Insufficient efficacy of vagus nerve stimulation for epileptic spasms and tonic spasms in children with refractory epilepsy

Okanishi, Tohru; Fujimoto, Ayataka; Nishimura, Mitsuyo; Kanai, Sotaro; Motoi, Hirotaka; Homma, Yoichiro; Enoki, Hideo

doi:10.1016/j.eplepsyres.2017.12.010

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…29 While all three groups exhibited significant decrease in seizure frequency after one year of VNS, those with combined focal/generalized epilepsy exhibited a 50% median seizure frequency decrease, while those with focal epilepsy exhibited a median seizure frequency decrease of 75%. Considering patients with combined focal/generalized epilepsy have multiple semiologies by nature, it is possible that certain semiologies tend to be resistant to VNS therapy 30,31 and predominant seizure frequency went unchanged. For example, 20% of our patients with combined focal/generalized epilepsy had primarily atonic seizures pre-VNS (versus only 11% and 4% of generalized and focal epilepsy patients, respectively).…”

Section: Factors Associated With Vns Response At One Yearmentioning

confidence: 99%

Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy

Muthiah

Mallela

Vodovotz

et al. 2022

Preprint

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Introduction Epilepsy impacts 470,000 children in the United States, and children with epilepsy are estimated to expend 6 times more on healthcare than those without epilepsy. For patients with antiseizure medication (ASM)-resistant epilepsy and unresectable seizure foci, vagus nerve stimulation (VNS) is a treatment option. Predicting response to VNS has been historically challenging. We aimed to create a clinical prediction score which could be utilized in a routine outpatient clinical setting. Methods We performed an 11-year, single-center retrospective analysis of patients <21 years old with ASM-resistant epilepsy who underwent VNS. The primary outcome was >50% seizure frequency reduction after one year. Univariate and multivariate logistic regressions were performed to assess clinical factors associated with VNS response; 70% and 30% of the sample were used to train and validate the multivariate model, respectively. A prediction score was developed based on the multivariate regression. Sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated. Results This analysis included 365 patients. Multivariate logistic regression revealed that variables associated with VNS response were: <4 years of epilepsy duration before VNS (p=0.008) and focal motor seizures (p=0.037). The variables included in the clinical prediction score were: epilepsy duration before VNS, age at seizure onset, number of pre-VNS ASMs, if VNS was the patient's first therapeutic epilepsy surgery, and predominant seizure semiology. The final AUC was 0.7013 for the "fitted" sample and 0.6159 for the "validation" sample. Conclusions We developed a clinical model to predict VNS response in one of the largest samples of pediatric VNS patients to date. While the presented clinical prediction model demonstrated an acceptable AUC in the training cohort, clinical variables alone likely do not accurately predict VNS response. This score may be useful upon further validation, though its predictive ability underscores the need for more robust biomarkers of treatment response.

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Section: Factors Associated With Vns Response At One Yearmentioning

confidence: 99%

Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy

Muthiah

Mallela

Vodovotz

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Other treatment options involving antiepileptic drugs, dietary therapy, and epilepsy surgery have been selected for patients whose first-line treatment was unsuccessful. Vagus nerve stimulation is less effective for medically intractable ES [ 26 , 55 ]. Hormonal treatments have also been selected to treat late-onset ES, although few studies have investigated these treatments [ 46 , 56 ].…”

Section: Epileptic Spasms: Characteristics Of Clinical and Neurophysiological Findings Mechanisms And Treatment Optionsmentioning

confidence: 99%

Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection

Okanishi

Fujimoto

2021

Brain Sciences

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In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.

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“…On the one hand, VNS is less invasive and carries a low risk of severe complications such as epidural or subdural hematoma and disconnection syndrome, which are complications of CC [ 2 , 8 , 9 , 10 ]. On the other hand, CC is more likely to improve seizure frequency or severity than VNS, particularly for drop attacks or epileptic spasms [ 9 , 10 , 11 , 12 ]. The selection of these two techniques appears to depend on seizure type, surgical risk, and the wishes of the patient and caregivers, although no universally accepted indications have been determined.…”

Section: Introductionmentioning

confidence: 99%

Effects of Vagus Nerve Stimulation following Corpus Callosotomy for Patients with Drug-Resistant Epilepsy

et al. 2021

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Objective: The effectiveness of vagus nerve stimulation (VNS) for residual seizures after corpus callosotomy (CC) has not yet been fully investigated. We hypothesized that seizure control would be improved by VNS after CC. The purpose of this study was to compare seizure frequency between patients with implantation of a VNS generator (post-VNS group) or without VNS (non-post-VNS group) following CC. Methods: We retrospectively reviewed patients who underwent CC between January 2009 and May 2019 in our institution. We evaluated proportions of ≥50% reduction in seizure frequency (responders) and seizure reduction rate 1 and 2 years after VNS. To investigate factors related to responders, uni- and multivariate logistic regression analyses were performed regarding age, number of anti-seizure medications (ASMs), addition of novel ASMs (levetiracetam, lacosamide or perampanel), and post-VNS or non-post-VNS status. Results: Thirteen post-VNS patients and 24 non-post-VNS patients were analyzed in this study. Responder rate at 1 year after VNS differed significantly between the post-VNS group (53.9%) and non-post-VNS group (12.5%, p = 0.017). Number of ASMs at the time of CC and post-VNS were significantly associated with responders in univariate analyses (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13–0.88, p = 0.025 and OR 8.2, 95%CI 1.6–41.6, p = 0.011, respectively), whereas age, sex, seizure frequency, and addition of novel ASMs were not. In multivariate analysis, the presence of VNS procedures after CC was the only factor favorably associated with responder status (OR 82.2, 95%CI 1.55–4355.7, p = 0.03). Conclusions: VNS therapy after CC may increase the proportion of responders independent of the addition of novel ASMs.

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Insufficient efficacy of vagus nerve stimulation for epileptic spasms and tonic spasms in children with refractory epilepsy

Cited by 10 publications

References 15 publications

Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy

Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy

Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection

Effects of Vagus Nerve Stimulation following Corpus Callosotomy for Patients with Drug-Resistant Epilepsy

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