Integrating the 5-SENSE Score for Patient Selection in Vagus Nerve Stimulation for Drug-Resistant Epilepsy

TL;DR

This study explores how the 5-SENSE score can help choose patients for vagus nerve stimulation in drug-resistant epilepsy by analyzing seizure focality.

Contribution

The study applies the 5-SENSE score, originally for SEEG planning, to predict VNS therapy outcomes in drug-resistant epilepsy patients.

Findings

The 5-SENSE score shows an association between seizure-onset zone focality and VNS therapy effectiveness.

High focality groups show varied responses, suggesting individualized treatment strategies are needed.

Detailed preoperative assessments may improve patient selection and clinical outcomes for VNS.

Abstract

Addressing the challenge of drug-resistant epilepsy, our study offers a novel perspective by retrospectively applying the 5-SENSE score, initially created for stereoelectroencephalography (SEEG) planning, to evaluate its predictive value in patients undergoing vagus nerve stimulation (VNS) therapy.

We conducted a comprehensive preoperative diagnostic work-up, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT), video-electroencephalogram (video-EEG), and clinical semiology. We then stratified 76 patients into three groups - low, moderate, and high focality - based on the focality of the seizure-onset zone. Such stratification was made to check the scoring ability in predicting VNS therapy seizure reduction.

Our findings demonstrate an association between the extent of focality at the seizure-onset zone and the effectiveness of VNS, which may help to define the role of the 5-SENSE score in patient selection for VNS. This high dispersion of responses in the group with high focality reinforces the idea that outcome estimation is difficult and argues for an individualized strategy in the treatment of drug-resistant epilepsy.

A study at the level of the 5-SENSE score indicates the importance of detailed preoperative assessments that may better optimize selection for VNS therapy and further improve clinical outcomes.

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