Cognition-Enhancing Effect of Vagus Nerve Stimulation in Patients With Alzheimer’s Disease

Sjögren, Magnus; Jonsson, Michael; Runnerstam, Magnus; Silander, Hans C:son; Ben‐Menachem, Elinor; Sjögren, J. C.; Hellström, Per

doi:10.4088/jcp.v63n1103

Cited by 179 publications

(111 citation statements)

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“…These results are consistent with previous evidence demonstrating VNS-induced cognitive and behavioral improvements that were not related to the changes in seizure frequency [51][52][53][54]. It seems contradictory that VNS improves the behavioral performance in all patients, while it increases the P3 amplitude only in responders.…”

Section: Discussionsupporting

confidence: 92%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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Currently, the mechanism of action of vagus nerve stimulation (VNS) is not fully understood, and it is unclear which factors determine a patient's response to treatment. Recent preclinical experiments indicate that activation of the locus coeruleus noradrenergic system is critical for the antiepileptic effect of VNS. This study aims to evaluate the effect of VNS on noradrenergic signaling in the human brain through a noninvasive marker of locus coeruleus noradrenergic activity: the P3 component of the event-related potential. We investigated whether VNS differentially modulates the P3 component in VNS responders versus VNS nonresponders. For this purpose, we recruited 20 patients with refractory epilepsy who had been treated with VNS for at least 18 months. Patients were divided into 2 groups with regard to their reduction in mean monthly seizure frequency: 10 responders (>50 %) and 10 nonresponders (≤50 %). Two stimulation conditions were compared: VNS OFF and VNS ON. In each condition, the P3 component was measured during an auditory oddball paradigm. VNS induced a significant increase of the P3 amplitude at the parietal midline electrode, in VNS responders only. In addition, logistic regression analysis showed that the increase of P3 amplitude can be used as a noninvasive indicator for VNS responders. These results support the hypothesis that activation of the locus coeruleus noradrenergic system is associated with the antiepileptic effect of VNS. Modulation of the P3 amplitude should be further investigated as a noninvasive biomarker for the therapeutic efficacy of VNS in patients with refractory epilepsy.

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Section: Discussionsupporting

confidence: 92%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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“…The Phase III clinical trials for VNS began in 1990, and our center was one of the first to participate in Europe. Initially, 18 patients were included, and since then a total of 245 patients have been implanted, including the patients in the Alzheimer study 36 and the 3 patients lost to follow-up. This case series is, to our knowledge, the first longitudinal series dealing with complications to vagus nerve stimulation that ranges up to 25 years.…”

Section: Discussionmentioning

confidence: 99%

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Révész

Rydenhag

Ben‐Menachem

2016

PED

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134

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OBJECTIVE The goal of this paper was to investigate surgical and hardware complications in a longitudinal retrospective study. METHODS The authors of this registry study analyzed the surgical and hardware complications in 247 patients who underwent the implantation of a vagus nerve stimulation (VNS) device between 1990 and 2014. The mean follow-up time was 12 years. RESULTS In total, 497 procedures were performed for 247 primary VNS implantations. Complications related to surgery occurred in 8.6% of all implantation procedures that were performed. The respective rate for hardware complications was 3.7%. Surgical complications included postoperative hematoma in 1.9%, infection in 2.6%, vocal cord palsy in 1.4%, lower facial weakness in 0.2%, pain and sensory-related complications in 1.4%, aseptic reaction in 0.2%, cable discomfort in 0.2%, surgical cable break in 0.2%, oversized stimulator pocket in 0.2%, and battery displacement in 0.2% of patients. Hardware-related complications included lead fracture/malfunction in 3.0%, spontaneous VNS turn-on in 0.2%, and lead disconnection in 0.2% of patients. CONCLUSIONS VNS implantation is a relatively safe procedure, but it still involves certain risks. The most common complications are postoperative hematoma, infection, and vocal cord palsy. Although their occurrence rates are rather low at about 2%, these complications may cause major suffering and even be life threatening. To reduce complications, it is important to have a long-term perspective. The 25 years of follow-up of this study is of great strength considering that VNS can be a life-long treatment for many patients. Thus, it is important to include repeated surgeries such as battery and lead replacements, given that complications also may occur with these surgeries.

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“…At 5 years of follow-up after beginning the stimulation, Kuba et al reported 64.4% of patients were responders whose 15.5% experienced 90% seizure reduction, and 5.5% were seizure-free (19). Tatum Several studies reported the efficacy of VNS in different disorders except epilepsy such as Lennox-Gastaut syndrome, migraine, depression, Alzheimer disease, multiple sclerosis for postural cerebellar tremor and dysphagia, eating disorders like bulimia nervosa and Tourette syndrome (11,16,17,21,22,23,33). It seems VNS will be a treatment modality for many diseases in the future.…”

Section: Degiorgio Et Al Investigated 195 Patients With Generalizedmentioning

confidence: 99%

Vagal nerve stimulation effects on generalized-partial seizures and medication in adult drug resistans epilepsy patients

Özdoğan

Nurhat²,

Düzkalır³

et al. 2013

Turkish Neurosurgery

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Cognition-Enhancing Effect of Vagus Nerve Stimulation in Patients With Alzheimer’s Disease

Cited by 179 publications

References 0 publications

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Vagal nerve stimulation effects on generalized-partial seizures and medication in adult drug resistans epilepsy patients

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