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Elliott RE; Morsi A; Geller EB; Carlson CC; Devinsky O; Doyle WK
"Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation"
Neurosurgery 2011 Dec; 69(6):1210-1217
BACKGROUND:: Using the Cyberonics registry, Amar and colleagues (2004) reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES). OBJECTIVE:: To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE). METHODS:: We retrospectively reviewed 376 patients (188 females; 265 adults; mean age of 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed one or more prior craniotomies for TRE and 266 (70.7%) had no history of IES. RESULTS:: The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types and more commonly had focal or multifocal versus generalized seizures (P<0.05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs. 56.5%, P=0.42). There was no correlation between type of failed IES (callosotomy versus resection) and seizure reduction with VNS therapy. CONCLUSION:: Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. VNS should be considered a palliative treatment option for patients with TRE, including patients who failed cranial epilepsy surgeries

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