A Prospective Long-Term Study on the Outcome After Vagus Nerve Stimulation at Maximally Tolerated Current Intensity in a Cohort of Children With Refractory Secondary Generalized Epilepsy

Cukiert, Arthur; Cukiert, Cristine Mella; Burattini, José Augusto; Lima, Alessandra Moura; Forster, Cássio; Baise, Carla; Argentoni-Baldochi, Meire

doi:10.1111/j.1525-1403.2012.00522.x

Cited by 35 publications

(28 citation statements)

References 26 publications

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“…In open-label studies assessing VNS in pediatric populations, responder rates varied between 22% 29 and 90%. 30 , 31 Even though over 600 young patients have been recruited in prospective and retrospective studies so far, most of these studies have a small sample size, and a number of them focus on specific epilepsy syndromes or etiologies, such as Lennox–Gastaut syndrome 32 , 33 or tuberous sclerosis. 30 Although the results of these studies overall suggest that VNS can be a useful treatment for refractory epilepsy in children, generalizing these findings to the broader pediatric population requires large-scale RCTs.…”

Section: Vnsmentioning

confidence: 99%

Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

Cox¹,

Seri²,

Cavanna³

2014

NDT

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About one third of patients with epilepsy are refractory to medical treatment. For these patients, alternative treatment options include implantable neurostimulation devices such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation systems (RNS). We conducted a systematic literature review to assess the available evidence on the clinical efficacy of these devices in patients with refractory epilepsy across their lifespan. VNS has the largest evidence base, and numerous randomized controlled trials and open-label studies support its use in the treatment of refractory epilepsy. It was approved by the US Food and Drug Administration in 1997 for treatment of partial seizures, but has also shown significant benefit in the treatment of generalized seizures. Results in adult populations have been more encouraging than in pediatric populations, where more studies are required. VNS is considered a safe and well-tolerated treatment, and serious side effects are rare. DBS is a well-established treatment for several movement disorders, and has a small evidence base for treatment of refractory epilepsy. Stimulation of the anterior nucleus of the thalamus has shown the most encouraging results, where significant decreases in seizure frequency were reported. Other potential targets include the centromedian thalamic nucleus, hippocampus, cerebellum, and basal ganglia structures. Preliminary results on RNS, new-generation implantable neurostimulation devices which stimulate brain structures only when epileptic activity is detected, are encouraging. Overall, implantable neurostimulation devices appear to be a safe and beneficial treatment option for patients in whom medical treatment has failed to adequately control their epilepsy. Further large-scale randomized controlled trials are required to provide a sufficient evidence base for the inclusion of DBS and RNS in clinical guidelines.

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Section: Vnsmentioning

confidence: 99%

Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

Cox¹,

Seri²,

Cavanna³

2014

NDT

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“…There is no consensus on the adequate stimulation paradigm during VNS. The more commonly used parameters include cycling stimulation, but higher intensity was used to further decrease seizure frequency, and lower frequency was tried to treat side effects 67 . All seizure types and syndromes have been treated by VNS.…”

Section: Introductionmentioning

confidence: 99%

How technology is driving the landscape of epilepsy surgery

et al. 2020

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This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap. K E Y W O R D Sepilepsy surgery, high-intensity focused ultrasound, intraoperative MRI, laser ablation, neuromodulation, robots 842 |

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“…Moreover, it has been found that VNS improves attention, cognition, behavior, mood, and quality of life (QOL) besides of reducing seizure burden. [ 3 4 5 6 7 ] Therefore, VNS therapy provides an alternative method for patients with PRE, especially for those with multifocal or unlocalized epileptogenic foci.…”

Section: Introductionmentioning

confidence: 99%

Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant Epilepsy

Meng

Jia

Ren

et al. 2015

Chinese Medical Journal

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Background:Over past two decades, vagus nerve stimulation (VNS) has been widely used and reported to alleviate seizure frequency worldwide, however, so far, only hundreds of patients with pharmaco-resistant epilepsy (PRE) have been treated with VNS in mainland China. The study aimed to evaluate the effectiveness of VNS for Chinese patients with PRE and compare its relationship with age cohort and gender.Methods:We retrospectively assessed the clinical outcome of 94 patients with PRE, who were treated with VNS at Beijing Fengtai Hospital and Beijing Tiantan Hospital between November 2008 and April 2014 from our database of 106 consecutive patients. The clinical data analysis was retrospectively examined.Results:Seizure frequency significantly decreased with VNS therapy after intermittent stimulation of the vagus nerve. At last follow-up, we found McHugh classifications of Class I in 33 patients (35.1%), Class II in 27 patients (28.7%), Class III in 20 patients (21.3%), Class IV in 3 patients (3.2%), and Class V in 11 patients (11.7%). Notably, 8 (8.5%) patients were seizure-free while ≥50% seizure frequency reduction occurred in as many as 60 patients (63.8%). Furthermore, with regard to the modified Engel classification, 12 patients (12.8%) were classified as Class I, 11 patients (11.7%) were classified as Class II, 37 patients (39.4%) were classified as Class III, 34 patients (36.2%) were classified as Class IV. We also found that the factors of gender or age are not associated with clinical outcome.Conclusions:This comparative study confirmed that VNS is a safe, well-tolerated, and effective treatment for Chinese PRE patients. VNS reduced the seizure frequency regardless of age or gender of studied patients.

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A Prospective Long-Term Study on the Outcome After Vagus Nerve Stimulation at Maximally Tolerated Current Intensity in a Cohort of Children With Refractory Secondary Generalized Epilepsy

Cited by 35 publications

References 26 publications

Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

How technology is driving the landscape of epilepsy surgery

Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant Epilepsy

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