Long-term outcomes and prognosis factors of vagus nerve stimulation in patients with refractory epilepsy

Springer Science and Business Media LLC
Cuiping Xu1, Lin Hua2, Junjie Xu3, Xiaohua Zhang1, Guiliang Hao1, Qiang Qiang Liu3, Ding Cheng-yun4, Shan Wang4, Quanjun Zhao5, Xiao Bai5, Kui Chen6, Duanyu Ni1, Yongjie Li1, Tao Yu1, Yuping Wang2
1Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical, University, Beijing 100053, China
2Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
3Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
4Department of Epilepsy, First Affiliated Hospital, General Hospital of People’s Liberation Army, Beijing, 100048, China
5Department of Neurosurgery, The 306th Hospital of PLA, Beijing, 100101, China
6Department of Neurology, Beijing Friendship Hospital, Beijing, 100050, China

Tóm tắt

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.

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