Elsevier

Seizure

Volume 58, May 2018, Pages 120-126
Seizure

Clinical outcomes of VNS therapy with AspireSR® (including cardiac-based seizure detection) at a large complex epilepsy and surgery centre

https://doi.org/10.1016/j.seizure.2018.03.022Get rights and content
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Highlights

  • AspireSR® responds on-demand to ictal tachycardia associated with ∼80% of seizures.

  • Newly inserted AspireSR® resulted in 59% of patients achieving ≥50% improvement at 13 months.

  • Battery change to AspireSR® offered 71% of patients ≥50% benefit at mean 21 months.

  • AutoStim renders VNS therapy independent of patient/caregiver compliance.

  • AspireSR® VNS therapy could modify patient counseling from the rule of one- thirds.

Abstract

Purpose

To compare the efficacy of AspireSR® to preceding VNS battery models for battery replacements, and to determine the efficacy of the AspireSR® for new implants.

Methods

Data were collected retrospectively from patients with epilepsy who had VNS AspireSR® implanted over a three-year period between June 2014 and June 2017 by a single surgeon. Cases were divided into two cohorts, those in whom the VNS was a new insertion, and those in whom the VNS battery was changed from a previous model to AspireSR®. Within each group, the seizure burden was compared between the periods before and after insertion of AspireSR®.

Results

Fifty-one patients with a newly inserted AspireSR® VNS model had a significant reduction in seizure frequency (p < 0.001), with 59% (n = 30) reporting ≥50% reduction. Of the 62 patients who had an existing VNS, 53% (n = 33) reported ≥50% reduction in seizure burden when the original VNS was inserted. After the battery was changed to the AspireSR®, 71% (n = 44) reported a further reduction of ≥50% in their seizure burden. The size of this reduction was at least as large as that resulting from the insertion of their existing VNS in 98% (61/62) of patients.

Conclusion

The results suggest that approximately 70% of patients with existing VNS insertions could have significant additional benefit from cardiac based seizure detection and closed loop stimulation from the AspireSR® device. For new insertions, the AspireSR® device has efficacy in 59% of patients. The ‘rule of thirds’ used in counseling patients may need to be modified accordingly.

Keywords

Vagal nerve stimulation (VNS)
AspireSR®
Automatic stimulation (AutoStim)
Pharmacoresistant epilepsy
Cardiac-based seizure detection (CBSD)

Cited by (0)

1

Co-first authors.