Vagus nerve stimulation for medically refractory absence epilepsy

A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patie...

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Published in:	Seizure (London, England) Vol. 22; no. 4; pp. 267 - 270
Main Authors:	Arya, Ravindra, Greiner, Hansel M., Lewis, Amanda, Mangano, Francesco T., Gonsalves, Cornelia, Holland, Katherine D., Glauser, Tracy A.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01.05.2013
Subjects:	Absence seizures Adolescent Anticonvulsants - therapeutic use Child Childhood absence epilepsy Epilepsy, Absence - drug therapy Epilepsy, Absence - physiopathology Epilepsy, Absence - therapy Female Follow-Up Studies Humans Juvenile absence epilepsy Male Medically refractory epilepsy Neurology Retrospective Studies Treatment Outcome Vagus nerve stimulation Vagus Nerve Stimulation - methods Young Adult Medically refractory epilepsy Absence seizures Juvenile absence epilepsy Vagus nerve stimulation Childhood absence epilepsy
ISSN:	1059-1311, 1532-2688, 1532-2688
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Abstract	A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patient population. Patients were identified by a chart review of all VNS recipients between January 1, 2006 and December 31, 2011. The diagnosis of CAE and JAE was based on conventional criteria. Details of demography, epilepsy phenomenology, management and outcomes were extracted. The outcome measures included reduction in daily seizure frequency measured as a percentage of pre-VNS seizure frequency and classified on International League Against Epilepsy (ILAE) outcome scale. Nine patients (7 CAE, 2 JAE) with a mean age of seizure onset of 5.4 years (±3.9) were identified. Mean duration of epilepsy prior to VNS implant was found to be 3.9 years (±1.4). These patients had failed a median of 5 anti-epileptic drugs before being referred for consideration of surgical treatment. After a mean follow-up of 33.9 months (±25.5, minimum 4 months), 1 patient attained complete seizure freedom (ILAE class 1), 6 had ILAE class 4 and 2 had ILAE class 5 outcomes, respectively. Mean reduction in daily seizure frequency was found to be 53.5±60.3% (1-sided p-value for paired t-test=0.04), with a 50% responder rate of 55.6%. VNS may be considered as a therapeutic option in patients with medically refractory absence epilepsy.
AbstractList	A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patient population. Patients were identified by a chart review of all VNS recipients between January 1, 2006 and December 31, 2011. The diagnosis of CAE and JAE was based on conventional criteria. Details of demography, epilepsy phenomenology, management and outcomes were extracted. The outcome measures included reduction in daily seizure frequency measured as a percentage of pre-VNS seizure frequency and classified on International League Against Epilepsy (ILAE) outcome scale. Nine patients (7 CAE, 2 JAE) with a mean age of seizure onset of 5.4 years (±3.9) were identified. Mean duration of epilepsy prior to VNS implant was found to be 3.9 years (±1.4). These patients had failed a median of 5 anti-epileptic drugs before being referred for consideration of surgical treatment. After a mean follow-up of 33.9 months (±25.5, minimum 4 months), 1 patient attained complete seizure freedom (ILAE class 1), 6 had ILAE class 4 and 2 had ILAE class 5 outcomes, respectively. Mean reduction in daily seizure frequency was found to be 53.5±60.3% (1-sided p-value for paired t-test=0.04), with a 50% responder rate of 55.6%. VNS may be considered as a therapeutic option in patients with medically refractory absence epilepsy. Abstract Purpose A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patient population. Methods Patients were identified by a chart review of all VNS recipients between January 1, 2006 and December 31, 2011. The diagnosis of CAE and JAE was based on conventional criteria. Details of demography, epilepsy phenomenology, management and outcomes were extracted. The outcome measures included reduction in daily seizure frequency measured as a percentage of pre-VNS seizure frequency and classified on International League Against Epilepsy (ILAE) outcome scale. Results Nine patients (7 CAE, 2 JAE) with a mean age of seizure onset of 5.4 years (±3.9) were identified. Mean duration of epilepsy prior to VNS implant was found to be 3.9 years (±1.4). These patients had failed a median of 5 anti-epileptic drugs before being referred for consideration of surgical treatment. After a mean follow-up of 33.9 months (±25.5, minimum 4 months), 1 patient attained complete seizure freedom (ILAE class 1), 6 had ILAE class 4 and 2 had ILAE class 5 outcomes, respectively. Mean reduction in daily seizure frequency was found to be 53.5 ± 60.3% (1-sided p -value for paired t -test = 0.04), with a 50% responder rate of 55.6%. Conclusion VNS may be considered as a therapeutic option