engleski

Minimally invasive neurosurgical treatment of patients with pharmacoresistant epilepsy: our experiences

Background and aim: Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients aged 12 years or older was approved in Europe in 1994 and in the United States in 1997. The precise mode of action is not known however, various studies have suggested that VNS acts through 1) direct afferent projections - increases seizure threshold through connections with nucleus tractus solitarii ; 2) modulation of neurotransmiters - widespread release of GABA and glycine ; 3) neural ''network'' regulation. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Zagreb. Methods: We have implanted VNS in 17 patients with pharmacoresistant epilepsy - 11 (6M, 5F) were MRI negative and 6 (3M, 3F) were MRI positive and were inoperable due to localisation of the pathomorphologic changes (ganglioglioma, hamartoma, various types of cortical dysplasia). Nine patients had complex partial seizures with secondary generalisation, 2 patients had simple partial seizures with secondary generalisation, 3 patients had Lennox-Gastaut syndrome, while 2 patients had primary generalised epilepsy. Results and conclusion: After continuous follow-up of MRI negative patients during 7 years and MRI positive patients during one year there was statistically significant decrease in mean-seizure frequency of 50-75%. The most frequent side effects were hoarseness, throat pain, cough and local muscular pain on the place of implanted generator, but they were mild and transitory. VNS was effective mode of therapy in our group of patients with pharmacoresistant epilepsy.

vagus nerve stimulation; treatment; pharmacoresistant epilepsy

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