Efficacy of vagus nerve stimulation in brain tumor–associated intractable epilepsy and the importance of tumor stability

Clinical article

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Object

Vagus nerve stimulation (VNS) is a viable option for patients with medically intractable epilepsy. However, there are no studies examining its effect on individuals with brain tumor–associated intractable epilepsy. This study aims to evaluate the efficacy of VNS in patients with brain tumor–associated medically intractable epilepsy.

Methods

Epilepsy surgery databases at 2 separate epilepsy centers were reviewed to identify patients in whom a VNS device was placed for tumor-related intractable epilepsy between January 1999 and December 2011. Preoperative and postoperative seizure frequency and type as well as antiepileptic drug (AED) regimens and degree of tumor progression were evaluated. Statistical analysis was performed using odds ratios and t-tests to examine efficacy.

Results

Sixteen patients were included in the study. Eight patients (50%) had an improved outcome (Engel Class I, II, or III) with an average follow-up of 39.6 months. The mean reduction in seizure frequency was 41.7% (p = 0.002). There was no significant change in AED regimens. Seizure frequency decreased by 10.9% in patients with progressing tumors and by 65.6% in patients with stable tumors (p = 0.008).

Conclusions

Vagus nerve stimulation therapy in individuals with brain tumor–associated medically intractable epilepsy was shown to be comparably effective in regard to seizure reduction and response rates to the general population of VNS therapy patients. Outcomes were better in patients with stable as opposed to progressing tumors. The authors' findings support the recommendation of VNS therapy in patients with brain tumor–associated intractable epilepsy, especially in cases in which imminent tumor progression is not expected. Vagus nerve stimulation may not be indicated in more malignant tumors.

Abbreviations used in this paper:AED = antiepileptic drug; VNS = vagus nerve stimulation.

Article Information

Address correspondence to: Theodore H. Schwartz, M.D., Departments of Neurological Surgery, Neurology, Neuroscience, and Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box #99, New York, New York 10065. email: schwarh@med.cornell.edu.

Please include this information when citing this paper: published online April 19, 2013; DOI: 10.3171/2013.3.JNS121890.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Amar APApuzzo MLLiu CY: Vagus nerve stimulation therapy after failed cranial surgery for intractable epilepsy: results from the vagus nerve stimulation therapy patient outcome registry. Neurosurgery 62:Suppl 25065132008

2

Amar APDeGiorgio CMTarver WBApuzzo ML: Long-term multicenter experience with vagus nerve stimulation for intractable partial seizures: results of the XE5 trial. Stereotact Funct Neurosurg 73:1041081999

3

Amar APHeck CNLevy MLSmith TDeGiorgio CMOviedo S: An institutional experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome. Neurosurgery 43:126512801998

4

Ardesch JJBuschman HPWagener-Schimmel LJvan der Aa HEHageman G: Vagus nerve stimulation for medically refractory epilepsy: a long-term follow-up study. Seizure 16:5795852007

5

Awad IARosenfeld JAhl JHahn JFLüders H: Intractable epilepsy and structural lesions of the brain: mapping, resection strategies, and seizure outcome. Epilepsia 32:1791861991

6

Ben-Menachem E: Vagus nerve stimulation for treatment of seizures?. Arch Neurol 55:2312321998

7

Ben-Menachem EMañon-Espaillat RRistanovic RWilder BJStefan HMirza W: Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. Epilepsia 35:6166261994

8

Berg ATLangfitt JShinnar SVickrey BGSperling MRWalczak T: How long does it take for partial epilepsy to become intractable?. Neurology 60:1861902003

9

Berg ATShinnar SLevy SRTesta FMSmith-Rapaport SBeckerman B: Two-year remission and subsequent relapse in children with newly diagnosed epilepsy. Epilepsia 42:155315622001

10

Cascino GD: Epilepsy and brain tumors: implications for treatment. Epilepsia 31:Suppl 3S37S441990

11

Cascino GDKelly PJHirschorn KAMarsh WRSharbrough FW: Stereotactic resection of intra-axial cerebral lesions in partial epilepsy. Mayo Clin Proc 65:105310601990

12

Chavel SMWesterveld MSpencer S: Long-term outcome of vagus nerve stimulation for refractory partial epilepsy. Epilepsy Behav 4:3023092003

13

Cramer JA: Exploration of changes in health-related quality of life after 3 months of vagus nerve stimulation. Epilepsy Behav 2:4604652001

14

de Groot MReijneveld JCAronica EHeimans JJ: Epilepsy in patients with a brain tumour: focal epilepsy requires focused treatment. Brain 135:Pt 4100210162012

15

De Herdt VBoon PCeulemans BHauman HLagae LLegros B: Vagus nerve stimulation for refractory epilepsy: a Belgian multicenter study. Eur J Paediatr Neurol 11:2612692007

16

DeGiorgio CMSchachter SCHandforth ASalinsky MThompson JUthman B: Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 41:119512002000

17

Dodrill CBMorris GL: Effects of vagal nerve stimulation on cognition and quality of life in epilepsy. Epilepsy Behav 2:46532001

18

Duffau H: Surgery of low-grade gliomas: towards a ‘functional neurooncology’. Curr Opin Oncol 21:5435492009

