Epilepsy Surgery and Vagal Nerve Stimulation: What All Neurologists Should Know

ABSTRACT

Epilepsy surgery treatment should be considered as standard of care for all patients with medically intractable partial-onset epilepsy who are found to be good surgical candidates based on their presurgical evaluation. Delaying surgical treatment continues to be a problem among neurologists. The early recognition of pharmacoresistance and patients' referral for presurgical evaluation can shorten the time to identify potential surgical candidates. A successful early surgery can be expected to significantly improve these patients' quality of life, not only because of a seizure-free state but also by improving psychiatric comorbidities. Vagal nerve stimulation (VNS) is currently the only FDA-approved neurostimulation treatment strategy for patients who are not considered candidates for epilepsy surgery. VNS has been shown to decrease seizure frequency by approximately 50% in 30 to 40% of implanted patients. The future of epilepsy surgery and neurostimulation for those individuals with medically intractable partial-onset epilepsy shows great promise.

KEYWORDS

Intractable epilepsy - temporal lobe epilepsy - frontal lobe epilepsy - mesial temporal sclerosis - neurostimulation

REFERENCES

• 1 Hauser W A. Incidence and prevalence. In: Engle J Jr, Pedley TA Epilepsy: A Comprehensive Textbook. Philadelphia, PA; Lippincott-Raven 1997: 47-57
• 2 Kwan P, Brodie M J. Refractory epilepsy: a progressive, intractable but preventable condition?.  Seizure. 2002;  11 77-84
• 3 Khoury J S, Winokur R S, Tracy J I et al.. Predicting seizure frequency after epilepsy surgery.  Epilepsy Res. 2005;  67 89-99
• 4 Kwan P, Brodie M J. Early identification of refractory epilepsy.  N Engl J Med. 2000;  342 314-319
• 5 French J A, Kanner A M, Bautista J et al.. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.  Neurology. 2004;  62 1261-1273
• 6 Morrell F, Whistler W W, Bleck T P. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy.  J Neurosurg. 1989;  70 231-239
• 7 Wiebe S, Blume W T, Girvin J P et al.. A randomized, controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med. 2001;  345 311-318
• 8 Spencer S S, Berg A T, Vickery B G et al.. Initial outcomes in the Multicenter Study of Epilepsy Surgery.  Neurology. 2003;  61 1680-1685
• 9 Engel Jr J, Wiebe S, French J et al.. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons.  Neurology. 2003;  60 538-547
• 10 Wiebe S, Blume W T, Girvin J P Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group et al.. A randomized, controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med. 2001;  345 311-318
• 11 Jeha L E, Najm I, Bingamen W et al.. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery.  Brain. 2007;  130(Pt 2) 574-584
• 12 Kossoff E H, Vining E P, Pillas D J et al.. Hemispherectomy for intractable unihemispheric epilepsy etiology vs outcome.  Neurology. 2003;  61 887-890
• 13 Devinsky O, Barr W B, Vickrey B G et al.. Changes in depression and anxiety after resective surgery for epilepsy.  Neurology. 2005;  65 1744-1749
• 14 Téllez-Zenteno J F, Dhar R, Hernandez-Ronquillo L, Wiebe S. Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects.  Brain. 2007;  130(Pt 2) 334-345
• 15 Sperling M R, Feldman H, Kinman J et al.. Seizure control and mortality in epilepsy.  Ann Neurol. 1999;  46 45-50
• 16 Kanner A M, Kaydanova Y, deToledo-Morrell L et al.. Tailored anterior temporal lobectomy: relation between extent of resection of mesial structures and postsurgical seizure outcome.  Arch Neurol. 1995;  52 173-178
