Abstracts

Rationale: Successful epilepsy surgery (Engel classes I and II) accounts for 74% of our series of 2000+ patients at Instituto de Neurologia de Goi⮩a. The remaining 26% have limited therapeutic options beyond the first surgery and reoperation was offered to 203 cases. In recent years, the option of VNS was an important addition to our therapeutic arsenal and we present the results of 17 such cases. Methods: Prospective analysis of implanted VNS patients in the last eight years. Patients without prior epilepsy surgery were excluded. Reduction of seizure frequency was rated in percentage and patients were grouped in focal or generalized epilepsies. Results: Seventeen patients with previous epilepsy surgery underwent VNS implantation. Ten of them had generalized epilepsies and were submitted to callosotomies. Seven had focal epilepsies; five of them had two previous surgeries, one had three and one had four. In the group of generalized epilepsies (n = 10), four (40%) had greater than 80% reduction in seizure frequency. In the group of focal epilepsies (n = 7), three (43%) had greater than 80% reduction in seizure frequency. Conclusions: For the majority of patients with poor response to epilepsy surgery, a second operation is generally indicated. When reoperation is not indicated or still not sufficient to provide seizure control, VNS therapy should be considered. Funding: None.