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Quality of Life and Memory after Vagus Nerve Stimulator Implantation for Epilepsy

Published online by Cambridge University Press:  02 December 2014

Jeannette McGlone ,
Ivan Valdivia ,
Marsha Penner ,
Jaime Williams ,
R. Mark Sadler  and
David B. Clarke
Jeannette McGlone
Affiliation:
The Department of Psychology, Dalhousie University Department of Psychology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Ivan Valdivia
Affiliation:
The Department of Psychology, Dalhousie University Department of Psychology, The Ottawa Hospital, Ottawa, ON
Marsha Penner
Affiliation:
Department of Pharmacology, Dalhousie University
Jaime Williams
Affiliation:
Department of Psychology, Queen Elizabeth II Health Sciences Centre, Halifax, NS Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
R. Mark Sadler
Affiliation:
Department of Medicine (Neurology), Dalhousie University
David B. Clarke
Affiliation:
Department of Surgery (Neurosurgery), Dalhousie University
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Abstract

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Objective:

This prospective, case control study evaluates quality of life (QOL), depressive affect, and memory outcomes of epilepsy patients implanted with a vagus nerve stimulator (VNS).

Methods:

Three groups of patients with epilepsy underwent assessment on two occasions: 1) patients with a VNS were tested before and 12 months after implantation (n = 16); 2) patients who underwent cerebral resective surgery were tested pre- and post-operatively (n = 10); and 3) patients under medical management (n = 9). Group means were compared on the QOLIE-89, Geriatric Depression Scale, Wechsler Memory Scale - III, and the Memory Observation Questionnaire. Secondary analyses calculated the reliable change index, providing information on change beyond measurement error and chance.

Results:

Mean ratings of QOL, depression, and memory complaints and objective memory scores remained stable or improved in all the groups. The QOL improved more after cerebral resective surgery than VNS or medication controls, but the VNS and medication control groups did not differ. In the VNS group, QOL was not related to seizure reduction. The percentage of cases showing real change in memory was equivalent across groups, except in one of eight indices (i.e., verbal recognition memory).

Conclusions:

This first case controlled design found that vagus nerve stimulation as an adjunctive therapy for seizure control did not change QOL, depressive affect, or objective memory scores over one-year more so than medical management alone. We point out the need for larger case control, non-industry funded investigations.

résumé:

<span class='bold'>RÉSUMÉ:</span> Objectif:

Le but de cette étude prospective cas-témoin était d’évaluer la qualité de vie (QV), l’affect dépressif et la mémoire de patients épileptiques chez qui un stimulateur du nerf vague (SNV) a été implanté.

<span class='bold'> <span class='italic'>Méthodes:</span></span>

Trois groupes de patients épileptiques ont été évalués à deux reprises : 1) des patients porteurs d’un SNV ont été évalués avant et 12 mois après son implantation (n = 16); des patients qui ont subi une résection cérébrale chirurgicale ont été évalués avant et après la chirurgie (n = 10); 3) des patients sous traitement médical (n = 9). Nous avons comparé les moyennes des groupes pour les tests suivants : QOLIE-89, Geriatric Depression Scale, Wechsler Memory Scale-III et Memory Observation Questionnaire. Nous avons également calculé le reliable change index, ce qui ajoute de l’information sur le changement qui n’est pas dü à l’erreur de mesure ou au hasard.

<span class='bold'> <span class='italic'>Résultats:</span></span>

La moyenne des évaluations de la QV, de la dépression et des symptömes mnésiques et les scores objectifs d’évaluation de la mémoire sont demeurés stables ou se sont améliorés chez tous les groupes de patients. La QV s’est améliorée davantage après la résection cérébrale chirurgicale qu’après l’implantation d’un SNV ou chez les patients sous traitement médical. Cependant, aucune différence n'a été observée entre les groupes SNV et traitement médical. Dans le groupe SNV, la QV n’était pas reliée à la diminution des crises. Le pourcentage de cas qui présentaient un changement mnésique réel était équivalent dans tous les groupes sauf pour un des huit indices (la mémoire de reconnaissance verbale).

<span class='bold'> <span class='italic'>Conclusions:</span></span>

Cette première étude cas-témoin a montré que la stimulation du nerf vague comme thérapie d’appoint pour le contröle des crises n’a pas modifié la QV, l’affect dépressif ou les scores à l’évaluation de la mémoire objective un an après par rapport au traitement médical. Nous soulignons la nécessité d’études cas-témoin de plus grande envergure, non subventionnées par l’industrie.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 3 , July 2008 , pp. 287 - 296
Copyright
Copyright © The Canadian Journal of Neurological 2008

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