Vagus nerve stimulation in the treatment of patients with pharmacoresistant epilepsy: our experiences [Stimulacija vagusnog živca u liječenju bolesnika s farmakorezistentnom epilepsijom: naša iskustva]

Hajnšek, Sanja and Petelin, Željka and Poljaković, Zdravka and Mrak, Goran and Paladino, Josip and Desnica, Andrej (2011) Vagus nerve stimulation in the treatment of patients with pharmacoresistant epilepsy: our experiences [Stimulacija vagusnog živca u liječenju bolesnika s farmakorezistentnom epilepsijom: naša iskustva]. Collegium Antropologicum, 35 (3). pp. 755-760. ISSN 0350-6134

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Abstract

Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients older than 12 years was approved in Europe in 1994 and in the United States in 1997. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Centre Zagreb. From 1997 to 2001 we have implanted VNS in 11 patients with pharmacoresistant epilepsy, who were magnetic resonance imaging (MRI) negative and from May 2007 to May 2009 in 11 patients with pharmacoresistant epilepsy, 9 of them were MRI positive, and were inoperable due to localisation of the pathomorphologic changes (ganglioglioma, hamartoma, various types of cortical dysplasia, porencephalic cysts), 2 were MR negative. In the group of MRI negative patients 1 patient had complex partial seizures (CPS), 6 patients had CPS with secondary generalisation, 2 patients had primary generalized epilepsy (PGE) including myoclonic, absence, atonic and tonic-clonic seizures, one patient had PGE and CPS, and 3 patients had Lennox-Gastaut syndrome (LGS). In the group of MRI positive patients one patient had elementary partial seizures (EPS) and CPS, two patients had EPS and CPS with secondary generalisation, one patient had CPS, 3 patients had CPS with secondary generalisation, and 2 patients had CPS with secondary generalisation as well as atonic seizures. After continuous follow-up of 11 MRI negative patients during 5 years and 2 MRI negative patients during one year there was decrease in mean-seizure frequency of 51.67%. After continuous follow-up of 9 MRI positive patients during 2 years there was decrease in mean-seizure frequency of 61.9%. The most frequent side effects were hoarseness, throat pain and cough in the "on phase" of the VNS, but they were mild and transitory. We can conclude that VNS was effective mode of therapy in our group of patients with pharmacoresistant epilepsy.

Abstract in Croatian

Stimulator vagusnog živca (engl. Vagus nerve stimulator – VNS) odobren je za liječenje refraktornih parcijalnih epileptičkih ataka s ili bez sekundarne generalizacije u bolesnika starijih od 12 godina u Europi 1994. godine i u SAD-u 1997. godine. U našem smo istraživanju pratili učinkovitost VNS-a u bolesnika s farmakorezistentnom epilepsijom koji su hospitalizirani u Klinici za neurologiju Kliničkog bolničkog centra Zagreb. Od 1997. do 2001. godine VNS je ugrađen u 11 bolesnika s farmakorezistentnom epilepsijom, koji su bili MR (magnetska rezonanca) negativni, a od svibnja 2007. do svibnja 2009. godine u 11 bolesnika s farmakorezistentnom epilepsijom, od kojih je 9 bilo MR pozitivno, i nisu bili kandidati za resektivno neurokirurško liječenje zbog lokalizacije patomorfoloških promjena (gangliogliomi, hamartomi, različiti tipovi kortikalne displazije, porencefalične ciste), a 2 bolesnika bilo je MR negativno. U grupi MR negativnih bolesnika jedan bolesnik je imao kompleksne parcijalne epileptičke atake (engl. complex partial seizures - CPS), 6 bolesnika imalo je CPS sa sekundarnom generalizacijom, 2 bolesnika imalo je primarno generaliziranu epilepsiju (PGE) uključujući mioklone, absence, atoničke i toničko-kloničke epileptičke napadaje, jedan bolesnik imao je PGE i CPS, a 3 bolesnika imalo je Lennox-Gastautov sindrom (LGS). U grupi MR pozitivnih bolesnika jedan bolesnik imao je elementarne parcijalne epileptičke atake (engl. elementary partial seizures - EPS) i CPS, dva bolesnika imala su EPS i CPS sa sekundarnom generalizacijom, jedan bolesnik imao je CPS, 3 bolesnika imala su CPS sa sekundarnom generalizacijom, a 2 bolesnika imala su CPS sa sekundarnom generalizacijom kao i atoničke atake. Nakon kontinuiranog praćenja 11 MR negativnih bolesnika tijekom 5 godina te 2 MR negativna bolesnika tijekom godine dana nađeno je smanjenje u prosječnoj učestalosti epileptičkih ataka za 51,67%. Nakon kontinuiranog praćenja 9 MR pozitivnih bolesnika tijekom 2 godine nađeno je smanjenje u prosječnoj učestalosti epileptičkih ataka za 61,9%. Najčešće nuspojave bile su promuklost, bol u grlu i kašalj u »on-fazi« rada stimulatora. Navedene nuspojave bile su blagog intenziteta i prolaznog karaktera. Stimulacija vagusnog živca pokazala se kao učinkovit način liječenja u našoj grupi bolesnika s farmakorezistentnom epilepsijom.

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