Abstracts

RATIONALE: Patients with developmental delay (DD) and seizures pose special challenges in the treatment of epilepsy. Many patients with DD have medically refractory seizures, but due to their diffuse or multifocal neuronal dysfunction, these patients may be poor candidates for resective epilepsy surgery. Further treatment alternatives are clearly needed in these patients. Only limited published data are currently available regarding vagus nerve stimulation (VNS) in adults with epilepsy and DD. We present data on all adult VNS patients implanted at the University of Michigan with epilepsy, DD, and at least 3 months follow up.
METHODS: 24 patients with DD underwent placement of VNS for medically refractory seizures. Strict seizure calendars were kept, beginning 3 months prior to surgery. Patients were excluded if they had less than 3 months post surgical follow up (2 patients). Their devices were activated 2 weeks after implant procedure, stimulation parameters were gradually titrated up as tolerated, and medicines were not increased.
RESULTS: The 22 patients included in this study ranged in age from 18-50 years, and 6 patients (27%) were female. 8 patients (36%) resided in a supervised living environment. 3 patients had undergone prior resective surgery. 10 patients (45%) had symptomatic generalized epilepsy, and 12 patients (55%) had focal epilepsy. At latest post-implant follow up, 13 patients (59%) had at least a 50% improvement in seizure frequency, including 3 patients (14%) who had at least a 75% improvement, and 1 patient (5%) who was seizure free. No patients had worsening of seizure frequency. In 13 patients (59%), a majority of seizures were aborted or shortened with magnet-induced, on-demand stimulation. Behavioral improvement was noted in 4 patients (18%), while behavioral worsening was not noted in any patients. No surgical complications were seen in this group.
CONCLUSIONS: VNS has been successful in providing substantial improvement in seizures for the majority of developmentally delayed patients in this series. Additional benefits seen in a number of patients included termination or shortening of seizures with on-demand therapy, as well as improvement of behavior. VNS appears to be a safe and effective adjunctive treatment for seizures in developmentally delayed adults.
OBJECTIVE: At the end of this program, participants should be able to discuss the efficacy, safety and additional beneficial effects of VNS in developmentally delayed adults with epilepsy.
(Disclosure: Honoraria - Cyberonics, Inc.)