VNS in patients with previous unsuccessful resective epilepsy surgery: antiepileptic and psychotropic effects.
OBJECTIVE
To assess the efficacy of vagus nerve stimulation (VNS) in patients with medically and surgically intractable complex partial seizures (CPS).


METHODS
Sixteen patients with previous temporal [15] and frontal [one] resections were treated with VNS between 1994 and 1999 at King's College Hospital, London, UK. Post-operative video-electroencephalogram telemetry had shown that CPS started from the operated side in 12 patients, contralaterally in three and bilaterally independently in one.


RESULTS
Three patients (18.75%) had 50% or more reduction in seizure frequency, but one showed severe worsening of epilepsy, which remitted upon VNS discontinuation. The antiepileptic effect of VNS was not different with respect to the type of operation (anterior temporal lobectomy vs amygdalohippocampectomy), the side of operation, or the side of seizure onset. We observed psychotropic effects in two patients with post-ictal psychosis, in two others with depression, and in a child with severe behavioral disorder.


CONCLUSIONS
VNS may have a rather limited antiepileptic role to play in patients with persistent seizures following epilepsy surgery, but may independently possess useful antipsychotic and mood-stabilizing properties.
Koutroumanidis
M
M
Department of Neurology, King's College Hospital, London, UK. m.koutroumanidis@iop.kcl.ac.uk
Binnie
C D
CD
Hennessy
M J
MJ
Alarcon
G
G
Elwes
R D C
RD
Toone
B K
BK
Chandler
C
C
Selway
R
R
Polkey
C E
CE
O'Connor
S A
SA
D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D004567:Electrodes, Implanted; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000209:etiology / Q000628:therapy*; D013702:Temporal Lobe / Q000503:physiopathology / Q000601:surgery; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*