Neurosurgery

anesthesia and we now recommend that all patients have their VNS turned off during general anesthetic for other reasons. There is also evidence from our clinical experience, and from a study by Malow et al., that during VNS activation, there are decreases in airflow and respiratory effort, which are probably insignificant except in patients with pre-existing obstructive sleep apnoea.

A number of papers show that seizure frequency is reduced but seizures are seldom abolished by VNS. Binnie suggests that a better than 50% reduction in seizures occurs at 18 months in 50% of patients [24]. Similar figures (between 40 and 50%, with a greater than 50% reduction, showing an improvement with time) are given by other authors. Everyone is agreed that sustained freedom from seizures, equivalent to Engel I outcome in resective surgery, is rare, occurring in about 2% of patients. Results in children are also encouraging. In a group of 60 children, a greater than 50% reduction in 42% of them at 18 months has been reported and, in a group of 38 children, 26 had a greater than 50% reduction, 11 of whom had a greater than 75% reduction in seizure frequency. By contrast, the results have been unencouraging in a group of severely disabled children with epileptic encephalopathy. Boon and his colleagues in Ghent have reported a halving of direct epilepsy-related medical costs and reduction to one-third of hospital admissions for patients with VNS.

Sleep Apnea

Sleep Apnea

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