• Preci Hamilton, Imad Soryal, Prince Dhahri, Welege Wimalachandra, Anna Leat, Denise Hughes, Nicole Toghill, James Hodson, Vijay Sawlani, Tom Hayton, Shanika Samarasekera, Manny Bagary, Dougall McCorry, and Ramesh Chelvarajah.
• Complex Epilepsy and Surgery Service, Queen Elizabeth Hospital Birmingham, United Kingdom. Electronic address: preci.hamilton@lthtr.nhs.uk.
• Seizure. 2018 May 1; 58: 120-126.

PurposeTo compare the efficacy of AspireSR® to preceding VNS battery models for battery replacements, and to determine the efficacy of the AspireSR® for new implants.MethodsData were collected retrospectively from patients with epilepsy who had VNS AspireSR® implanted over a three-year period between June 2014 and June 2017 by a single surgeon. Cases were divided into two cohorts, those in whom the VNS was a new insertion, and those in whom the VNS battery was changed from a previous model to AspireSR®. Within each group, the seizure burden was compared between the periods before and after insertion of AspireSR®.ResultsFifty-one patients with a newly inserted AspireSR® VNS model had a significant reduction in seizure frequency (p < 0.001), with 59% (n = 30) reporting ≥50% reduction. Of the 62 patients who had an existing VNS, 53% (n = 33) reported ≥50% reduction in seizure burden when the original VNS was inserted. After the battery was changed to the AspireSR®, 71% (n = 44) reported a further reduction of ≥50% in their seizure burden. The size of this reduction was at least as large as that resulting from the insertion of their existing VNS in 98% (61/62) of patients.ConclusionThe results suggest that approximately 70% of patients with existing VNS insertions could have significant additional benefit from cardiac based seizure detection and closed loop stimulation from the AspireSR® device. For new insertions, the AspireSR® device has efficacy in 59% of patients. The 'rule of thirds' used in counseling patients may need to be modified accordingly.Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

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