Interrater reliability of Engel, International League Against Epilepsy, and McHugh seizure outcome classifications following vagus nerve stimulator implantation

Object Interrater reliability as measured by the kappa (κ) statistic is a widely used and valuable tool to measure the robustness of a scoring system. Seizure frequency reduction is a central outcome measure following vagus nerve stimulation (VNS). A specific VNS scoring system has been proposed by McHugh, but its interrater reliability has not been tested. The authors assessed its interrater reliability and compared it with that of the Engel and International League Against Epilepsy (ILAE) systems. Methods Using the Engel, ILAE, and McHugh scoring systems, 3 observers independently rated the medical records of children who had undergone vagus nerve stimulator implantation between January 2001 and April 2011 at the Southampton University Hospital. The interrater agreements were then calculated using the κ statistic. Results Interrater reliability for the McHugh scale (κ0.693) was very good and was superior to those of the Engel (κ0.464) and ILAE (κ0.491) systems for assessing outcome in patients undergoing VNS. Conclusions The authors recommend considering the McHugh scoring system when assessing outcomes following VNS.

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Corpus Callosotomy for Intractable Epilepsy Revisited: The Children’s Hospital of Michigan Series

Journal of Child Neurology ◽

10.1177/0883073817697847 ◽

2017 ◽

Vol 32 (7) ◽

pp. 624-629 ◽

Cited By ~ 15

Author(s):

Aimee F. Luat ◽

Eishi Asano ◽

Ajay Kumar ◽

Harry T. Chugani ◽

Sandeep Sood

Keyword(s):

Vagus Nerve ◽

Intractable Epilepsy ◽

Endoscopic Approach ◽

Seizure Outcome ◽

Nerve Stimulator ◽

Corpus Callosotomy ◽

Seizure Reduction ◽

Palliative Procedure ◽

Vagus Nerve Stimulator ◽

Drug Resistant Epilepsy

Corpus callosotomy is a palliative procedure performed to reduce the severity of drug-resistant epilepsy. The authors assessed its efficacy on different seizure types in 20 subjects (age range 5-19 years); 8 with active vagus nerve stimulator. Fifteen had complete callosotomy, 3 had anterior 2/3, and 2 had anterior 2/3 followed later by complete callosotomy. Ten had endoscopic approach. In all, 65% had ≥ 50% reduction of generalized seizures leading to falls (atonic, tonic, myoclonic); 35% became seizure-free (follow-up period: 6 months to 9 years; mean 3 years). Seizure outcome distribution was better for generalized than for partial seizures ( P = .003). Endoscopic approach was as effective as transcranial approach. Seven subjects who failed vagus nerve stimulator therapy responded with ≥50% seizure reduction. Corpus callosotomy is an effective treatment for intractable generalized epilepsy leading to falls with significant seizure reduction or even elimination of seizures, in the majority of children.

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Dysphagia following implantation of an vagus nerve stimulator - a case report

Neuropediatrics ◽

10.1055/s-0033-1337880 ◽

2013 ◽

Vol 44 (02) ◽

Author(s):

C Reutlinger ◽

D Mergardt ◽

C Maxton

Keyword(s):

Case Report ◽

Vagus Nerve ◽

Nerve Stimulator ◽

Vagus Nerve Stimulator

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Implanted vagus nerve stimulation in 126 patients: surgical technique and complications

Perspectives in Surgery ◽

10.33699/pis.2020.99.7.304-310 ◽

2020 ◽

Vol 99 (7) ◽

Keyword(s):

Vagus Nerve ◽

Vocal Cord ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Pulse Generator ◽

Operative Procedure ◽

Intractable Epilepsy ◽

Vagal Nerve ◽

University Hospital ◽

Nerve Stimulator

Introduction: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. Methods: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.1−58.4 years). Results: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. Conclusion: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.

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