Quality of life after vagal nerve stimulator insertion

Mikati, Mohamad A.; Ataya, Nour; El-Ferezli, Jessica C; Baghdadi, Tarafa S.; Turkmani, Ali; Comair, Youssef G.; Kansagra, Sujay; Najjar, Marwan

doi:10.1684/epd.2009.0244

Cited by 39 publications

(28 citation statements)

References 32 publications

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“…Klinkenberg and colleagues also examined QOLIE-89 scores before and 6 months after VNS in 41 adults with epilepsy, observing significant improvements in mood and overall QOL with stimulation [21]. In pediatric patients with epilepsy, a few small VNS studies have reported improved alertness or social interactions based on retrospective chart review [22, 23] or neuropsychological evaluation [24]. One investigation indirectly inferred increased quality-adjusted life years with VNS based on reduced hospitalizations recorded in U.S. Medicaid data [25].…”

Section: Discussionmentioning

confidence: 99%

Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data

Englot

Hassnain

Rolston

et al. 2017

Epilepsy & Behavior

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Objective 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. Method Using the VNS Therapy Patient Outcome Registry, we examined 7 metrics related to QOL after VNS for epilepsy in over 5,000 patients (including over 3,000 with ≥ 12 months 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. Results 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. Significance 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.

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Section: Discussionmentioning

confidence: 99%

Quality-of-life metrics with vagus nerve stimulation for epilepsy from provider survey data

Englot

Hassnain

Rolston

et al. 2017

Epilepsy & Behavior

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“…examined quality of life changes following VNS for refractory epilepsy and showed an improvement in the total quality of life and social indices that correlated with the reduction in seizure burden. [16] Others have reported similar beneficial effects on the quality of life assessments following VNS therapy in children. [2535] A more focused review of very young children, less than three years of age, using VNS therapy for catastrophic epilepsy and cognitive impairment suggested increases in quality of life, parental satisfaction, and even achievement of developmental milestones.…”

Section: Methodsmentioning

confidence: 87%

Vagal nerve stimulation for pharmacoresistant epilepsy in children

Hauptman¹,

Mathern²

2012

Surg Neurol Int

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Vagus nerve stimulation (VNS) is an adjunctive treatment for adult patients with pharmacoresistant epilepsy. Little is known about VNS therapy for children with epilepsy. This article will: (1) Review the contemporary medical literature related to VNS therapy in children with epilepsy, (2) describe the experience of VNS treatment in 153 children less than 18 years of age, in the University of California, Los Angeles (UCLA) Pediatric Epilepsy Surgery Program, from 1998 to 2012, and (3) describe the surgical technique used for VNS implantation at UCLA. Review of the literature finds that despite different etiologies and epilepsy syndromes in children, VNS appears to show a similar profile of efficacy for seizure control compared to adults, and low morbidity and mortality. The UCLA experience is similar to that reported in the literature for children. VNS constitutes about 21% of our pediatric epilepsy surgery volume. We have implanted VNS in infants as young as six months of age and the most common etiology is the Lennox-Gastaut Syndrome. About 5% of the patients are seizure-free with VNS therapy and there is a low rate of surgically related complications. The UCLA surgical approach emphasizes minimal direct manipulation of the vagus nerve and adequate wire loops, to prevent a lead fracture. In summary, VNS is a viable palliative treatment for medically refractory epilepsy in children, with outcomes and complications equal to adult patients. Being a small child is not a contraindication for VNS therapy, if needed for refractory epilepsy.

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“…One patient was excluded from this review because of accidental death shortly after implantation, of causes unrelated to his underlying condition or the device. Mean age at implantation was 9.4 years (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Mean duration of epilepsy prior to implantation was 6.5 years.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…1 Numerous reports have established VNS therapy as a safe and effective treatment option for children and adults who have refractory epilepsy. [1][2][3][4][5][6] The cost effectiveness of VNS therapy has also been assessed and established in the developing world, 7,8 however there are very little reports on its use in developing countries, 9 and none that address cost related issues. In this report, we describe the experience with VNS therapy in children with refractory epilepsy from the two major university hospitals in Jordan, and perform an analysis of direct hospital costs and cost utility.…”

Section: Introductionmentioning

confidence: 99%