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Antiepileptic drug use during the first 12 months of vagus nerve stimulation therapy

A registry study

From the Comprehensive Epilepsy Center, New York Presbyterian–Weill Cornell Medical Center, New York, NY.

Address correspondence and reprint requests to Dr. Douglas R. Labar, New York Presbyterian–Weill Cornell Medical Center, 525 E 68th St., K-615, New York, NY 10021.

Article abstract Understanding interrelationships between antiepileptic drugs (AEDs) and vagus nerve stimulation (VNS) therapy can guide research into epilepsy treatment. A constant cohort of patients with data available at baseline and 12 months were drawn from the VNS patient outcome registry and analyzed for changes in AEDs and seizure rates. Of the 1,407 patients, group 1 (n = 896) took fewer (n = 228) or the same (n = 668) AEDs at 12 months compared to baseline. Group 2 (n = 511) took additional (n = 251) or different (n = 260) AEDs. Median seizure rate reductions after 12 months of VNS therapy were 58% in group 1 and 55% in group 2. The number of and specific AEDs remained unchanged for 668 patients and dosages remained the same for 269 (40%) of these patients. The most commonly discontinued drugs were topiramate (n = 115), tiagabine (n = 78), carbamazepine (n = 62), lamotrigine (n = 56), and gabapentin (n = 52). Changes in seizure rates were not significantly different among patients who added levetiracetam (n = 151), zonisamide (n = 71), or oxcarbazepine (n = 46) to VNS. Changes in seizure rates were not significantly different among patients whose baseline AEDs were carbamazepine (n = 273), lamotrigine (n = 238), valproate (n = 201), topiramate (n = 190), or phenytoin (n = 151). Our results suggest the following: (a) patients commonly stay on the same AEDs during 12 months of treatment with VNS; (b) the registry cohort who had reduced AEDs by month 12 did not appear to experience any seizure exacerbation; and (c) no specific AED shows promise of unique additive antiepileptic effects in combination with VNS.

This article has been cited by other articles:

				J. B. Renfroe and J. W. Wheless Earlier use of adjunctive vagus nerve stimulation therapy for refractory epilepsy Neurology, September 24, 2002; 59(90064): S26 - 30. [Abstract] [Full Text]