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Epilepsy Behav. 2013 Sep;28(3):374-8. doi: 10.1016/j.yebeh.2013.05.021. Epub 2013 Jul 6.

Vagus nerve stimulation in refractory epilepsy: new indications and outcome assessment.

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Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.


Although vagus nerve stimulation (VNS) is an effective alternative option for patients with refractory epilepsy unsuitable for conventional resective surgery, predictors of a better control of seizure frequency and severity are still unavailable. This prospective study reports on 39 patients, including 4 children affected by epilepsia partialis continua (EPC), who underwent VNS for refractory epilepsy. The overall seizure frequency outcome was classified into three groups according to reduction rate: ≥75%, ≥50%, and <50%. Engel and McHugh classifications were also used. The median follow-up period was 36months. A seizure reduction rate ≥50% or EPC improvement was observed in 74% of the patients. Twenty-one out of 35 cases (60%) resulted in Engel classes II and III. Outcome, as defined by the McHugh scale, showed a responder rate of 71%. These results suggest that younger patient age and focal or multifocal epilepsy are related to a better seizure control and cognitive outcome. Vagus nerve stimulation could also be considered as an effective procedure in severe conditions, such as drug-refractory EPC.


Palliative surgery; Refractory epilepsy; Vagus nerve stimulation

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