Abstracts

Rationale: Despite the wide variety of antiepileptic drugs (AEDs) currently available, about one-fourth of patients are not able to achieve seizure free status. Vagal nerve stimulation has been shown to be a safe and effective option for adults and children with seizures refractory to medical management. However, predicting which patients are the best candidates for VNS and defining markers of successful treatment of epilepsy with this method remains unclear. With the difficulties in access to health care after Hurricane Katrina, there is very limited data available about epilepsy and the impact of treatment in patients in Louisiana. This study analyzes the demographics and impact of VNS in adult patients with refractory seizures at a tertiary epilepsy center in New Orleans seen between 2010-2013. Methods: A non-comparative retrospective chart review was performed for seventeen patients. Patient records were analyzed before and after VNS for seizure qualities, frequency, associated disorders, treatment and outcome. Results: The average age of onset of seizures was 10.7 years old (range: 6 months-45 years old), including 11 female and 6 male patients. Patients had an average of 2 to 3 different types of seizures, most commonly complex partial and generalized tonic-clonic seizures. Before placement of VNS, patients experienced seizures for an average of 23 years (range 12-44 years) with the majority of patients experiencing their most common seizure at least once daily (range of biweekly to multiple per day). Five patients concurrently suffered from depression. Patients were prescribed an average of 3 AEDs, including drugs like felbatol, depakote, and phenobarbitol, in addition to VNS. Two patients underwent lobectomy procedures prior to VNS implantation, one with a left temporal lobectomy and the other with a partial corpus callosotomy and partial left frontal resection, and both were found to have better control of their seizures post VNS treatment. The overwhelming majority of patients experienced better control of their seizures after VNS implantation with decreased frequency of seizures ranging from seizure free to seizures weekly or monthly as opposed to daily.Conclusions: A large proportion of patients suffer from seizures intractable to medical management causing significantly decreased quality of life. Management of these patients has been a struggle for both patients and physicians. VNS is a safe and effective alternative that may reduce disease burden and considerably improve quality of life.