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Effectiveness of vagal nerve stimulation in medication-resistant epilepsy. Comparison between patients with and without medication changes

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Abstract

Background

Vagal nerve stimulation (VNS) response is not immediate. A progressive decline in seizure frequency is usually found during a period of 12–18 months after implantation. During this time, the patient’s medication is usually modified, which can create doubts about whether their clinical improvement is due to medication changes or to VNS itself. Our goal is to compare two groups of patients treated with VNS, with and without changes in their medication.

Methods

We prospectively analyze 85 patients who were treated with VNS in our hospital between 2005 and 2014. In 43 patients, changes in the antiepileptic drugs (EAD) were not allowed during the postoperative follow-up and they were compared with 42 patients who were left at the option of neurologist make changes in medication. We analyzed the clinical situation at 18 months and compared the two groups.

Results

Overall, 54.1% of patients had a reduction in seizures of 50% or higher (responders). In the group with no changes in medication, responders reached 63%, while in the group in which changes in medication were allowed, 45.2% were responders. Between responders and non-responders, there were no statistical differences in type of epilepsy, frequency, previous surgery, or intensity of stimulation.

Conclusions

We did not find a statistical difference in seizure frequency reduction between patients with or without changes in medication during their follow-up, so changes in medication did not improve the outcome. Furthermore, the absence of changes in AED can help to optimize the parameters of the stimulator in order to improve its effectiveness.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital La Princesa, C/Diego de León 62, 28006, Madrid, Spain

    María A. García-Pallero, Eduardo García-Navarrete, Cristina V. Torres, Marta Navas & R. G. Sola

  2. Department of Neurophysiology, University Hospital La Princesa, C/Diego de León 62, 28006, Madrid, Spain

    Jesús Pastor

Authors
  1. María A. García-Pallero
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  2. Eduardo García-Navarrete
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  3. Cristina V. Torres
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  4. Jesús Pastor
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  5. Marta Navas
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  6. R. G. Sola
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Corresponding author

Correspondence to María A. García-Pallero.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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García-Pallero, M.A., García-Navarrete, E., Torres, C.V. et al. Effectiveness of vagal nerve stimulation in medication-resistant epilepsy. Comparison between patients with and without medication changes. Acta Neurochir 159, 131–136 (2017). https://doi.org/10.1007/s00701-016-3027-6

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  • DOI: https://doi.org/10.1007/s00701-016-3027-6

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