• 17 McKhann II G M, Schoenfeld-McNeil J, Born D E et al.. Intraoperative hippocampal electrocorticography to predict the extent of hippocampal resection in temporal lobe epilepsy surgery.  J Neurosurg. 2000;  93 44-52
• 18 Berg A T, Vickrey B G, Langfitt J T et al.. Reduction of AEDs in postsurgical patients who attain remission.  Epilepsia. 2006;  47 64-71
• 19 Davies K G, Bell B D, Bush A J, Wyler A R. Prediction of verbal memory loss in individuals after anterior temporal lobectomy.  Epilepsia. 1998;  39 820-828
• 20 Van Wagenen W P, Herren R Y. Surgical division of commissural pathways in the corpus callosum: relation to spread of an epileptic attack.  Arch Neurol Psychiatry. 1940;  44 740-759
• 21 Nei M, O'Connor M, Liporace J, Sperling M R. Refractory generalized seizures: response to corpus callosotomy and vagal nerve stimulation.  Epilepsia. 2006;  47 115-122
• 22 Dichter M A, Brodie M J. Drug therapy: new antiepileptic drugs.  N Engl J Med. 1996;  334 1583-1590
• 23 Bauman J A, Ridgway E B, Devinsky O, Doyle W K. Subpectoral implantation of the vagus nerve stimulator.  Neurosurgery. 2006;  58(suppl 2) ONS-322-ONS-325
• 24 DeGiorgio C M, Schachter S C, Handforth A et al.. Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures.  Epilepsia. 2000;  41 1195-1200
• 25 McHugh J C, Singh H W, Phillips J, Murphy K, Doherty C P, Delanty N. Outcome measurement after vagal stimulation therapy: proposal of a new classification.  Epilepsia. 2007;  48 375-378
• 26 Vonck K, Thadani V, Gilbert K et al.. Vagus nerve stimulation for refractory epilepsy: a transatlantic experience.  J Clin Neurophysiol. 2004;  21 283-289
• 27 Nadkarni S, LaJoie J, Devinsky O. Current treatments of epilepsy.  Neurology. 2005;  64(suppl 3) S2-S11
• 28 Buoni S, Mariottini A, Pieri S et al.. Vagus nerve stimulation for drug-resistant epilepsy in children and young adults.  Brain Dev. 2004;  26 158-163
• 29 Wilfong A A, Schultz R J. Vagus nerve stimulation for treatment of epilepsy in Rett syndrome.  Dev Med Child Neurol. 2006;  48 683-686
• 30 Blount J P, Tubbs R S, Kankirawatana P et al.. Vagus nerve stimulation in children less than 5 years old.  Childs Nerv Syst. 2006;  22 1167-1169
• 31 Bremer A, Eriksson A S, Roste G K, Knudtzen B, Nakken K O. Vagal nerve stimulation in children with drug-resistant epilepsy.  Tidsskr Nor Laegeforen. 2006;  126 896-898
• 32 Saneto R P, Sotero de Menezes M A, Ojemann J G et al.. Vagus nerve stimulation for intractable seizures in children.  Pediatr Neurol. 2006;  35 323-326
• 33 Alexopoulos A V, Kotogal P, Loddenkemper T, Hammel J, Bingaman W E. Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy.  Seizure. 2006;  15 491-503
• 34 Ghacibeh G A, Shenker J I, Shenal B, Uthman B M, Heilman K M. The influence of vagus nerve stimulation on memory.  Cogn Behav Neurol. 2006;  19 119-122
• 35 Schachter S C. Vagus nerve stimulation: mood and cognitive effects.  Epilepsy Behav. 2004;  5(suppl 1) S56-S59
• 36 Harden C L, Pulver M C, Ravdin L D et al.. A pilot study of mood in epilepsy patients treated with vagus nerve stimulation.  Epilepsy Behav. 2000;  1 93-99
• 37 Amar A P, Apuzzo M L. Vagus nerve stimulation therapy for patients with persistent seizures after epilepsy surgery.  Stereotact Funct Neurosurg. 2003;  80(1–4) 9-13
• 38 Amar A P, Apuzzo M L, Liu C Y. Vagus nerve stimulation therapy after failed cranial surgery for intractable epilepsy: results from the vagus nerve stimulation patient outcome registry.  Neurosurgery. 2004;  55 1086-1093
• 39 Spanaki M V, Allen L S, Mueller W M, Morris G L. Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center.  Seizure. 2004;  13 587-590
• 40 MacDonald J, Couldwell W T. Revision of vagal nerve stimulator electrodes: technical approach.  Acta Neurochir (Wien). 2004;  146 567-570