Two Year Experience of VNS

Efficacy in Refractory Epilepsy in Iraq

(Neurosciences Hospital)

Mohammad A.S. Kamil, Zaki Nooh Hasan, Sajid Ibrahim Kadhim, Ahmed A Salam Al Atraqchi ,Aqeel

Kareem Hatim ,Moneer K. Faraj

“Patients who fail two AED medications used appropriately are likely to have a medically refractory seizure disorder and should be investigated for alternative forms of treatment.

Potential treatment options include experimental drug trials, surgical treatment, electrical stimulation and combination of the above.

Vagus nerve stimulation (VNS) is approved by Food and Drug Administration

(FDA) for management of intractable epilepsy in 1997.

It is possible that VNS may interrupt the spread of epileptiform activity if delivered at a theoretically critical time; It is possible that VNS causes small changes in brain dynamics resulting in larger effects that inhibit the brain from becoming dynamically entrained, thus interrupting any progression towards a clinical seizure.

Patients and method:

A retrospective study evaluating ,

Thirty-four patients diagnosed as refractory epilepsy according to ILAE criteria who had been operated for VNS implantation by a team of neurologists and neurosurgeons in neurosciences hospital in Baghdad, they were interviewed at epilepsy center, by taking thorough history and revaluation of the epilepsy state, frequency and severity of the attacks, number of the anti-epileptic drugs (AEDs), duration of the epilepsy before and after the implantation of the device was assessed.

Twenty-one male thirteen females were enrolled in the study .

The first implant in Neurosciences hospital in Iraq was at 24-2-2008 and last one in 5-1-2009 which included in this study,all subjects consented to participate in the research prior to their inclusion in the study, and the local ethics committee approved the study protocol.

Two weeks after implantation

first programming was done and then periodic programming every two weeks depending on clinical assessment.

RESULTS

1) Improvement in the severity of the attacks.

2) Frequency of the seizure attacks before and after implantation of the device.

3) No. of the AED before and after implantation of the device.

4) Adverse effects of the device on the patients.

Severity of the attacks:

Severity of the attacks

NO.

Implantation of device

Mean± SD t P value

34 before 118.95±40.36

9.37 <or= 0.005

after 54±38.53

severity of theattacks frequency of the

attacks/month No.of the drugs

118.95

225.04

2.95

54 50.65

2.43

before implantation

after implantation

Improvement in the severity of the attacks

Severity

of the

attacks

100%

improvemen

t

50%-99%

improvemen

t

<50% Improveme

nt

No improvemen

t

9(34) 26.5%

9(34) 26.5%

16(34) 47%

0(34) 0%

Frequency of the seizure attacks before and after implantation of the device

Frequenc

y of the

attacks/ month

N Implantatio

n of the

device

Mean ± SD t P value

34 Before 225.04±244.2 3.49 0.0022

After 50.65±74.35

Improvement in the frequency of the attacks per month

Frequency of

seizure attacks

/month

100%

improvement >50%

improveme

nt

<50%

improvement No

improvement

9(34) 26.5%

13(34) 38%

5(34) 14.7%

7(34) 20.5%

improvement in theseverity of attacks improvement in the

frequency /month

26.5 26.5

26.5

38

47

14.7

0

20.5

100%

50% -- 99%

<50%

no improvement

No. of the AED before and after implantation of the device

No. Of

the drugs

N Implantation

of the device Mean ±

SD T P value

34 Before 2.95±0.67 2.95 0.007

After 2.43±0.81

Adverse effects of the device on the patients Statistical analysis of the side

effects observed by the patients after implantation of the device shows hoarseness of the voice the most common side

effect 55.8%. Followed by dysphagia 41%, cough, dyspnea,

palpitation 14.7%, and headache5.8%. The device were removed in 4 patients because

of the Infection at the site of the device in one patient; Aspiration pneumonia in one, Suicidal attempt in one and Loss of contact in one.

Conclusions

Vagal nerve stimulation is a good adjunctive tool of therapy added on drug therapy for patient with refractory epilepsy.

It is effective safe and well tolerated in our patient.

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