Efficacy of vagus nerve stimulation in posttraumatic versus nontraumatic epilepsy

Englot, Dario J.; Rolston, John D.; Wang, Doris D.; Hassnain, Kevin H.; Gordon, Christopher P.; Chang, Edward F.

doi:10.3171/2012.8.jns122

Cited by 50 publications

(32 citation statements)

References 32 publications

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“…Favorable response to therapy, with ≥50% reduction in seizure frequency, was reached by 1972 of 4483 (44%) patients after three months of therapy, and by 618 of 1104 (56%) patients after 24 months. Patients with a history of Lennox-Gastaut syndrome or epilepsy stemming from a traumatic source may benefit from an improved treatment response [50]. Adverse events associated with VNS include hoarseness (37–62%), cough (7–21%), pain (6–17%), and infection (4–6%) [67,29,10,42].…”

Section: Neurostimulation Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

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Section: Neurostimulation Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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“…(2012) retrospectively compared outcomes of VNS in patients with post-traumatic epilepsy (PTE) and those with non-traumatic epilepsy. The group found PTE patients to have larger reductions in seizure frequency and a greater clinical response compared to non-traumatic epileptics [181]. Current pilot studies by Dr. Samadani and colleagues to understand prospective clinical outcomes in patients who receive a VNS after TBI are underway and successful work would pave the way for larger trials [182].…”

Section: Seizure Treatmentsmentioning

confidence: 99%

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Algattas

Huang

2013

IJMS

226

178

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Traumatic Brain Injury (TBI) affects a large proportion and extensive array of individuals in the population. While precise pathological mechanisms are lacking, the growing base of knowledge concerning TBI has put increased emphasis on its understanding and treatment. Most treatments of TBI are aimed at ameliorating secondary insults arising from the injury; these insults can be characterized with respect to time post-injury, including early, intermediate, and late pathological changes. Early pathological responses are due to energy depletion and cell death secondary to excitotoxicity, the intermediate phase is characterized by neuroinflammation and the late stage by increased susceptibility to seizures and epilepsy. Current treatments of TBI have been tailored to these distinct pathological stages with some overlap. Many prophylactic, pharmacologic, and surgical treatments are used post-TBI to halt the progression of these pathologic reactions. In the present review, we discuss the mechanisms of the pathological hallmarks of TBI and both current and novel treatments which target the respective pathways.

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Section: Resultsmentioning

confidence: 99%

“…Two surgical intervention studies were identified for the treatment of adults with PTE . One study was a retrospective case‐control study of 317 adults with drug‐resistant PTE compared with 1,763 patients with drug‐resistant non‐PTE who were treated with a vagal nerve stimulator (VNS) (Table ) . Englot et al reported a significant reduction in seizures (of 73% at 2 years follow‐up) following VNS therapy in people with PTE, which was higher than that in patients treated for non‐PTE (61%).…”

Section: Resultsmentioning

confidence: 99%

Management of post‐traumatic epilepsy: An evidence review over the last 5 years and future directions

2017

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SummaryPost‐traumatic epilepsy (PTE) is a relatively underappreciated condition that can develop as a secondary consequence following traumatic brain injury (TBI). The aim of this rapid evidence review is to provide a synthesis of existing evidence on the effectiveness of treatment interventions for the prevention of PTE in people who have suffered a moderate/severe TBI to increase awareness and understanding among consumers. Electronic medical databases (n = 5) and gray literature published between January 2010 and April 2015 were searched for studies on the management of PTE. Twenty‐two eligible studies were identified that met the inclusion criteria. No evidence was found for the effectiveness of any pharmacological treatments in the prevention or treatment of symptomatic seizures in adults with PTE. However, limited high‐level evidence for the effectiveness of the antiepileptic drug levetiracetam was identified for PTE in children. Low‐level evidence was identified for nonpharmacological interventions in significantly reducing seizures in patients with PTE, but only in a minority of cases, requiring further high‐level studies to confirm the results. This review provides an opportunity for researchers and health service professionals to better understand the underlying pathophysiology of PTE to develop novel, more effective therapeutic targets and to improve the quality of life of people with this condition.

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Efficacy of vagus nerve stimulation in posttraumatic versus nontraumatic epilepsy

Cited by 50 publications

References 32 publications

Seizure outcomes in nonresective epilepsy surgery: an update

Seizure outcomes in nonresective epilepsy surgery: an update

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

Management of post‐traumatic epilepsy: An evidence review over the last 5 years and future directions

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