RESUMEN
INTRODUCTION: Following approval in 2009 of vagus nerve stimulation (VNS Therapy) for drug-resistant epilepsy (DRE) in the Russian Federation, this is the first multicenter study across Russia to evaluate the safety and efficacy of adjunctive VNS Therapy. METHODS: The retrospective, observational registry included 58 pediatric patients with DRE (5-17 years old at implantation) who had ≥2 years of VNS. To ensure a robust evaluation process, changes in seizure frequency were evaluated for all seizure types as well as "most disabling" seizures (defined as seizures accompanied by falls, physical trauma, and/or incontinence in the absence of preventative measures). RESULTS: With 2 years of VNS Therapy, 37 of 49 patients (76%) experiencing the most disabling epileptic seizures had a >50% decrease in frequency of such seizures, and 16 (33%) reported no longer experiencing the "most disabling" seizure type. In addition, based on the McHugh Outcome scale, VNS Therapy had a positive outcome on both frequency and severity of all epileptic seizure types, with a >50% decrease in frequency of all epileptic seizure types noted in 37 of 58 patients (64%), and 31% of patients had a Class I outcome, including 11 patients (19%) who achieved seizure freedom. VNS Therapy also had a positive effect on the frequency of status epilepticus: 13 patients (22%) had status epilepticus prior to implantation with a mean rate of 9.4 ± 17.7 events per year (range, 0-52), and after VNS Therapy, only one patient continued to experience status epilepticus (at 1 event per 4-6 months). VNS Therapy had an acceptable safety profile and no adverse events leading to VNS discontinuation were reported. CONCLUSIONS: The results demonstrate that VNS Therapy is being safely and effectively applied to pediatric patients in the Russian healthcare system.
Asunto(s)
Epilepsia Refractaria , Epilepsia , Estado Epiléptico , Estimulación del Nervio Vago , Humanos , Niño , Preescolar , Adolescente , Estimulación del Nervio Vago/efectos adversos , Estimulación del Nervio Vago/métodos , Estudios Retrospectivos , Epilepsia Refractaria/terapia , Epilepsia Refractaria/etiología , Epilepsia/etiología , Convulsiones/etiología , Sistema de Registros , Resultado del Tratamiento , Nervio VagoRESUMEN
OBJECTIVES: To assess the influence of different factors on health-related QOL in adults with epilepsy in Moscow, Russia. METHOD: We evaluated quality of life in 242 patients (98 de novo and 144 previously inadequately treated) by using QOLIE-31. Partial cryptogenic or symptomatic epilepsy was diagnosed in 214 patients, in 28-idiopathic generalized epilepsy. Stepwise regression analysis was performed to assess the influence of different factors on QOL. RESULTS: In patients with epilepsy in Russia the total score of QOLIE-31 was rather low-42.13+/-4.14. Relationship of quality of life (total score) and frequency of seizures and duration of disease was analyzed. Frequency of seizures was the most significant parameter related to QOL (R=0.46 with total score). Duration of disease also correlated with QOL score (R=0.24 with total score). Significant but rather weak association (link) between frequency of seizures and almost all of subscales of quality of life was noticed. Duration of epilepsy correlated with less number of subscales: Energy/fatigue, Medication effects, Social functioning, Overall QOL subscales. When factors influencing on QOL were separately analyzed in newly diagnosed and previously treated patients frequency of seizures was the most important parameter in both groups. CONCLUSIONS: Frequency of seizures is the most important factor influencing on QOL in adults with epilepsy (newly diagnosed and previously treated).