title: Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data.
abstract: Drug-resistant epilepsy is a devastating disorder associated with diminished quality of life (QOL). Surgical resection leads to seizure freedom and improved QOL in many epilepsy patients, but not all individuals are candidates for resection. In these cases, neuromodulation-based therapies such as vagus nerve stimulation (VNS) are often used, but most VNS studies focus exclusively on reduction of seizure frequency. QOL changes and predictors with VNS remain poorly understood.
  
  
  
  Using the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5000 patients (including over 3000 with ≥12months follow-up), as subjectively assessed by treating physicians. Trends and predictors of QOL changes were examined and related to post-operative seizure outcome and likelihood of VNS generator replacement.
  
  
  
  After VNS therapy, physicians reported patient improvement in alertness (58-63%, range over follow-up period), post-ictal state (55-62%), cluster seizures (48-56%), mood change (43-49%), verbal communication (38-45%), school/professional achievements (29-39%), and memory (29-38%). Predictors of net QOL improvement included shorter time to implant (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6), generalized seizure type (OR, 1.2; 95% CI, 1.0-1.4), female gender (OR, 1.2; 95% CI, 1.0-1.4), and Caucasian ethnicity (OR, 1.3; 95% CI, 1.0-1.5). No significant trends were observed over time. Patients with net QOL improvement were more likely to have favorable seizure outcomes (chi square [χ2]=148.1, p<0.001) and more likely to undergo VNS generator replacement (χ2=68.9, p<0.001) than those with worsened/unchanged QOL.
  
  
  
  VNS for drug-resistant epilepsy is associated with improvement on various QOL metrics subjectively rated by physicians. QOL improvement is associated with favorable seizure outcome and a higher likelihood of generator replacement, suggesting satisfaction with therapy. It is important to consider QOL metrics in neuromodulation for epilepsy, given the deleterious effects of seizures on patient QOL.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: englot@gmail.com.
authors.forename: Dario J
authors.initials: DJ
authors.lastname: Englot
authors.affiliation: Livanova, Inc., Houston, TX, USA.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Hassnain
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.affiliation: Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Harward
authors.affiliation: Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Saurabh R
authors.initials: SR
authors.lastname: Sinha
authors.affiliation: Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Haglund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D012042:Registries / Q000706:statistics & numerical data*; D055536:Vagus Nerve Stimulation / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Epilepsy; Quality of life; Surgery; VNS; Vagus nerve stimulation