Abstract Details

Title Efficacy and Response Predictors for Refractory Epilepsy Treated with Vagal Nerve Stimulation: The Saskatoon Experience

Topic Epilepsy

Presentation(s) P01 - (-)

Poster/Presentation
Number 044

Objective

Background VNS is a relatively new approach to refractory epilepsy. The number of different devices available, the various stimulation settings, inter-patient differences and the high variability of efficacy across centers has lead to a paucity of high quality data. Additionally, many of the mechanisms underlying VNS are still unknown, and in vivo studies are performed mostly on animals. Regardless, recent meta-analyses show, on average, about a 50% reduction in seizure frequency, in refractory cases. Since this effect does not hold in all centers or patient groups, a structured review of the efficacy of VNS in the SHR can not only add to the literature on efficacy, but also assist in selecting those patients that would be most likely to benefit from this procedure.

Design/Methods A measurement instrument was created to include patient demographics; seizure etiology; seizure classification; seizure frequency; anti epileptic drugs used; and VNS parameters, adverse effects and efficacy. The instrument will be retrospectively applied to all patients in the SHR who have underwent VNS for the purposes of refractory epilepsy.

Results Of 18 patients, 83% had generalized epilepsy. A response (>50% seizure reduction) was seen in 61% of our the patients. 83% of patients reported a reduction in seizure frequency; however, no patients were able to effectively decrease the number of anti-epileptic drugs they were on. All reported side effects were minor and self limiting.

Conclusions VNS appears to be an effective, and relatively safe, option for refractory epilepsy. Our experience has shown and effect in generalized epilepsy, a group which has been under represented in the literature. Larger retrospective and prospective trials are needed to help predictors of response.

Authors/Disclosures
Ilia Poliakov, MD (Saskatoon MS Clinic) PRESENTER	No disclosure on file
Jose F. Tellez Zenteno, MD, PhD, FRCP	No disclosure on file
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.

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