About this trial
Vagal nerve stimulation (VNS) can be indicated in patients with drug-resistant epilepsy who are not eligible for resective epilepsy surgery with responders rates about 50% (≥50% seizure reduction). At the moment, there is not a widely-accepted possibility to predict VNS efficacy in a given patient based on pre-implantation data, which can lead to unnecessary surgery and improper allocation of financial resources. The principal aim of PRECISE (PRediction of vagal nerve stimulation EfficaCcy In drug-reSistant Epilepsy) study is to verify the predictability of VNS efficacy by analysis of pre-implantation routine EEG. The PRECISE relies on the results of our previous work, which developed a statistical classifier for VNS response (responders vs. non-responders) based on differences in EEG power spectra dynamics (Pre-X-Stim). PRECISE is designed as a prospective multicentre study in which patients indicated to VNS therapy will be recruited. Patients will be classified as predicted responders vs. predicted non-responders using pre-implantation EEG analyses. After the first and the second year of the study, the real-life outcome (responder vs. non-responder) will be determined. The real-life outcome and predicted outcome will be compared in terms of accuracy, specificity, and sensitivity. In the meantime, the patients will be managed according to the best clinical practice to obtain the best therapeutical response.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Drug-resistant epilepsy indicated to VNS based on clinical decision.
Drug-resistant epilepsy is defined as a failure of adequate trials of two tolerated, appropriately chosen, and used antiepileptic drug schedules (whether as monotherapy or in combination) to achieve sustained seizure freedom (Kwan et al., 2010).
Age ≥ 18 years
Availability to record 20 minutes of EEG with photic stimulation, hyperventilation, and eye-opening/closing according to the pre-defined protocol.
Disqualifiers
The indication and planning of resection brain surgery as a treatment option for drug-resistant epilepsy. If a patient clearly demonstrates his refusal of resection surgery, he/she can be included in the study.
The presence of psychogenic non-epileptic seizures which cannot be reliably distinguished from epileptic seizures by a patient/family member/caregiver.
The presence of other condition which can resemble epileptic seizures which cannot be reliably distinguished from epileptic seizures by a patient/family member/caregiver.
Metabolic condition or other diseases, in which the increase of seizure frequency is expectable.
Trial design
Single group
Treatments tested in this trial
Statistical model for the prediction of VNS efficacy
Other interventionstatistical model for the prediction of VNS efficacy based on a mathematical and statistical analysis of scalp EEG data
Treatment groups
Trial outcomes
Primary outcomes
Accuracy of statistic model for prediction of response to VNS therapy
Accuracy of statistic model for prediction of response to VNS therapy in terms of responders and non-responders in drug-resistant epilepsy
Secondary outcomes
The quantification of differences in EEG power spectra
The quantification of differences in EEG power spectra (Relative Mean Power, %) between real-life responders and real-life non-responders to VNS therapy in drug-resistant epilepsy
Prediction of patients' response to VNS therapy
Prediction of patients' response to VNS therapy in terms of responders (≥ 50% seizure reduction from baseline) and non-responders (\<50% seizure reduction from baseline)
Sponsors and contacts
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Masaryk University
Lead sponsor
St. Anne's University Hospital Brno, Czech Republic
Collaborator
University Hospital, Motol
Collaborator
Na Homolce Hospital
Collaborator
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