Abstract Details

Title Responsive Neurostimulation vs. Vagus Nerve Stimulation in Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-004

Objective To perform a systematic literature review to compare long-term seizure outcomes with responsive neurostimulation (RNS) vs. vagus nerve stimulation (VNS)

Background RNS is a recent development to treat pharmacoresistant focal epilepsy. VNS is more established for focal and generalized epilepsy. No systematic seizure outcome comparison exists comparing these modalities. We performed a systematic literature review to compare long-term outcomes.

Design/Methods We analyzed the pivotal trials of VNS (E-01 to E-05 studies) and a larger retrospective analysis of VNS registry data. For RNS, the results of the pivotal trial, long-term follow-up, and subgroup analyses of temporal lobe epilepsy and neo-cortical epilepsy were analyzed. Responder rates (RR- percentage of patients with ≥ 50% decrease in seizure frequency) were used to compare outcomes at similar time periods from implantation.

Results Pivotal trial data at three years revealed RR of 42.7% for VNS, and 57.9% for RNS (χ²=4.0329, p-value=0.045) for focal-onset seizures. VNS registry data at 2 years post-implant revealed RR of 58% for complex partial seizures with VNS (VNS registry), compared to 55% for RNS (χ²=0.081375, p-value=0.775). At 4 years post-implant, the RR was 61% for VNS (all seizure types, VNS registry), compared to 60.8% for RNS (χ²=0, p-value=1.0). Seizure freedom rates were not available at similar post-implant periods for statistical comparison. Statistical analyses were performed in R.

Conclusions RNS outcomes were marginally better than VNS (p=0.045) in pivotal trial data. However, the initial VNS trials compared low vs. high stimulation settings and may have under-estimated seizure improvement. There were no outcome differences for complex partial seizures (p=0.775) or all seizure types (p=1.0). The available data thus do not show whether VNS or RNS lead to better seizure outcomes in treatment of focal epilepsy. A direct head-to-head comparison of the efficacy of VNS compared to RNS in focal epilepsy to guide clinical decision-making is critically needed.

Authors/Disclosures
Henry Skrehot PRESENTER	Mr. Skrehot has nothing to disclose.
	No disclosure on file
Zulfi Haneef, MD, MBBS, MRCP, FAAN	Dr. Haneef has received publishing royalties from a publication relating to health care.

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