Epileptologists probe vagus nerve stimulation in children with refractory epilepsy: a promise against sudden unexpected death in epilepsy

Abstract

It is clear that sudden unexpected death in epilepsy (SUDEP) is mainly a problem for people with refractory epilepsy, but our understanding of the best way to its prevention is still incomplete. Although the pharmacological treatments available for epilepsies have expanded, some antiepileptic drugs are still limited in clinical efficacy. In the present paper, we described an experience with vagus nerve stimulation (VNS) treatment by opening space and providing the opportunity to implement effective preventative maps to reduce the incidence of SUDEP in children and adolescents with refractory epilepsy.Key words: epilepsy, vagus nerve stimulation, SUDEP. RESUMOEstá claro que a morte súbita e inesperada em epilepsias (SUDEP) é principalmente um problema para as pessoas com epilepsia refratária, mas o entendimento para estabelecer medidas preventivas ainda está incompleto. Embora os tratamentos farmacológicos disponíveis para epilepsias tenham sido expandidos, algumas drogas antiepilépticas ainda são limitadas em termos de eficácia clínica. No presente trabalho, foi descrita uma experiência com a estimulação do nervo vago (VNS), abrindo espaço e fornecendo a oportunidade de implementar eficazes mapas preventivoss para reduzir a incidência da SUDEP em crianças e adolescentes com epilepsia refratária.Palavras-Chave: epilepsia, estimulação do nervo vago, SUDEP. 954Arq Neuropsiquiatr 2012;70(12): [953][954][955] that the risk of sudden death in people with epilepsy is estimated to be at least 20 times higher than that of the general population 10 . In general terms, SUDEP is responsible for 7.5 to 17% of all deaths in people with epilepsy, and it has an incidence among adults between 1:500 and 1:1,000 patient-years 11 . Concerning risk factors, the main currently described are refractoriness of the epileptic condition, presence of convulsive seizures, early onset of epilepsy, antiepileptic medication (polytherapy with antiepileptic drugs), young age, and duration of the seizure disorder 9,12,13 . The causes of SUDEP are still unknown, but researches consistently suggest that the main mechanism for SUDEP is autonomic dysregulation, i.e., cardiac and respiratory abnormalities during and after seizures 9,12-14 . In addition, it is clear that SUDEP is mainly, but not exclusively, a problem for people with uncontrolled epilepsy 13 , but our understanding of the best way to its prevention is still incomplete. Strict evidence still lacks for its effectiveness, but epidemiologic and observational data seem to suggest some measures to minimize the risk of SUDEP, and these include: good seizure control, stress reduction, participation in physical activity and sports (with appropriate professional supervision), dietary management (omega-3 supplementation), night supervision, family members' knowledge of cardiopulmonary resuscitation techniques, and the basics of defibrillator use 13,15,16 . Despite the great scientific advances of SUDEP over the past two decades, most of the information described above was conducted in adu...

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

“…24 Another potential application of VNS in heart diseases is in the rate and rhythm control of AF. 10, 25, 26 VNS has been reported to reduce the incidence of sudden unexpected death in epilepsy (SUDEP), 1, 2 but others failed to confirm that finding. 27 …”

“…1, 2 Recent studies showed that there is significant interictal cardiac electrical instability (elevated T wave alternans) in patients with drug-resistant epilepsy, which was effectively suppressed by VNS. 3 Because T wave alternans is enhanced by sympathetic activation, 4 these findings suggest that VNS might be associated with reduced sympathetic tone.…”

Health Technology Assessment Report on Vagus Nerve Stimulation in Drug-Resistant Epilepsy

“…On the other hand, a review of 17 papers did not recommend the use of VNS for resistant status epilepticus (RSE); nevertheless, a more recent review by Dibué-Adjei concludes that VNS can interrupt RSE in 74% of patients, with a class IV evidence level [ 83 ]. VNS was considered as a promising tool in the prevention or reduction in sudden unexpected death in epilepsy (SUDEP) [ 84 , 85 , 86 ]. However, the audit of 466 VNS cases enrolled at a single center showed that patients with VNS carried a similar risk for SUDEP as other drug refractory patients [ 87 ].…”