Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study

Javier Peña-Ceballos; Patrick B Moloney; Antonio Valentin; Cara O'Donnell; Niamh Colleran; Brenda Liggan; Breege Staunton-Grufferty; Patricia Ennis; Roger Grogan; Gerard Mullins; Daniel J Costello; Colin P Doherty; Kieron J Sweeney; Hany El Naggar; Ronan D Kilbride; Peter Widdess-Walsh; Donncha O'Brien; Norman Delanty

doi:10.1016/j.seizure.2023.09.019

Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study

Javier Peña-Ceballos, Patrick B Moloney, Antonio Valentin, Cara O'Donnell, Niamh Colleran, Brenda Liggan, Breege Staunton-Grufferty, Patricia Ennis, Roger Grogan, Gerard Mullins, Daniel J Costello, Colin P Doherty, Kieron J Sweeney, Hany El Naggar, Ronan D Kilbride, Peter Widdess-Walsh, Donncha O'Brien, Norman Delanty

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Abstract

OBJECTIVE: Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE.

METHODS: We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort.

RESULTS: Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy.

SIGNIFICANCE: Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.

Original language	English
Pages (from-to)	98-105
Number of pages	8
Journal	Seizure
Volume	112
DOIs	https://doi.org/10.1016/j.seizure.2023.09.019
Publication status	Published - Nov 2023

Keywords

Adult
Humans
Female
Male
Vagus Nerve Stimulation/methods
Retrospective Studies
Epilepsy, Generalized/therapy
Drug Resistant Epilepsy/therapy
Myoclonus
Seizures
Immunoglobulin E
Treatment Outcome
Vagus Nerve

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Peña-Ceballos, J., Moloney, P. B., Valentin, A., O'Donnell, C., Colleran, N., Liggan, B., Staunton-Grufferty, B., Ennis, P., Grogan, R., Mullins, G., Costello, D. J., Doherty, C. P., Sweeney, K. J., El Naggar, H., Kilbride, R. D., Widdess-Walsh, P., O'Brien, D., & Delanty, N. (2023). Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study. Seizure, 112, 98-105. https://doi.org/10.1016/j.seizure.2023.09.019

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title = "Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study",

abstract = "OBJECTIVE: Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE.METHODS: We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort.RESULTS: Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy.SIGNIFICANCE: Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.",

keywords = "Adult, Humans, Female, Male, Vagus Nerve Stimulation/methods, Retrospective Studies, Epilepsy, Generalized/therapy, Drug Resistant Epilepsy/therapy, Myoclonus, Seizures, Immunoglobulin E, Treatment Outcome, Vagus Nerve",

author = "Javier Pe{\~n}a-Ceballos and Moloney, {Patrick B} and Antonio Valentin and Cara O'Donnell and Niamh Colleran and Brenda Liggan and Breege Staunton-Grufferty and Patricia Ennis and Roger Grogan and Gerard Mullins and Costello, {Daniel J} and Doherty, {Colin P} and Sweeney, {Kieron J} and {El Naggar}, Hany and Kilbride, {Ronan D} and Peter Widdess-Walsh and Donncha O'Brien and Norman Delanty",

note = "Copyright {\textcopyright} 2023. Published by Elsevier Ltd.",

year = "2023",

month = nov,

doi = "10.1016/j.seizure.2023.09.019",

language = "English",

volume = "112",

pages = "98--105",

journal = "Seizure",

issn = "1059-1311",

publisher = "W.B. Saunders Ltd",

}

Peña-Ceballos, J, Moloney, PB, Valentin, A, O'Donnell, C, Colleran, N, Liggan, B, Staunton-Grufferty, B, Ennis, P, Grogan, R, Mullins, G, Costello, DJ, Doherty, CP, Sweeney, KJ, El Naggar, H, Kilbride, RD, Widdess-Walsh, P, O'Brien, D & Delanty, N 2023, 'Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study', Seizure, vol. 112, pp. 98-105. https://doi.org/10.1016/j.seizure.2023.09.019

TY - JOUR

T1 - Vagus nerve stimulation in refractory idiopathic generalised epilepsy

T2 - An Irish retrospective observational study

AU - Peña-Ceballos, Javier

AU - Moloney, Patrick B

AU - Valentin, Antonio

AU - O'Donnell, Cara

AU - Colleran, Niamh

AU - Liggan, Brenda

AU - Staunton-Grufferty, Breege

AU - Ennis, Patricia

AU - Grogan, Roger

AU - Mullins, Gerard

AU - Costello, Daniel J

AU - Doherty, Colin P

AU - Sweeney, Kieron J

AU - El Naggar, Hany

AU - Kilbride, Ronan D

AU - Widdess-Walsh, Peter

AU - O'Brien, Donncha

AU - Delanty, Norman

PY - 2023/11

Y1 - 2023/11

N2 - OBJECTIVE: Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE.METHODS: We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort.RESULTS: Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy.SIGNIFICANCE: Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.

AB - OBJECTIVE: Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE.METHODS: We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort.RESULTS: Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy.SIGNIFICANCE: Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.

KW - Adult

KW - Humans

KW - Female

KW - Male

KW - Vagus Nerve Stimulation/methods

KW - Retrospective Studies

KW - Epilepsy, Generalized/therapy

KW - Drug Resistant Epilepsy/therapy

KW - Myoclonus

KW - Seizures

KW - Immunoglobulin E

KW - Treatment Outcome

KW - Vagus Nerve

U2 - 10.1016/j.seizure.2023.09.019

DO - 10.1016/j.seizure.2023.09.019

M3 - Article

C2 - 37778300

SN - 1059-1311

VL - 112

SP - 98

EP - 105

JO - Seizure

JF - Seizure

ER -

Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study

Abstract

Keywords

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