vagal nerve stimulation is an add on therapy for refractory epilepsy

1. TwoYear Experience ofVNS
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

2.  “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.

3.  Vagus nerve stimulation (VNS) is
approved by Food and Drug Administration
(FDA) for management of intractable
epilepsy in 1997.
 It is possible thatVNS 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.

4. Patients and method:
 A retrospective study evaluating ,
Thirty-four patients diagnosed as refractory
epilepsy according to ILAE criteria who had been
operated forVNS 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.

5.  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.

7.  Two weeks after implantation
first programming was done and then
periodic programming every two weeks
depending on clinical assessment.

9. 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.

10. 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

11. severity of the
attacks frequency of the
attacks/month No.of the drugs
118.95
225.04
2.95
54
50.65
2.43
before implantation
after implantation

12. 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%

13. 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

14. 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%

15. improvement in the
severity 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

16. 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

17. 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.

18. 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.

19. THANKYOU