in patients with medically refractory absence epilepsy. A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patient population.PURPOSEA proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap for the treatment of such patients, this series is reported to generate estimate for efficacy of vagus nerve stimulation (VNS) in this patient population.Patients were identified by a chart review of all VNS recipients between January 1, 2006 and December 31, 2011. The diagnosis of CAE and JAE was based on conventional criteria. Details of demography, epilepsy phenomenology, management and outcomes were extracted. The outcome measures included reduction in daily seizure frequency measured as a percentage of pre-VNS seizure frequency and classified on International League Against Epilepsy (ILAE) outcome scale.METHODSPatients were identified by a chart review of all VNS recipients between January 1, 2006 and December 31, 2011. The diagnosis of CAE and JAE was based on conventional criteria. Details of demography, epilepsy phenomenology, management and outcomes were extracted. The outcome measures included reduction in daily seizure frequency measured as a percentage of pre-VNS seizure frequency and classified on International League Against Epilepsy (ILAE) outcome scale.Nine patients (7 CAE, 2 JAE) with a mean age of seizure onset of 5.4 years (±3.9) were identified. Mean duration of epilepsy prior to VNS implant was found to be 3.9 years (±1.4). These patients had failed a median of 5 anti-epileptic drugs before being referred for consideration of surgical treatment. After a mean follow-up of 33.9 months (±25.5, minimum 4 months), 1 patient attained complete seizure freedom (ILAE class 1), 6 had ILAE class 4 and 2 had ILAE class 5 outcomes, respectively. Mean reduction in daily seizure frequency was found to be 53.5±60.3% (1-sided p-value for paired t-test=0.04), with a 50% responder rate of 55.6%.RESULTSNine patients (7 CAE, 2 JAE) with a mean age of seizure onset of 5.4 years (±3.9) were identified. Mean duration of epilepsy prior to VNS implant was found to be 3.9 years (±1.4). These patients had failed a median of 5 anti-epileptic drugs before being referred for consideration of surgical treatment. After a mean follow-up of 33.9 months (±25.5, minimum 4 months), 1 patient attained complete seizure freedom (ILAE class 1), 6 had ILAE class 4 and 2 had ILAE class 5 outcomes, respectively. Mean reduction in daily seizure frequency was found to be 53.5±60.3% (1-sided p-value for paired t-test=0.04), with a 50% responder rate of 55.6%.VNS may be considered as a therapeutic option in patients with medically refractory absence epilepsy.CONCLUSIONVNS may be considered as a therapeutic option in patients with medically refractory absence epilepsy.
Author	Gonsalves, Cornelia Mangano, Francesco T. Greiner, Hansel M. Glauser, Tracy A. Arya, Ravindra Lewis, Amanda Holland, Katherine D.
Author_xml	– sequence: 1 givenname: Ravindra surname: Arya fullname: Arya, Ravindra email: ravindra.arya4@gmail.com, Ravindra.Arya@cchmc.org organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 2 givenname: Hansel M. surname: Greiner fullname: Greiner, Hansel M. organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 3 givenname: Amanda surname: Lewis fullname: Lewis, Amanda organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 4 givenname: Francesco T. surname: Mangano fullname: Mangano, Francesco T. organization: Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 5 givenname: Cornelia surname: Gonsalves fullname: Gonsalves, Cornelia organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 6 givenname: Katherine D. surname: Holland fullname: Holland, Katherine D. organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States – sequence: 7 givenname: Tracy A. surname: Glauser fullname: Glauser, Tracy A. organization: Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Keywords	Medically refractory epilepsy Absence seizures Juvenile absence epilepsy Vagus nerve stimulation Childhood absence epilepsy
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Snippet	A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In view of evidence gap... Abstract Purpose A proportion of patients with childhood and juvenile absence epilepsies (CAE, JAE) are likely to be classified as medically refractory. In...
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SubjectTerms	Absence seizures Adolescent Anticonvulsants - therapeutic use Child Childhood absence epilepsy Epilepsy, Absence - drug therapy Epilepsy, Absence - physiopathology Epilepsy, Absence - therapy Female Follow-Up Studies Humans Juvenile absence epilepsy Male Medically refractory epilepsy Neurology Retrospective Studies Treatment Outcome Vagus nerve stimulation Vagus Nerve Stimulation - methods Young Adult
Title	Vagus nerve stimulation for medically refractory absence epilepsy
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