Evaluating vagus nerve stimulation treatment with heart rate monitoring in pediatric patients with intractable epilepsy

Santhumayor, Brandon A.; Karkare, Shefali; Kothare, Sanjeev V.; Rodgers, Shaun

doi:10.1007/s00381-021-05416-0

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…The objective is thus to try to abort a seizure or reduce its propagation and thereby improve the clinical results. [9][10][11][12] Similarly to deep brain stimulation (DBS), whose mechanisms of action are still not entirely understood, [13][14][15][16][17] the full mechanisms by which VNS exerts its antiepileptic effect are still elusive. Many mechanisms in humans and in various animal models have been described.…”

Section: Introductionmentioning

confidence: 99%

Latest Views on the Mechanisms of Action of Surgically Implanted Cervical Vagal Nerve Stimulation in Epilepsy

Carron¹,

Roncon²,

Lagarde³

et al. 2023

Neuromodulation: Technology at the Neural Interface

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Section: Introductionmentioning

confidence: 99%

Latest Views on the Mechanisms of Action of Surgically Implanted Cervical Vagal Nerve Stimulation in Epilepsy

Carron¹,

Roncon²,

Lagarde³

et al. 2023

Neuromodulation: Technology at the Neural Interface

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“…VNS-based neuromodulation continues to progress rapidly. One recent technical advance is closed-loop monitoring which detects tachycardia associated with seizures and provides stimulation at that time with early evidence of improved seizure control in pediatric [30][31][32] and adult 33 populations. The precise trigger thresholds remain the subject of refinement, but closed-loop stimulation trended toward improved seizure response in 1 large, long-term, propensity-matched pediatric cohort, 34 with effect size increasing over time.…”

Section: Future Directionsmentioning

confidence: 99%

Pediatric Vagus Nerve Stimulation: Case Series Outcomes and Future Directions

et al. 2023

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BACKGROUND:Vagus nerve stimulation (VNS) is a neuromodulatory procedure most extensively studied as an adjunct to medically refractory epilepsy. Despite widespread adoption and decades of clinical experience, clinical predictors of response to VNS remain unclear.OBJECTIVE:To evaluate a retrospective cohort of pediatric patients undergoing VNS at our institution to better understand who may benefit from VNS and identify factors which may predict response to VNS.METHODS:We conducted a retrospective cohort study examining pediatric patients undergoing VNS over nearly a 20-year span at a single institution. Presurgical evaluation, including demographics, clinical history, and diagnostic electroencephalogram, and imaging findings were examined. Primary outcomes included VNS response.RESULTS:Two hundred ninety-seven subjects were studied. The mean age at surgery was 10.1 (SD = 4.9, range = 0.8-25.3) years; length of follow-up was a mean of 4.6 years (SD = 3.5, median = 3.9 years, range 1 day-16.1 years). There was no association between demographic factors, epilepsy etiology, or genetic basis and VNS outcomes. There was an association between reduction in main seizure type with positive MRI finding. Of all MRI findings analyzed, brain atrophy was significantly associated with worse VNS outcomes, whereas dysplastic hippocampus and chronic periventricular leukomalacia findings were found to be associated with improved outcomes. Increased seizure semiology variability and seizure type were also associated with improved seizure outcomes.CONCLUSION:Predicting response to VNS remains difficult, leading to incompletely realized benefits and suboptimal resource utilization. Specific MRI findings and increased seizure semiology variability and type can help guide clinical decision making and patient counseling.

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Vagus nerve stimulation and sudden unexpected death in epilepsy: views and evidence

et al. 2022

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Evaluating vagus nerve stimulation treatment with heart rate monitoring in pediatric patients with intractable epilepsy

Cited by 5 publications

References 24 publications

Latest Views on the Mechanisms of Action of Surgically Implanted Cervical Vagal Nerve Stimulation in Epilepsy

Latest Views on the Mechanisms of Action of Surgically Implanted Cervical Vagal Nerve Stimulation in Epilepsy

Pediatric Vagus Nerve Stimulation: Case Series Outcomes and Future Directions

Vagus nerve stimulation and sudden unexpected death in epilepsy: views and evidence

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