title: Vagus nerve stimulation in refractory epilepsy: new indications and outcome assessment.
abstract: Although vagus nerve stimulation (VNS) is an effective alternative option for patients with refractory epilepsy unsuitable for conventional resective surgery, predictors of a better control of seizure frequency and severity are still unavailable. This prospective study reports on 39 patients, including 4 children affected by epilepsia partialis continua (EPC), who underwent VNS for refractory epilepsy. The overall seizure frequency outcome was classified into three groups according to reduction rate: ≥75%, ≥50%, and <50%. Engel and McHugh classifications were also used. The median follow-up period was 36months. A seizure reduction rate ≥50% or EPC improvement was observed in 74% of the patients. Twenty-one out of 35 cases (60%) resulted in Engel classes II and III. Outcome, as defined by the McHugh scale, showed a responder rate of 71%. These results suggest that younger patient age and focal or multifocal epilepsy are related to a better seizure control and cognitive outcome. Vagus nerve stimulation could also be considered as an effective procedure in severe conditions, such as drug-refractory EPC.
authors.affiliation: Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.
authors.forename: Carlo Efisio
authors.initials: CE
authors.lastname: Marras
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiesa
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Benedictis
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
authors.forename: Michele
authors.initials: M
authors.lastname: Rizzi
authors.forename: Flavio
authors.initials: F
authors.lastname: Villani
authors.forename: Francesca
authors.initials: F
authors.lastname: Ragona
authors.forename: Laura
authors.initials: L
authors.lastname: Tassi
authors.forename: Aglaia
authors.initials: A
authors.lastname: Vignoli
authors.forename: Elena
authors.initials: E
authors.lastname: Freri
authors.forename: Nicola
authors.initials: N
authors.lastname: Specchio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Broggi
authors.forename: Marina
authors.initials: M
authors.lastname: Casazza
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*; D055815:Young Adult
keywords: Palliative surgery; Refractory epilepsy; Vagus nerve stimulation