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Date of Award

Spring 2021

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Mike Huber

Second Advisor

Elizabeth Masten

Abstract

Epilepsy is a common neurological condition that effects people worldwide. Through improper firing of neurons in the brain, epilepsy causes seizures. Most seizures manifesting as unconscious convulsions, which can result in injury, emergency room visits, and hospitalizations. Epilepsy is normally treated with antiepileptic drugs (AEDs), but when seizures fail to come under control with the use of 2 or more AEDs, patients are considered to have intractable epilepsy. Resective surgery is an option for some, but many patients are not candidates. The current first line treatment for intractable epilepsy is AED polypharmacy, but every AED comes with a long list of side effects. Vagus nerve stimulation (VNS) therapy has become an increasingly popular option for treatment of intractable epilepsy. It has been shown to have a minimal side effect profile with seemingly high efficacy when it comes to reducing seizure frequency. As a result this review poses the following question: In individuals over the age of 12 with intractable epilepsy, would the use of vagus nerve stimulation therapy be more effective in controlling seizure activity, improving quality of life, and cause less adverse reactions to patients as compared to polypharmacy antiepileptic drug treatments?

A literature search was performed using PubMed in October 2019 and Mendeley in November 2019. 7 articles were chosen for critical appraisal based on publication date, age of participants, type of epilepsy, and the use of VNS. The study designs and results were then examined thoroughly and compared to one another. All 7 studies found a reduction in seizure frequency with the use of VNS. This was found in both the retrospective studies and clinical trials. 3 studies found an improvement in participants quality of life (QOL) and 2 studies found a significant decrease in AED use when VNS therapy was used. All of the results were measured through long term follow up appointments and surveys. One study found no significant AED reduction, but this was likely due to 9 out of the 20 participants dropping out of the study before the 2-year mark. One study also focused on the financial aspect of VNS therapy and found it to be quite cost effective.

All of the articles found significant decrease in seizure frequency with VNS therapy. Their conclusions were credible due to the fact that most studies contained large sample sizes and long term follow up periods in order to make their results more reliable. The analysis revealed that VNS therapy significantly decreases seizure frequency and is cost effective, but more studies need to be done to determine its effect on AED burden. If future clinical trials show a significant decrease in number or dose of AEDs during VNS therapy, clinicians could be inclined to start VNS earlier in their treatment plans.

As the number of people diagnosed with intractable epilepsy increases, more treatment options should be examined besides polypharmacy AEDs. AEDs have a large side effect profile and while they can be effective at stopping seizures, they can also decrease a patient’s QOL. This analysis demonstrates the efficacy and effectiveness of VNS therapy in treating patients with intractable epilepsy. As such, it should be encouraged due to its high success rate, cost effectiveness, and minimal side effect profile. However, more research should be conducted to determine VNS therapy’s true effect on AED burden.

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Additional Files

PICO PAPER Advantages of Vagus Nerve Stimulation Therapy in the Treatment of Intractable Epilepsy.docx (59 kB)
Poster Presentation Vagus nerve stimulation and intractable epilepsy.pptx (1006 kB)

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Advantages of Vagus Nerve Stimulation Therapy in the Treatment of Intractable Epilepsy

Epilepsy is a common neurological condition that effects people worldwide. Through improper firing of neurons in the brain, epilepsy causes seizures. Most seizures manifesting as unconscious convulsions, which can result in injury, emergency room visits, and hospitalizations. Epilepsy is normally treated with antiepileptic drugs (AEDs), but when seizures fail to come under control with the use of 2 or more AEDs, patients are considered to have intractable epilepsy. Resective surgery is an option for some, but many patients are not candidates. The current first line treatment for intractable epilepsy is AED polypharmacy, but every AED comes with a long list of side effects. Vagus nerve stimulation (VNS) therapy has become an increasingly popular option for treatment of intractable epilepsy. It has been shown to have a minimal side effect profile with seemingly high efficacy when it comes to reducing seizure frequency. As a result this review poses the following question: In individuals over the age of 12 with intractable epilepsy, would the use of vagus nerve stimulation therapy be more effective in controlling seizure activity, improving quality of life, and cause less adverse reactions to patients as compared to polypharmacy antiepileptic drug treatments?

A literature search was performed using PubMed in October 2019 and Mendeley in November 2019. 7 articles were chosen for critical appraisal based on publication date, age of participants, type of epilepsy, and the use of VNS. The study designs and results were then examined thoroughly and compared to one another. All 7 studies found a reduction in seizure frequency with the use of VNS. This was found in both the retrospective studies and clinical trials. 3 studies found an improvement in participants quality of life (QOL) and 2 studies found a significant decrease in AED use when VNS therapy was used. All of the results were measured through long term follow up appointments and surveys. One study found no significant AED reduction, but this was likely due to 9 out of the 20 participants dropping out of the study before the 2-year mark. One study also focused on the financial aspect of VNS therapy and found it to be quite cost effective.

All of the articles found significant decrease in seizure frequency with VNS therapy. Their conclusions were credible due to the fact that most studies contained large sample sizes and long term follow up periods in order to make their results more reliable. The analysis revealed that VNS therapy significantly decreases seizure frequency and is cost effective, but more studies need to be done to determine its effect on AED burden. If future clinical trials show a significant decrease in number or dose of AEDs during VNS therapy, clinicians could be inclined to start VNS earlier in their treatment plans.

As the number of people diagnosed with intractable epilepsy increases, more treatment options should be examined besides polypharmacy AEDs. AEDs have a large side effect profile and while they can be effective at stopping seizures, they can also decrease a patient’s QOL. This analysis demonstrates the efficacy and effectiveness of VNS therapy in treating patients with intractable epilepsy. As such, it should be encouraged due to its high success rate, cost effectiveness, and minimal side effect profile. However, more research should be conducted to determine VNS therapy’s true effect on AED burden.