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Preliminary reports have suggested that chronic,intermittent stimulation of the vagus nerve(VNS)is an alternative treatment for patients with medically refractory seizures.We performed a multicenter,randomized, controlled trial to evaluate the efficacy and safety of adjunctive NVS in patients with poorly controlled partial seizures.An implanted,programmable pacemaker-like device was connected to two stimulating electrodes wrapped around the left vagus nerve.One hundred fourteen patients were randomized to receive 14 weeks of high-level stimulation(presumed therapeutic dose)or low-level stimulation(presumed subtherapeutic dose)using a blinded, parallel study design.Seizure frequency was compared with a 12-week baseline.Mean reduction in seizure frequency was 24.5%for the"high" stimulation group versus 6.1%for the"low"stimulation group(p=0.01).Thirty- one percent of patients receiving high stimulation had a seizure frequency reduction of>/=50%,versus 13%of patients in the low group(p=0.02). Treatment emergent side effects were largely limited to a transient hoarseness occurring during the stimulation train.One patient with no previous history of cardiac disease experienced a myocardial infarction during the third month of vagal stimulation.VNS may be an effective alternative for patients who have failed antiepileptic drug therapy and are not optimal candidates for epilepsy surgery. |
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seizure
seizure,intractable
seizure,intractable,treatment of
seizure,treatment of
treatment of neurologic disorder
vagus nerve
vagus nerve stimulation
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