EEG Reactivity Predicts Individual Efficacy of Vagal Nerve Stimulation in Intractable Epileptics

Conclusion: We present a new statistical model with which EEG reactivity to external stimuli during routine presurgical evaluation can be seen as a promising avenue for the identification of patients with favorable VNS outcome. This novel method for the prediction of VNS efficacy might represent a breakthrough in the management of drug-resistant epilepsy, with wide-reaching medical and economic implications. Introduction Resective surgery is currently the best therapeutic option for treatment of patients with drug-resistant epilepsy, but a substantial number of intractable patients remains who are ineligible for such treatment or for whom resective surgery fails to abolish seizures. Chronic vagal nerve stimulation (VNS) has become a well-established alternative, offering a palliative method of treatment for drug-resistant epilepsy; it rarely results in complete seizure freedom (~5% of treated patients), but provides substantial (≥50%) seizure reduction in 50–60% of individuals. Unfortunately, however, seizure frequency remains unchanged after VNS therapy in ~25% of patients (1, 2). Identifying individuals who will benefit from VNS therapy prior to the implantation of the VNS device would improve patient selection, minimize unnecessary surgical procedures, and reduce associated financial expenses dramatically; and yet there exists no method with which to predict individual efficacy pre-intervention (2). Achieving a pre-operative classific...
Source: Frontiers in Neurology - Category: Neurology Source Type: research