Long-term results of electrical stimulation of the left vagus nerve in treatment of drug-resistant epilepsy in patients of different ages

Currently, the effectiveness of medical and surgical treatment of focal forms does not exceed 75 %. In cases when control over attacks by means of conservative therapy is not possible, and resection indications for surgical intervention are not present, the use of vagus nerve electrical stimulation is recommended.

The study objective is to evaluate the effectiveness of vagus nerve electrical stimulation in treatment of drug-resistant epilepsy depending on the type of the disease and patient age.

Materials and methods. Retrospective analysis of treatment results of 45 patients (22 children between 2 and 17 years of age (mean age 12.3 years) and 23 adults between 18 and 62 years of age (mean age 29.4 years)) with drug-resistant epilepsy was performed. All patients were implanted with electric stimulator of the left vagus nerve. Control examination was carried out 1 year after surgery, the evaluation method – McHugh scale.

Results. In the child group, the results corresponded to class I per the McHugh sale in 30 % of cases, class II – in 26 %; class III – in 26 %, class IV – in 18 %. In the adult group, the results corresponded to class I in 18 % of cases, class II – in 19 %, class III – in 37 %, class IV – in 26 %. In patients with duration of the disease >10 years, results of electrical stimulation were good or excellent in 44 % of cases, for patients with duration between 5 and 10 years – in 40 % of cases, with duration <5 years – in 60 %, but due to small sample size the results are not statistically significant. In patients with simple partial seizures, the treatment was effective in 4 (54 %) of 7 cases, in patients with generalized seizures – in 16 (42.8 %) of 38 cases. The best results were also obtained for interventions in patients between 10 and 15 years of age.

Conclusion. Children respond better to vagus nerve electrical stimulation; in the adult age group, it is noted that patients with aura have a better response to therapy with vagus nerve electrical stimulation; smaller epianamnesis is associated with better efficiency; patients with symptomatic epilepsy have a worse response to therapy, than patients with cryptogenic epilepsy; there were no gender differences in the effectiveness of vagus nerve electrical stimulation.

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