Does vagus nerve stimulation influence pregnancy outcomes?

Sabers, Anne; Buchgreitz, L.; Neuhuber, Winfried

doi:10.1016/j.brs.2017.12.006

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…VNS can activate the hypothalamus, which is a key structure in the hypothalamic-pituitary-gonadal axis ( 14 ). However, while ascending fibers of the vagus nerve can activate the hypothalamus, they do not have an apparent effect on the downstream target organs ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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Safe and effective implantation and use of vagal nerve stimulation in new-onset refractory status epilepticus in early pregnancy: a case report

et al. 2023

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IntroductionThe management of new-onset refractory status epilepticus (NORSE) in pregnancy may be complicated by anti-seizure medication (ASM) polytherapy-associated teratogenicity. We aim to demonstrate the safety and efficacy of vagal nerve stimulation (VNS) in a pregnant patient presenting with NORSE.Case descriptionA 30-year old female, at 5-weeks' gestation presented with drug-refractory myoclonic status epilepticus, responsive only to high levels of anesthetic agents. The severity of seizures did not allow extubation, and the patient remained ventilated and sedated. VNS was implanted 26 days after seizure onset. The immediate post-operative output was 0.25 mA, which was rapidly titrated up to 0.5 mA the next morning, and to 0.75 mA that afternoon. This was further increased to 1.0 mA on 3rd day post-operation, and to 1.25 mA 7 days post-op. Myoclonic jerks diminished significantly 7 days post-op, allowing extubation. Twenty days after VNS implantation, no myoclonic jerks were observed. There was also a notable neurological improvement including increased alertness and mobility, and ability to obey commands. Drug overdose was subsequently found to be the most likely etiology of her NORSE. An early pregnancy assessment 17 days after VNS implantation showed a normally sited pregnancy, normal fetal heart activity and crown-rump length. The patient remained seizure free, gained functional independence and delivered a premature but otherwise healthy baby at 33 weeks' gestation.ConclusionNORSE is challenging to manage, further compounded in pregnancy due to the teratogenicity of ASMs and ASM polytherapy. This is the first case-study to report the safe implantation and use of VNS during the first trimester of pregnancy for the management of NORSE.

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Section: Discussionmentioning

confidence: 99%

“…Whilst contradictory evidence exists as to whether the vagus nerve can directly influence pelvic organ function ( 15 , 16 ), other studies suggest it has little impact on pregnancy ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Safe and effective implantation and use of vagal nerve stimulation in new-onset refractory status epilepticus in early pregnancy: a case report

et al. 2023

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“…All 3 patients treated their attacks repeatedly during pregnancy and reported some degree of benefit, with no labor or delivery complications with healthy children. Vagus nerve stimulation and trigeminal nerve stimulation have been reported in patients with non‐headache indications such as depression and epilepsy without any clear signal of teratogenicity attributable to the devices . A case was also reported of a woman with chronic cluster headache who effectively used occipital nerve stimulation as a preventive therapy throughout her pregnancy; the device had already been implanted and used preconception .…”

Section: Neuromodulation In Special Populationsmentioning

confidence: 99%

“…Vagus nerve stimulation and trigeminal nerve stimulation have been reported in patients with non-headache indications such as depression and epilepsy without any clear signal of teratogenicity attributable to the devices. 61,62 A case was also reported of a woman with chronic cluster headache who effectively used occipital nerve stimulation as a preventive therapy throughout her pregnancy; the device had already been implanted and used preconception. 63 No adverse labor or delivery outcomes occurred.…”

Section: Neuromodulation In Special Populationsmentioning

confidence: 99%

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

2019

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Headache disorders are among the most common and disabling medical conditions worldwide. Pharmacologic acute and preventive treatments are often insufficient and poorly tolerated, and the majority of patients are unable to adhere to their migraine treatments due to these issues. With improvements in our understanding of migraine and cluster headache pathophysiology, neuromodulation devices have been developed as safe and effective acute and preventive treatment options. In this review, we focus on neuromodulation devices that have been studied for migraine and cluster headache, with special attention to those that have gained food and drug administration (FDA) clearance. We will also explore how these devices can be used in patients who might have limited pharmacologic options, including the elderly, children, and pregnant women.

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“…Therefore, VNS therapy may influence neuroendocrine activity (e.g., the production of oxytocin and its storage and release from the pituitary gland) and thus the potential to affect pregnancy and fetal development cannot be ignored. 2 An experimental study by Sato et al in nonpregnant rats demonstrated that efferent VNS can influence uterine blood flow and contractions. 3 Although efferent VNS fibers form only 20% of the vagus nerve trunk, with substantially fewer fibers conveyed to the uterus than to the heart, the theoretical possibility of VNS-induced alterations of uterine functions during pregnancy and delivery cannot be excluded.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

Chrastina

Doležalová

Novák

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Vagus nerve stimulation (VNS) has been employed worldwide as an adjunctive therapy in drug-resistant epilepsy patients. However, the mechanisms of VNS action potentially increase the risk of obstetric complications. The study presents the long-term single-center experience with pregnancies and childbirth in women with VNS for refractory epilepsy based on prospectively collected epileptologic data and a retrospective analysis of pregnancy, childbirth, and data about long-term child development. Material and Methods From a group of patients with VNS implanted for refractory epilepsy between October 1999 and January 2018, all the women of childbearing age (younger than 40 years) were identified. After checking their hospital records for data about any pregnancies, the women with confirmed childbirth during active VNS stimulation and their general practitioners were interviewed based on a prepared questionnaire regarding their gynecologic history, the course of pregnancy and childbirth, gestational week, birth weight and length, any congenital anomalies of the child, and the child's psychomotor development, school performance, and somatic health problems. Results From the group of 257 patients implanted with VNS for refractory epilepsy, 4 women (1.5%) became pregnant and gave birth (all on polypharmacotherapy). The mean interval from VNS implantation to birth was 44.3 months. Slight seizure worsening during the last trimester was reported in one woman. In one patient, acute caesarean section was required due to placental separation. Planned birth induction and caesarean section were used in the other two women because of their seizure disorder. No malfunction of the stimulation system was detected during pregnancy or after birth. No congenital malformations were observed. The two children who were of school age at the time of this study require special schooling. Conclusions The study results confirmed a high rate of obstetric interventions in patients with VNS. Although no teratogenic effect of VNS has been proven, the higher incidence of children exposed to VNS needing special education requires attention.

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Does vagus nerve stimulation influence pregnancy outcomes?

Cited by 3 publications

References 10 publications

Safe and effective implantation and use of vagal nerve stimulation in new-onset refractory status epilepticus in early pregnancy: a case report

Safe and effective implantation and use of vagal nerve stimulation in new-onset refractory status epilepticus in early pregnancy: a case report

Neuromodulation for the Acute and Preventive Therapy of Migraine and Cluster Headache

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

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