Poza wskaźnikami odpowiedzi: Pozostałe napady padaczkowe i chęć ponownego poddania się stymulacji nerwu błędnego u pacjentów z opornąpadaczką
Beyond response rates: Residual seizure burden and willingness to undergo vagus nerve stimulation again in drug-resistant epilepsy
W skrócie
Badanie pokazało, że ponad połowa pacjentów z opornąpadaczką poddanych zabiegu stymulacji nerwu błędnego chciałaby go powtórzyć. Pacjenci, którzy wyrazili taką chęć, doświadczyli większej poprawy napadów i jakości życia, a przede wszystkim mieli mniej napadów po zabiegu. Wyniki sugerują, że liczba pozostałych napadów po leczeniu jest ważnym wskaźnikiem, który pomaga lepiej zrozumieć rzeczywisty wpływ zabiegu na życie pacjenta.
Oryginalny abstract (angielski)
OBJECTIVE: To assess whether postoperative residual seizure burden may provide patient-centered information beyond relative seizure improvement by examining willingness to undergo vagus nerve stimulation (VNS) again in drug-resistant epilepsy (DRE). METHODS: This single-center cross-sectional study included patients with DRE after VNS implantation. Baseline data were retrieved from an institutional database, and follow-up data were collected using a structured questionnaire. The primary outcome was willingness to undergo VNS again, treated as an exploratory decision-centered patient-reported measure and analyzed as yes versus no/uncertain. Subjective seizure improvement, quality-of-life (QoL) improvement, overall satisfaction, willingness to recommend VNS, and adverse effects were also assessed. Seizure burden before and after VNS was graded using broad frequency-based categories. Category improvement reflected relative improvement, whereas postoperative residual burden reflected the absolute burden remaining after treatment. RESULTS: Of 58 screened patients, 54 were included. Overall, 32/54 (59.3%) would undergo VNS again, 22/54 (40.7%) were satisfied, and 25/54 (46.3%) would recommend VNS. Subjective seizure improvement and QoL improvement were reported by 35/54 (64.8%) and 33/54 (61.1%) patients, respectively. Seizure burden category improved in 35/54 (64.8%), but 11/54 (20.4%) continued to have daily seizures after VNS. Patients willing to undergo VNS again were more likely than those unwilling or uncertain to report subjective seizure improvement (87.5% vs 31.8%, P < 0.001), QoL improvement (90.6% vs 18.2%, P < 0.001), and seizure burden category improvement (81.2% vs 40.9%, P = 0.004). They also had lower postoperative residual seizure burden (median category 1.0 [IQR 0.0-2.3] vs 3.0 [IQR 2.0-4.0], P < 0.001). CONCLUSIONS: Willingness to undergo VNS again was associated with relative improvement and lower postoperative residual seizure burden. These findings suggest that residual seizure burden may provide complementary patient-centered information when interpreted alongside conventional response measures and established patient-reported outcomes.