Long-term XXXX and psychosocial outcomes of vagus nerve stimulation for intractable @entity302 .

@entity1 @entity410 @entity245 @entity302 @entity734
UNASSIGNED: Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable @entity302 . Most studies have demonstrated short-term @entity410 outcomes, usually for up to 5years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term @entity410 and psychosocial outcomes in @entity1 with intractable @entity302 on VNS therapy for more than 15years. We identified @entity1 who had VNS implantation for treatment of intractable @entity302 from 1997 to 2013 at our Comprehensive @entity302 Program and gathered demographics including age at @entity302 onset and VNS implantation, @entity302 type, number of @entity734 ( @entity734 ) and @entity410 frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine @entity1 ' current @entity410 frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. @entity410 outcomes were based on modified Engel classification (I: @entity410 -free/rare simple partial @entity410 ; II: >90% @entity410 reduction (SR), III: 50-90% SR, IV: <50% SR; classes I to III (>50% SR)=favorable outcome). A total of 207 @entity1 underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at @entity302 onset of 9.4years (range: birth to 60years). There were 35 (39%) @entity1 with @entity302 , 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) @entity1 with an output current >2mA and 14 (16%) with rapid cycling. Of the 80 @entity1 with @entity410 frequency information, 16 (20%) had a modified Engel class I outcome, 14 (18%) had class II, 24 (30%) had class III, and 26 (33%) had class IV. Eighty percent said having VNS was worthwhile. Among the 90 @entity1 , 43 @entity1 were >= 18years old without @entity245 in whom psychosocial outcomes were further analyzed. There was a decrease in the number of @entity1 driving (31% vs 14%, p=0.052) and working (44% vs 35%, p=0.285) and an increase in the number of patients using antidepressant medication (14% vs 28%, p=0.057) at the time of survey compared to before VNS. In this subset, @entity1 with >50% SR (60%) were taking significantly fewer @entity734 at the time of survey compared to @entity1 with unfavorable outcomes (median: 3 vs 4, p=0.045). The associations of >50% SR with the psychosocial outcomes of driving, employment, and antidepressant use were not significant, although 77% of this subset said VNS was worthwhile. This is the first study that assesses both @entity410 and psychosocial outcomes, and demonstrates favorable @entity410 outcomes of >50% SR in 68% of @entity1 and @entity410 freedom in 20% of @entity1 . A large majority of @entity1 (80%) considered VNS therapy worthwhile regardless of @entity302 type and psychosocial outcomes.
