Does emergent implantation of a vagal nerve stimulator stop refractory status epilepticus in children?

Grioni, Daniele; Landi, Andrea; Fiori, Leonardo; Sganzerla, Erik P.

doi:10.1016/j.seizure.2018.08.008

Cited by 11 publications

(16 citation statements)

References 19 publications

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“…Vagus nerve stimulation (VNS) may serve as an alternative or adjunct therapy for dogs with refractory epilepsy. This method has been utilized in human medicine for treatment of various diseases, including pharmacoresistent epilepsy and status epilepticus (7,8). Side effects attributed to the implantable device in humans are minimal, most often causing a voice change and coughing, (7) although there have been more severe documented complications related to the surgical procedure used to implant the device.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Non-Invasive Vagus Nerve Stimulation (gammaCore VET™) for the Treatment of Refractory Seizure Activity in Dogs

et al. 2020

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Idiopathic epilepsy is the most common chronic neurologic condition in dogs. Approximately 20-30% of those dogs are refractory to standard medical therapy and commonly experience side effects from antiepileptic drugs. Non-invasive vagus nerve stimulation (nVNS) has been frequently used in human medicine as an adjunct seizure therapy with low incidence of adverse events. Canine studies are limited to invasive surgical implants with no non-invasive evaluations currently published. We investigated the feasibility and efficacy of nVNS (gammaCore VET) as an adjunct treatment for refractory epilepsy in dogs. In total, 14 client-owned dogs completed the trial of either 8-or 16-week treatment periods during which they received 90-120 s stimulation three times per day in the region of the left cervical vagus nerve. Owners recorded seizure type (focal or generalized) and frequency as well as any adverse effects. Out of 14 dogs, nine achieved a reduction in seizure frequency and four were considered responders with a 50% or greater reduction in seizures from baseline to the final treatment period. However, there was no statistically significant difference in overall seizure frequency (p = 0.53) or percent change in seizure frequency between groups (p = 0.75). Adverse effects occurred in 25% of dogs originally enrolled, with reports of a hoarse bark and limb trembling, lethargy, behavioral changes, and an increase in seizure frequency. Non-invasive VNS was found to be safe and easy to administer with mild adverse events. It is considered a feasible treatment option as an adjunct therapy in refractory seizures and should be further investigated.

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Section: Introductionmentioning

confidence: 99%

Feasibility of Non-Invasive Vagus Nerve Stimulation (gammaCore VET™) for the Treatment of Refractory Seizure Activity in Dogs

et al. 2020

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“…A systematic review showed VNS implantation was associated with cessation of 74% (28/38) RSE/SRSE patients in acute phase [7]. A case report presented three out of four genetic SE cases with success cessation by VNS implantation, which seemed even more tough than non-genetic SE [8], and gave us more evidence of applying VNS in our patient though no FIRES case has been reported with VNS successful management.…”

Section: Discussionmentioning

confidence: 66%

Vagus nerve stimulation for super-refractory status epilepticus in febrile infection–related epilepsy syndrome: a pediatric case report and literature review

Luo

Wang

et al. 2021

Childs Nerv Syst

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Febrile infection-related epilepsy syndrome (FIRES) is a devastating epileptic encephalopathy with limited treatment options and unclear etiology. Vagus nerve stimulation (VNS) is an FDA-approved therapy for refractory epilepsy that has been shown to decrease the frequency and severity of seizures. There is a growing interest in alternate non-pharmaceutical therapies for managing super-refractory status epilepticus (SRSE). We present a 29-month-old case, diagnosed with FIRES, whose seizures were successfully controlled by utilization of VNS after ineffective response to intensive pharmacotherapy and ketogenic diet treatment. The VNS was planted after 14 days of refractory seizure activity with a following rapid parameter titration for 42 days without evident side effect, which finally controlled the seizure in the acute phase. VNS may be a potential candidate for the treatment of SRSE in FIRES.

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“…Four cases have recently been reported with patients presenting different conditions: hemimegaloencephaly, non-ketotic hyperglycinemia, migrating focal seizures of infancy, and microdeletion of 1q43q44 causing microcephalia, corpus callosum agenesia, and epilepsy. All four conditions were genetically determined, and the authors reported cessation of SE in three out of the four cases (14).…”

Section: Discussionmentioning

confidence: 98%

Refractory Status Epilepticus in Genetic Epilepsy—Is Vagus Nerve Stimulation an Option?

et al. 2020

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Refractory and super-refractory status epilepticus (RSE, SRSE) are severe conditions that can have long-term neurological consequences with high morbidity and mortality rates. The usefulness of vagus nerve-stimulation (VNS) implantation during RSE has been documented by anecdotal cases and in systematic reviews; however, the use of VNS in RSE has not been widely adopted. We successfully implanted VNS in two patients with genetic epilepsy admitted to hospital for SRSE; detailed descriptions of the clinical findings and VNS parameters are provided. Our patients were implanted 25 and 58 days after status epilepticus (SE) onset, and a stable remission of SE was observed from the seventh and tenth day after VNS implantation, respectively, without change in anti-seizure medication. We used a fast ramp-up of stimulation without evident side effects. Our results support the consideration of VNS implantation as a safe and effective adjunctive treatment for SRSE.

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Does emergent implantation of a vagal nerve stimulator stop refractory status epilepticus in children?

Abstract: VNS can be effective in treating refractory or super-refractory Status Epilepticus.

Cited by 11 publications

References 19 publications

Feasibility of Non-Invasive Vagus Nerve Stimulation (gammaCore VET™) for the Treatment of Refractory Seizure Activity in Dogs

Feasibility of Non-Invasive Vagus Nerve Stimulation (gammaCore VET™) for the Treatment of Refractory Seizure Activity in Dogs

Vagus nerve stimulation for super-refractory status epilepticus in febrile infection–related epilepsy syndrome: a pediatric case report and literature review

Refractory Status Epilepticus in Genetic Epilepsy—Is Vagus Nerve Stimulation an Option?

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