Corabian P; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 140.

Alberta Heritage Foundation for Medical Research, Edmonton, Canada.

OBJECTIVE/PURPOSE: To determine the place of vagus nerve stimulation (VNS) as a treatment for medically refractory epilepsy in those who are not suitable candidates for surgery or who have failed to improve following surgery. This information was required for a funding decision by a Health Ministry. METHOD: Review of published articles (1995-1998) which reported on the efficacy and safety of VNS therapy as a treatment for patients with medically refractory epilepsy. The literature review was supplemented by opinion from Canadian neurology specialists with expertise in VNS therapy. RESULTS: VNS has been used since 1988 and the device used for therapy has received regulatory approval in the European Union, Canada and the United States. However, there are still unresolved issues associated with the use of VNS therapy. The main evidence on safety and efficacy comes from two well-conducted short-term randomized controlled trials, which compared two VNS protocols in a total of 312 patients. Both reported that high ("therapeutic") stimulation was statistically significantly more effective in reducing seizure frequency in these patients than low ("sub-therapeutic") stimulation. However, the clinical significance of these results is less clear. Data available from three small observational studies suggest that the therapeutic effect of VNS appears to be better and is achieved more rapidly in children than in adults with refractory epilepsy. The efficacy of VNS therapy for patients with generalized seizures has yet to be demonstrated. No criteria have been determined to indicate which patients are the most likely to benefit from use of this therapy. The impact of the VNS therapy on the quality of life of patients with refractory epilepsy and that of their companions is not clear. CONCLUSIONS: This review confirms previous findings that VNS therapy is promising but that its role in the management of refractory epilepsy is yet to be established. VNS provides an alternative approach to treatment of individuals for whom other management options are poor. The available clinical evidence warrants further investigations to solve outstanding issues and to define its role both in children and adults.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Canada
• Child
• Clinical Trials as Topic
• Combined Modality Therapy
• Electric Stimulation Therapy
• Epilepsy
• European Union
• Humans
• Seizures
• United States
• Vagus Nerve
• methods
• therapy
• hsrmtgs

Other ID:

• HTX/20602514

UI: 102194203

From Meeting Abstracts