The Use of Vagus Nerve Stimulation in the Treatment of Pharmacoresistant Epilepsy

Abstract

Pharmacoresistant epilepsy (PRE) is a form of the disease in which seizures continue despite adequate antiepileptic therapy with two peptides in the form of monotherapy or in combination. Due to the fact that resection and destructive surgical methods of treatment are not available for patients with drug-resistant primary generalized, multifocal seizures, or with the location of the epileptogenic zone in such patients in functionally significant areas of the brain, it is currently urgent to search for alternative minimally invasive treatment methods. One of these techniques is vagus nerve stimulation (VNS). To date, studies have been conducted reporting the efficacy and/or safety of VNS in epilepsy and its concomitant diseases. Objective — to evaluate the efficacy and safety of vagus nerve stimulation (VNS) in patients with a pharmacoresistant form of epilepsy. Materials and methods. 13 patients diagnosed with PRE aged 9 to 50 years were implanted with a VNS system based on City Clinical Hospital No. 40 (Ekaterinburg; 2022–2023). The duration of the catamnesis was 2–16 months. Results. A decrease in the number of seizures of the most disabling (dominant) type was revealed in 2 patients (15.4 %) with an installed stimulant in 2022, 3 patients (23.1 %) operated on in the same year noted the cessation of seizures for 2 months — 1.5 years; further adjustment of the stimulator is necessary. Positive dynamics was noted in patients who underwent VNS installation in 2023, however, the assessment of remission (reduction) in the frequency of seizures requires further monitoring. Anticonvulsant therapy is fully indicated in 5 patients (38.5 %), reducing the dose of drugs taken is recommended in 4 patients (30.8 %), reducing the dosage of the antiepileptic drug used with titration (gradual) withdrawal in 3 patients (23.1 %). Side effects on the background of VNS were observed in 2 patients (15.4 %). Conclusions. Vagus nerve stimulation has proven to be a safe and effective additional treatment method for patients with PRE. The technique allows you to reduce the frequency and severity of epileptic seizures. VNS is used in the treatment of pharmacoresistant epilepsy in patients who are not medically available for resection or destructive surgical techniques, or in patients who have already been operated on with unsatisfactory results.

For citation
Postnikova EА, Lazarev AYu, Kolotvinov VS, Shamov AYu. The use of vagus nerve stimulation in the treatment of pharmacoresistant epilepsy. Bulletin of USMU. 2024;(1):57–66. (In Russ.). EDN: https://elibrary.ru/XXPNHO.