Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy.

[Display omitted] • Retrospective multicenter study of safety and effectiveness of concurrent VNS and RNS treatment in 64 patients. • No negative interactions or safety concerns documented with concurrent use of VNS and RNS systems. • Median seizure frequency reduction in 63 patients that had the RNS placed after the VNS was 64% at last follow-up. • Addition of RNS treatment to active VNS therapy may provide additional reduction in seizure frequency. Clinical trials of a brain-responsive neurostimulator, RNS® System (RNS), excluded patients with a vagus nerve stimulator, VNS® System (VNS). The goal of this study was to evaluate seizure outcomes and safety of concurrent RNS and VNS stimulation in adults with drug-resistant focal-onset seizures. A retrospective multicenter chart review was performed on all patients with an active VNS and RNS who were treated for a minimum of 6 months with both systems concurrently. Frequency of disabling seizures at baseline before RNS, at 1 year after RNS placement, and at last follow-up were used to calculate the change in seizure frequency after treatment. Data on adverse events and complications related to each device were collected. Sixty-four patients from 10 epilepsy centers met inclusion criteria. All but one patient received RNS after VNS. The median follow-up time after RNS implantation was 28 months. Analysis of the entire population of patients with active VNS and RNS systems revealed a median reduction in seizure frequency at 1 year post-RNS placement of 43% with a responder rate of 49%, and at last follow-up a 64% median reduction with a 67% responder rate. No negative interactions were reported from the concurrent use of VNS and RNS. Stimulation-related side-effects were reported more frequently in association with VNS (30%) than with RNS (2%). Our findings suggest that concurrent treatment with VNS and RNS is safe and that the addition of RNS to VNS can further reduce seizure frequency. [ABSTRACT FROM AUTHOR]