Vagus nerve stimulation Generalized seizures Long-term efficacy |
| url | https://doi.org/10.1186/s42494-022-00109-w |
| work_keys_str_mv | AT cuipingxu longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT hualin longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT jiwenxu longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT xiaohuazhang longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT guilianghao longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT qiangqiangliu longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT chengyunding longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT shanwang longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT quanjunzhao longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT xiaojunbai longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT kuichen longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT duanyuni longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT yongjieli longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT taoyu longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy AT yupingwang longtermoutcomesandprognosisfactorsofvagusnervestimulationinpatientswithrefractoryepilepsy |