Patient-Specific Characteristics Associated with Favorable Response to Vagus Nerve Stimulation

• Published in: World neurosurgery Vol. 161; pp. e608 - e624
• Main Authors: Riestenberg, Robert A., Sherman, Alain E., Clark, Austin J.S., Shahlaie, Kiarash, Zwienenberg, Marike, Alden, Tord, Bandt, S. Kathleen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Drug Resistant Epilepsy - therapy; Hand; Humans; Medically refractory epilepsy; Prediction system; Retrospective Studies; Seizures; Vagus Nerve Stimulation; Medically refractory epilepsy; Prediction system; RPA; TTR; LOCF; MRI; CI; EEG; Vagus nerve stimulation; HR; VNS
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.02.055

The expansion in treatments for medically refractory epilepsy heightens the importance of identifying patients who are likely to benefit from vagus nerve stimulation (VNS). Here, we identify predictors with a positive VNS response. We present a retrospective analysis of 158 patients with medically refractory epilepsy. Patients were categorized as VNS responders or nonresponders. Baseline characteristics and time to VNS response were recorded. Univariate and multivariate Cox regression were used to identify predictors of response. Recursive partitioning analysis was used to identify likely VNS responders. Eighty-nine (56.3%) patients achieved ≥50% seizure frequency reduction. Left-hand dominance (hazard ratio [HR] 1.703, P = 0.038), age at epilepsy onset ≥15 years (HR 2.029, P = 0.005), duration of epilepsy ≥8 years (HR 1.968, P = 0.007) and age at implantation ≥35 years (HR 1.809, P = 0.020), and baseline seizure frequency <5/month (HR 1.569, P = 0.044) were significant univariate predictors of VNS response. Following multivariate Cox regression, left-hand dominance, age at epilepsy onset ≥15 years, and duration of epilepsy ≥8 years remained significant. With recursive partitioning analysis, patients with either age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month were stratified into Group A and had a 73.9% responder rate; the remaining patients stratified into Group B had a 43.8% responder rate. Patients with age at epilepsy onset ≥15 years, left-hand dominance, or baseline seizure frequency <5/month are ideal candidates for VNS.