The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: the PuLsE (Open Prospective Randomized Long-term Effectiveness) trial.
OBJECTIVE
To evaluate whether vagus nerve stimulation (VNS) as adjunct to best medical practice (VNS + BMP) is superior to BMP alone in improving long-term health-related quality of life (HRQoL).


METHODS
PuLsE (Open Prospective Randomized Long-term Effectiveness) was a prospective, randomized, parallel-group, open-label, and long-term effectiveness study (conducted at 28 sites in Europe and Canada). Adults with pharmacoresistant focal seizures (n = 112) received VNS + BMP or BMP (1:1 ratio). Medications and VNS parameters could be adjusted as clinically indicated for optimal seizure control while minimizing adverse effects. Primary endpoint was mean change from baseline HRQoL (using Quality of Life in Epilepsy Inventory-89 total score; QOLIE-89). Secondary endpoints included changes in seizure frequency, responder rate (≥50% decrease in seizure frequency), Centre for Epidemiologic Studies Depression scale (CES-D), Neurological Disorders Depression Inventory-Epilepsy scale (NDDI-E), Clinical Global Impression-Improvement scale (CGI-I), Adverse Event Profile (AEP), and antiepileptic drug (AED) load. The study was prematurely terminated due to recruitment difficulties prior to completing the planned enrollment of n = 362. Results for n = 96 who had baseline and at least one follow-up QOLIE-89 assessment (from months 3-12) were included in this analysis. Mixed model repeated measures (MMRM) analysis of variance was performed on change from baseline for the primary and secondary endpoints.


RESULTS
Significant between-group differences in favor of VNS + BMP were observed regarding improvement in HRQoL, seizure frequency, and CGI-I score (respective p-values < 0.05, 0.03, and 0.01). More patients in the VNS + BMP group (43%) reported adverse events (AEs) versus BMP group (21%) (p = 0.01), a difference reflecting primarily mostly transient AEs related to VNS implantation or stimulation. No significant difference between treatment groups was observed for changes in CES-D, NDDI-E, AEP, and AED load.


SIGNIFICANCE
VNS therapy as a treatment adjunct to BMP in patients with pharmacoresistant focal seizures was associated with a significant improvement in HRQoL compared with BMP alone. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
['Ryvlin|Philippe|P|', 'Gilliam|Frank G|FG|', 'Nguyen|Dang K|DK|', 'Colicchio|Gabriella|G|', 'Iudice|Alfonso|A|', 'Tinuper|Paolo|P|', 'Zamponi|Nelia|N|', 'Aguglia|Umberto|U|', 'Wagner|Louis|L|', 'Minotti|Lorella|L|', 'Stefan|Hermann|H|', 'Boon|Paul|P|', 'Sadler|Mark|M|', 'Benna|Paolo|P|', 'Raman|Pradheep|P|', 'Perucca|Emilio|E|']
D000293:Adolescent D000328:Adult D000368:Aged D000927:Anticonvulsants D004351:Drug Resistance D004828:Epilepsies, Partial D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011788:Quality of Life D016896:Treatment Outcome D055536:Vagus Nerve Stimulation D055815:Young Adult
Vagus nerve stimulation Epilepsy Health-related quality of life Seizures QOLIE-89