Generator replacement in epilepsy patients treated with vagus nerve stimulation

Vonck, Kristl; Dedeurwaerdere, Stefanie; De Groote, Liesbeth; Thadani, Vijay; Claeys, Pieter; Gossiaux, Fleur; Van Roost, Dirk; Boon, Paul

doi:10.1016/J.SEIZURE.2004.11.001

Title

Generator replacement in epilepsy patients treated with vagus nerve stimulation

Author

Vonck, Kristl

Dedeurwaerdere, Stefanie

De Groote, Liesbeth

Thadani, Vijay

Claeys, Pieter

Gossiaux, Fleur

Van Roost, Dirk

Boon, Paul

Abstract

Purpose: In epilepsy patients treated with vagus nerve stimulation (VNS), the occurrence of end of battery life (EOBL), when the generator will no Longer deliver any stimulation, was investigated with regard to seizure control. EOBL is preceeded by end of effective stimulation (EOES) when irregular stimulation may occur. Methods: In 14/78 patients, treated with VNS at Ghent University Hospital, generators were replaced at different times following EOES or EOBL. We retrospectively analysed the time of occurrence of EOES and EOBL and seizure control before and after generator replacement. Results: EOES or EOBL was indicated by Loss of seizure control, decreased perception of stimulation and recurrence of depression in 3, 3 and 1/14 patient(s), respectively. In 2 and 1/14 patient(s), EOBL and premature generator failure, respectively, were detected during routine check-up at the epilepsy clinic. In 4/14 patients, generator replacement was performed before estimated EOES. Pre-replacement seizure control could not be regained in 2/14 patients in whom replacement had been postponed for several months. Estimation of EOES and EOBL occurrence proved difficult in individual patients. Conclusion: EOES or EOBL may be indicated by toss of seizure control, decreased or irregular perception of stimulation by the patient and loss of other VNS-induced effects. Postponing generator replacement may result into permanent loss of seizure control. In responders we suggest generator replacement before EOBL. Our results call for performance of prospective studies in larger patient groups that may eventually lead to general guidelines on the indication and timing of generator replacement. (C) 2004 BEA Trading Ltd. Published by Elsevier Ltd. All rights reserved.

Language

English

Source (journal)

Seizure: European journal of epilepsy. - London

Publication

London : 2005

ISSN

1059-1311

DOI

10.1016/J.SEIZURE.2004.11.001

Volume/pages

14 :2 (2005) , p. 89-99