19

Engel JJ JrVan Ness PRasmussen TOutcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of Epilepsies ed 2New YorkRaven Press1993. 609621

20

Englot DJBerger MSBarbaro NMChang EF: Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. Epilepsia 53:51572012

21

Englot DJBerger MSChang EFGarcia PA: Characteristics and treatment of seizures in patients with high-grade glioma: a review. Neurosurg Clin N Am 23:2272352012

22

Englot DJHan SJBerger MSBarbaro NMChang EF: Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors. Neurosurgery 70:9219282012

23

Ghareeb FDuffau H: Intractable epilepsy in paralimbic World Health Organization Grade II gliomas: should the hippocampus be resected when not invaded by the tumor? Clinical article. J Neurosurg 116:122612342012

24

Goldring SRich KMPicker S: Experience with gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 33:15421986

25

Handforth ADeGiorgio CMSchachter SCUthman BMNaritoku DKTecoma ES: Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 51:48551998

26

Huf RLMamelak AKneedy-Cayem K: Vagus nerve stimulation therapy: 2-year prospective open-label study of 40 subjects with refractory epilepsy and low IQ who are living in long-term care facilities. Epilepsy Behav 6:4174232005

27

Kerrigan SGrant R: Antiepileptic drugs for treating seizures in adults with brain tumours. Cochrane Database Syst Rev 8CD0085862011

28

Klein MEngelberts NHvan der Ploeg HMKasteleijn-Nolst Trenité DGAaronson NKTaphoorn MJ: Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54:5145202003

29

Kostov HLarsson PGRøste GK: Is vagus nerve stimulation a treatment option for patients with drug-resistant idiopathic generalized epilepsy?. Acta Neurol Scand Suppl 187:55582007

30

Labar D: Vagus nerve stimulation for 1 year in 269 patients on unchanged antiepileptic drugs. Seizure 13:3923982004

31

Landy HJRamsay RESlater JCasiano RRMorgan R: Vagus nerve stimulation for complex partial seizures: surgical technique, safety, and efficacy. J Neurosurg 78:26311993

32

Maniker ALiu WCMarks DMoser KKalnin A: Positioning of vagal nerve stimulators: technical note. Surg Neurol 53:1781812000

33

McGlone JValdivia IPenner MWilliams JSadler RMClarke DB: Quality of life and memory after vagus nerve stimulator implantation for epilepsy. Can J Neurol Sci 35:2872962008

34

Milby AHHalpern CHBaltuch GH: Vagus nerve stimulation in the treatment of refractory epilepsy. Neurotherapeutics 6:2282372009

35

Morris GL IIIMueller WM: Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01–E05. Neurology 53:173117351999

36

Phi JHChung CK: Brain tumors in the mesial temporal lobe: long-term oncological outcome. Neurosurg Focus 27:2E52009

37

Pierzchala K: [Pharmacoresistant epilepsy—epidemiology and current studies.]. Neurol Neurochir Pol 44:2852902010. (Polish)

38

Qaddoumi ISultan IGajjar A: Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the Surveillance, Epidemiology, and End Results database. Cancer 115:576157702009

39

Reid SA: Surgical technique for implantation of the neurocybernetic prosthesis. Epilepsia 31:Suppl 2S38S391990

40

Rossignol ELortie AThomas TBouthiller AScavarda DMercier C: Vagus nerve stimulation in pediatric epileptic syndromes. Seizure 18:34372009

41

Rudà RTrevisan ESoffietti R: Epilepsy and brain tumors. Curr Opin Oncol 22:6116202010

42

Rutecki P: Anatomical, physiological, and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia 31:Suppl 2S1S61990

43

Schomas DALaack NNBrown PD: Low-grade gliomas in older patients: long-term follow-up from Mayo Clinic. Cancer 115:396939782009

44

Shellock FGBegnaud JInman DM: Vagus nerve stimulation therapy system: in vitro evaluation of magnetic resonance imaging-related heating and function at 1.5 and 3 tesla. Neuromodulation 9:2042132006

45

Sheth RD: Adolescent issues in epilepsy. J Child Neurol 17:Suppl 22S232S272002

46

Spanaki MVAllen LSMueller WMMorris GL III: Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center. Seizure 13:5875902004

47

Sucholeiki RAlsaadi TMMorris GL IIIUlmer JLBiswal BMueller WM: fMRI in patients implanted with a vagal nerve stimulator. Seizure 11:1571622002

48

Taphoorn MJ: Neurocognitive sequelae in the treatment of low-grade gliomas. Semin Oncol 30:6 Suppl 1945482003

49

Uthman BMReichl AMDean JCEisenschenk SGilmore RReid S: Effectiveness of vagus nerve stimulation in epilepsy patients: a 12-year observation. Neurology 63:112411262004

50

Vagus Nerve Stimulation Study Group: A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 45:2242301995

51

van Breemen MSWilms EBVecht CJ: Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 6:4214302007

52

Vonck KVan Laere KDedeurwaerdere SCaemaert JDe Reuck JBoon P: The mechanism of action of vagus nerve stimulation for refractory epilepsy: the current status. J Clin Neurophysiol 18:3944012001

53

You GSha ZJiang T: The pathogenesis of tumor-related epilepsy and its implications for clinical treatment. Seizure 21:1531592012

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