engleski

Dilemmas in early implantation of vagus nerve stimulation in patients with drug resistant epilepsy and depression – our experience

Vagus nerve stimulation (VNS) is a viable minimally invasive neurosurgical treatment option in drug resistant epilepsy and depression. In patients with drug resistant epilepsy, polytherapy is necessary, emphasizing the greater incidence of side effects which further impair the quality of life (QoL) at the physical, psychosocial and neurocognitive level. Patients with epilepsy oft en have depression, which can be the result of seizures, antiepileptic drugs (AEDs) or sociodemographic factors. In addition, epilepsy and depression share a similar neurobiologic basis that has been linked to biochemical changes, altered neurotransmission, hypothalamic-pituitary- adrenal axis abnormalities involved in chronic stress, inflammation, reduced neuroplasticity, and network dysfunction. However, the diagnosis of depression in patients with epilepsy, confirmed by psychiatric assessment, should be better understood when making a decision on early treatment with VNS. Selective serotonin reuptake inhibitors or psychotherapy should be considered as first line treatments for depression in patients with epilepsy, but these drugs can also compound cognitive and sedative side effects of antiepileptic agents. On the other hand, we should also consider side effects of VNS that can be implantation or stimulation associated. Considering the fact that QoL is known to be strongly linked to mood and improvement in the Beck Depression Inventory scores, and following published VNS studies in epilepsy that assessed QoL, we performed a study of QoL in a group of patients with drug resistant epilepsy treated at the Zagreb University Hospital Centre who had undergone VNS implantation. The study included 27 patients with drug resistant epilepsy with implanted VNS – case group (14 M and 13 F ; mean age 34.7±28.3 years) and 18 control patients with drug resistant epilepsy without implanted VNS (10 M and 8 F ; mean age 45.2±30.8 years). QoL was examined using the questionnaires Quality of life in Epilepsy (QoLIE-31 validated Croatian 1.0 version) and Beck Depression Inventory I (BDI I validated Croatian version). On statistical analysis, nonparametric Mann- Whitney test for independent samples was used. The study was approved by the Ethics Committee of the Zagreb University Hospital Centre. The Mann-Whitney test showed significant difference in the QoLIE-31 score between the case and control groups (p=0.041). In the case group, we noticed that younger patients had lower QoLIE-31 score and higher BDI-I score than the older ones. Our results showed positive influence on the QoL and mood improvement following VNS implantation in patients with drug resistant epilepsy.

drug resistant epilepsy ; vagus nerve stimulation

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