title: Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery.
abstract: OBJECTIVE
  Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy.
  
  
  METHODS
  All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months.
  
  
  RESULTS
  Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better).
  
  
  CONCLUSIONS
  VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.
authors.affiliation: University of South Florida, Department of Neurosurgery, Tampa, FL 33606, United States. fvale@health.usf.edu
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Vale
authors.forename: Amir
authors.initials: A
authors.lastname: Ahmadian
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
authors.forename: William O
authors.initials: WO
authors.lastname: Tatum
authors.forename: Selim R
authors.initials: SR
authors.lastname: Benbadis
mesh_terms: D000293:Adolescent; D000328:Adult; D001703:Biophysics; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D017211:Treatment Failure; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*; D055815:Young Adult