Lead revision surgery for vagus nerve stimulation in epilepsy

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Lead revision surgery for vagus nerve stimulation in epilepsy: Outcomes and efficacy

Authors: Hena Waseem, Scott J. Raffa , Selim R. Benbadis , Fernando L. Vale ,
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida,
Epilepsy Behav. 2014 Feb;31:110-3. doi: 10.1016/j.yebeh.2013.12.002. Epub 2014 Jan 3

Aim:

to analyse quality of life, clinical responses and antiepileptic burden after lead revision in VNS patients.

Methods:

Retrospective study in 10 patients (6 male; mean age 36 yrs and 4 females mean age 43 yrs) requiring lead revision. Follow up duration ranged from 1 – 8 years. Outcome measures were quality of life (standardized survey questionnaires: “much worse”, “worse”, “no change”, “better”, “much better”); seizure control (“less than 30%”, “30% to 60%”or “greater than 60%” reduction in seizure activity compared with preoperative levels); clinical response (“worse”, “no change” or “better” as compared with initial implantation, prior to device dysfunction) and antiepileptic burden (number of medications prescribed before and after VNS lead revision).

Results:

Seven patients had improvement in quality of life, and three experienced no change. Eight patients noted a restoration of clinical response comparable with initial VNS implantation. Seven patients reported 30–60% improvement in seizure reduction, two experienced >60%, and one noted <30%. Six patients had no change in AED burden. No surgical complications occurred.

http://www.ncbi.nlm.nih.gov/pubmed/24389021

Comments rerviewer, Prof van Nieuwenhuizen:

lead revisions are rare in VNS patients. Lead replacement is recommended in lead discontinuity confirmed by cervical X-rays or after a system diagnostic resulting in “high” or “low” impedance, with a confirmed functional generator diagnostic indicating “OK”. In this retrospective study, 14 out of 263 patients needed lead revision (5.3%); their common symptom being increased seizure frequency. Lead revision is performed through the cervical incision used for initial implantation. As dense adhesions and altered anatomy at the site of the electrodes are to be encountered, and taking into account the low incidence of lead revision, the technical skill of the surgeon is of great importance. This study shows that after lead revision, clinical response to VNS is restored, quality of life remains the same or is improved and AED burden remains stable.

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