The following is a summary of “Favorable combinations of antiseizure medication with vagus nerve stimulation to improve health-related quality of life in patients with epilepsy,” published in the December 2023 issue of Psychiatry by Sauer et al.

In this study, researchers investigated the potential combinations of vagus nerve stimulation (VNS) with specific antiseizure medications (ASMs) to enhance health-related quality of life (HrQoL) and alleviate depression in patients dealing with refractory epilepsy. VNS, known for its non-pharmacological approach and antidepressant effects, hasn’t been thoroughly explored regarding its interaction with ASMs targeting mood and HrQoL. Their observational study included 151 patients with refractory epilepsy who had undergone VNS implantation and maintained a stable ASM regimen for the initial 24 months post-implantation. Using standardized questionnaires (QOLIE10, EQVAS, EQ5D, and Beck Depression Inventory), the study group assessed HrQoL and depressive symptoms. Their multiple regression analysis aimed to discern synergistic ASM-VNS combinations affecting HrQoL.

At the two-year follow-up (N = 151, mean age 45.2 ± 17.0 years), they observed significant improvements (p < 0.05) in Beck Depression Inventory scores when VNS was combined with SV2A modulators (58.4%) or AMPA antagonists (44.4%). Notably, combinations of VNS with SV2A modulators (such as brivaracetam levetiracetam) or slow sodium channel inhibitors (like eslicarbazepine lacosamide) showed substantial increases of at least 30% in HrQoL (p < 0.05).

Their findings indicate that the combinations of SV2A modulators or slow sodium channel inhibitors with VNS exhibited more favorable effects on HrQoL compared to other ASMs. Beyond the potential synergies in reducing seizure frequency, the mitigation of behavioral side effects associated with SV2A modulators by VNS may be a critical factor contributing to the observed improvements in HrQoL in these specific combinations. This suggests a promising avenue for enhancing the well-being of patients grappling with refractory epilepsy by strategically pairing VNS with select ASMs targeting mood and quality of life aspects.

Source: sciencedirect.com/science/article/pii/S152550502300481X