Generator replacement in epilepsy patients treated with vagus nerve stimulation.
OBJECTIVE
In epilepsy patients treated with vagus nerve stimulation (VNS), the occurrence of end of battery life (EOBL), when the generator will no longer deliver any stimulation, was investigated with regard to seizure control. EOBL is preceeded by end of effective stimulation (EOES) when irregular stimulation may occur.


METHODS
In 14/78 patients, treated with VNS at Ghent University Hospital, generators were replaced at different times following EOES or EOBL. We retrospectively analysed the time of occurrence of EOES and EOBL and seizure control before and after generator replacement.


RESULTS
EOES or EOBL was indicated by loss of seizure control, decreased perception of stimulation and recurrence of depression in 3, 3 and 1/14 patient(s), respectively. In 2 and 1/14 patient(s), EOBL and premature generator failure, respectively, were detected during routine check-up at the epilepsy clinic. In 4/14 patients, generator replacement was performed before estimated EOES. Pre-replacement seizure control could not be regained in 2/14 patients in whom replacement had been postponed for several months. Estimation of EOES and EOBL occurrence proved difficult in individual patients.


CONCLUSIONS
EOES or EOBL may be indicated by loss of seizure control, decreased or irregular perception of stimulation by the patient and loss of other VNS-induced effects. Postponing generator replacement may result into permanent loss of seizure control. In responders we suggest generator replacement before EOBL. Our results call for performance of prospective studies in larger patient groups that may eventually lead to general guidelines on the indication and timing of generator replacement.
Vonck
Kristl
K
Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Belgium. kristl.vonck@ugent.be
Dedeurwaerdere
Stefanie
S
De Groote
Liesbeth
L
Thadani
Vijay
V
Claeys
Pieter
P
Gossiaux
Fleur
F
Van Roost
Dirk
D
Boon
Paul
P
D000328:Adult; D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000627:therapeutic use; D002648:Child; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D004351:Drug Resistance; D004553:Electric Conductivity; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D012008:Recurrence; D014159:Transducers; D014630:Vagus Nerve / Q000502:physiology*
D000927:Anticonvulsants