Effectiveness of vagal nerve stimulation in medication-resistant epilepsy. Comparison between patients with and without medication changes

García-Pallero, María A.; García-Navarrete, Eduardo; Torres, Cristina V.; Pastor, Jesús; Navas, Marta; Sola, Rafael G.

doi:10.1007/s00701-016-3027-6

Cited by 23 publications

(25 citation statements)

References 21 publications

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“…We analyzed age at seizure onset within each group in six studies [15,16,[18][19][20]24], including 416 patients; we found no significant difference between the good responders and poor responders (p = 0.530, SMD = 0.075, 95% CI: -0.159 to 0.310, heterogeneity test: Chi 2 = 7.44, p = 0.190, I 2 = 32.8%, Fig. 3).…”

Section: Discussionmentioning

confidence: 94%

“…At 6 m, 1, 2, 3, 4, 6 and 12 years after implantation, 33.99, 43.42, 46.50, 63.31, 52.71, 54.64, 70.37 and 82.90% of patients exhibited > 50% reduction of seizure frequency after VNS. In the 14 trials [7,[10][11][12][14][15][16][17][18][19][20][21][22]24], including a total of 906 participants, analysis age at VNS implantation as a predictor for VNS outcome within each group, we found no significant difference between the good responders and poor responders (p = 0.305, SMD = -0.075, 95% CI: -0.220 to 0.069; heterogeneity test: Chi 2 = 12.20, p = 0.526, I 2 = 0%, Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

“…We included 16 studies [7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] in this meta-analysis. The population of several studies was pediatric patients with drug-resistant epilepsy [19][20][21][22].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy

Wang

Tan

Zhu

et al. 2019

Seizure

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A B S T R A C TPurpose: To evaluate the predictors of seizure reduction outcome after vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE). Methods: A meta-analysis was performed using relevant research from databases such as PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov. Studies were selected according to predefined inclusion and exclusion criteria. The quality of studies was evaluated by using the Newcastle-Ottawa Scale (NOS) scale. All data was pooled by STATA 12.0 software for meta-analysis. Results: The review considered 1281 articles, and 16 articles with NOS score ≥6 were included in the analysis. The meta-analysis showed that at 6 m, 1, 2, 3, 4, 6 and 12 years after implantation, 33.99, 43.42, 46.50, 63.31, 52.71, 54.64, 70.37 and 82.90% of patients exhibited > 50% reduction of seizure frequency after VNS. The duration of epilepsy showed a significant difference between the good responders and poor responders (p = 0.038), whereas age at VNS implantation (p = 0.305), age at seizure onset (p = 0.530), seizure type (p = 0.11), etiology (p = 0.187), and history of previous epilepsy surgery (p = 0.075) were not predictors of seizure reduction outcome after VNS. Several features about the electroencephalogram (EEG) feature and heart rhythm complexity (HRV) have not been analyzed by a sufficient number of studies. Conclusions: DRE patients with shorter duration of epilepsy may be better candidates for VNS rather than those who are younger at onset and implantation. Several EEG or HRV features may have predictive value but more research is needed.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy

Wang

Tan

Zhu

et al. 2019

Seizure

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“…About 63% of the patients in drug unchanged group had a 50% frequency of seizure reduction, and 45.2% of the patients within drug change group had the 50% frequency of seizure reduction. Therefore, there is no statistical difference in frequency reduction whether there is any change of drugs . Changing the dosage and type of antiepileptic drugs (AED) may not influence the treatment results of VNS.…”

Section: Applicationmentioning

confidence: 99%

“…Therefore, there is no statistical difference in frequency reduction whether there is any change of drugs. 25 Changing the dosage and type of antiepileptic drugs (AED) may not influence the treatment results of VNS.…”

Section: Appli C Ati Onmentioning

confidence: 99%

Research progress of vagus nerve stimulation in the treatment of epilepsy

Fan

Shan

et al. 2019

CNS Neurosci Ther

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The International League Against Epilepsy (ILAE) defined drug‐resistant epilepsy (DRE) that epilepsy seizure symptoms cannot be controlled with two well‐tolerated and appropriately chosen antiepileptic drugs, whether they are given as monotherapy or in combination. According to the WHO reports, there is about 30%‐40% of epilepsy patients belong to DRE. These patients need some treatments other than drugs, such as epilepsy surgery, and neuromodulation treatment. Traditional surgical approaches may be limited by the patient's clinical status, pathological tissue location, or overall prognosis. Thus, neuromodulation is an alternative choice to control their symptoms. Vagus nerve stimulation (VNS) is one of the neuromodulation methods clinically, which have been approved by the Food and Drug Administration (FDA). In this review, we systematically describe the clinical application, clinical effects, possible antiepileptic mechanisms, and future research directions of VNS for epilepsy.

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The functional connectivity study on the brainstem‐cortical/subcortical structures in responders following cervical vagus nerve stimulation

Zhu

Wang

et al. 2020

Intl J of Devlp Neuroscience

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Background: Cervical vagus nerve stimulation (VNS) is an effective neuromodulation therapy for patients with drug-resistant epilepsy (DRE). The previous studies reported that VNS may reduce seizures by regulating the functional connectivity (FC) between cortical and subcortical regions. However, no studies on brainstem have been done in responders who achieved ≥50% seizure reduction following VNS. Methods: Eight healthy controls and eight patients who became responders after 3 months of operation were enrolled in this study. Resting-state functional MRI (rs-fMRI) was performed, and two sample and paired sample t test were, respectively, used to detect altered FC between brainstem and cortical/subcortical regions between controls and patients, between preoperative and postoperative patients. Results: In the control group, regions with highest FC to brainstem included bilateral anterior cingulate gyri, left basal ganglia, left insula, left cuneus, right precuneus, and bilateral cerebellum. In preoperative patients, right frontal middle gyrus, bilateral basal ganglia, and right cerebellum were showed highest FC to brainstem. Compared with the controls, preoperative patients exhibited increased FC in bilateral inferior frontal gyri, right temporal cortex, while decreased FC in left insula, left postcentral gyrus, right posterior cingulate gyrus, right precuneus, and left superior parietal gyrus. In postoperative patients, regions with increased FC to brainstem were left insula, left precuneus and left cuneus, and those with decreased FC were right inferior occipital gyrus and right cerebellum. Conclusions: Recurrent seizures caused disturbances in brainstem-cortical/subcortical FC, especially in motor executive function related regions and default mode 680 | ZHU et al. Highlights • Recurrent seizures caused disturbances in brainstem-cortical/subcortical functional connectivity. • VNS could reorganize the altered brainstemcortical/subcortical functional connectivity in responders. • Three months of stimulation may lead to significant changes in motor executive function related regions and default mode network.

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Effectiveness of vagal nerve stimulation in medication-resistant epilepsy. Comparison between patients with and without medication changes

Cited by 23 publications

References 21 publications

Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy

Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy

Research progress of vagus nerve stimulation in the treatment of epilepsy

The functional connectivity study on the brainstem‐cortical/subcortical structures in responders following cervical vagus nerve stimulation

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