VNS in brain tumor patiënts

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Efficacy of vagus nerve stimulation as a treatment for medically intractable epilepsy in brain tumor patients. A case-controlled study using the VNS therapy Patient Outcome Registry

Kunal S. Patel a, Douglas R. Labar b, Charles M. Gordon c, Kevin H. Hassnain c, Theodore H. Schwartz

Seizure 22 (2013) 627–633

Purpose:

Vagus nerve stimulation (VNS) therapy is a procedure to control seizure frequency in patients with medically intractable epilepsy. However, there is no data on efficacy in the subset of these patients with brain tumors. The purpose of this study is to evaluate the efficacy of VNS therapy in patients with brain tumor-associated medically intractable epilepsy.

Methods:

Data from the VNS therapy Patient Outcome Registry, maintained by the manufacturer of the device, Cyberonics Inc. (Houston, TX, USA), was queried to characterize the response of patients in whom a brain tumor was listed as the etiology of epilepsy. A case–control analysis was implemented and patient outcome was measured by Engel classification, median seizure response and responder rate ( _50% seizure reduction) using t-tests and chi-squared tests.

Results:

In 107 patients with an epilepsy etiology related to a brain tumor, seizure reduction was 45% at 3 months and 79% at 24 months with a responder rate of 48% at 3 months and 79% at 24 months. There was no statistical difference in seizure reduction compared with 326 case–control patients from the registry without brain tumors. There was no significant difference in anti-epileptic drug (AED) usage from baseline to 24 months post implant in either group.

Discussion:

VNS therapy is equally effective in patients who suffer seizures secondary to brain tumors as in patients without history of a brain tumor. VNS therapy is a viable treatment option for patients with brain tumor associated medically intractable epilepsy, assuming cytoreductive and other adjuvant therapies have been fully explored.

http://www.ncbi.nlm.nih.gov/pubmed/23768541

Comments reviewer, Prof Van Nieuwenhuizen:

This is a paper with an important message as physicians may be reluctant to initiate VNS in this group of patients (suffering from brain tumor) because these patients are already heavily loaded with medical procedures. 30 – 50% of patients with brain tumors may suffer from epilepsy. As is the same for the population of epilepsy patients in general, one third will become intractable. Surgical resection of the tumor will bring seizure freedom in 30 – 60%. In a portion of the patients who are not seizure free after tumor resection, epilepsy surgery may provide a solution. However, there are still patients who cannot be treated by this approach. For those patients, vagal nerve stimulation can be a valuable option. In the VNS therapy Outcome Registry, 7383 patients were found. 114 of these had a brain tumor, which was the cause of epilepsy; 107 of them were included in the study. 1780 non-brain tumor patients were included as matched controls. At three months after operation seizure reduction of 45% was found; at 24 months of 79%. These results were not statistically different from non-tumor controls. The same was true for the responder rate. There are some limitations to this study. First of all, the tumor as such is not specified. So, benign and malignant tumors are analysed together. Secondly, the referral to the data base is voluntary, depending on readiness to take action of the physician. Thirdly, the clinical context in which the VNS was installed remained unverified. In conclusion, consideration of VNS therapy in brain tumor patients is an important issue in improving quality of life for these patients.

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