National trends of Laser interstitial thermal therapy (LITT) and Vagus Nerve stimulation (VNS) for refractory epilepsy in adult patients: A Nationwide Inpatient Sample based propensity score matched analysis
Mayur Sharma , Victoria Scott , Beatrice Ugiliweneza , Dengzhi Wang , Maxwell Boakye , Joseph Neimat , Sanjeev Sreenivasan
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Abstract
Objective
The aim of our study was to report the national trends of Vagus nerve stimulation (VNS) and Laser interstitial thermal therapy (LITT) and compare their outcomes in patients with medically refractory epilepsy (RE).
Methods
Nationwide Inpatient Sample database (NIS, 1998–2018) was used to extract the data using the ICD-9/10 codes. Adult patients (>18 years) with a primary diagnosis of RE who underwent either VNS or LITT were included. Patient demographics, complications, length of hospital stay (LOS), discharge disposition and index-hospitalization costs were analyzed.
Results
A cohort of 226,248 patients with RE were included, of which only 0.66 % underwent VNS (n = 1500) and 0.34 % (n = 770) underwent LITT. VNS accounted for 66 % of the surgical procedures. The use of LITT gradually increased from 2012 (0.69/1000 RE cases) to 2018 (4.43/1000 RE cases) compared to VNS (2012: 9.85/1000 RE to 2018: 5.31/1000 RE cases). Median age was similar across the cohorts (LITT: 38 years; VNS: 36 years, p = 0.33). Index hospitalization median charges were significantly lower following LITT compared to VNS (LITT: $ 115,838; VNS: $ 131,984, p < 0.0033). No differences in terms of median LOS, discharge to home, complications and median index hospitalization charges were noted between the procedures (LITT vs. VNS).
Conclusion
LITT is increasingly being performed for RE with decreasing trends for VNS. The complications profile was similar among both the procedures. Both LITT and VNS are minimally invasive and safe treatment modalities in carefully selected patients with RE.
期刊介绍：
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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