Left Vagus Nerve Stimulation in Children With Refractory Epilepsy: An Update

Hornig, Gregory W.; Murphy, Jerome V.; Schallert, Gloria; Tilton, Christy

doi:10.1097/00007611-199705000-00003

Cited by 127 publications

(80 citation statements)

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“…Studies have shown favorable results in a large proportion (32-53%) of pediatric patients treated with adjunctive VNS, ranging from 50 -90% reductions in seizure frequency at ϳ1 year postoperatively. 34,56 Longterm follow-up at 36 months revealed a mean seizure frequency reduction of 74%. 57 Strong associations between improved seizure severity and QOL have been made, as has been seen in the adult population.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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“…The use of long-term vagus nerve stimulation (VNS) with intermittent electrical current was introduced for the treatment of refractory epilepsy first in adults (Binnie, 2000;Handforth et al, 1988;Labar et al, 1998;Morris and Mueller, 1999;Salinsky, 1995) and subsequently in children (Hornig et al, 1997;Patwardhan et al, 2000) and in older individuals (Sirven et al, 2000). VNS reduces seizure frequency by 50% in 30-40% of patients with severe epilepsy (Ben-Menachem, 2002) and represents the only non-pharmacological, non-surgical option for epilepsy treatment (Binnie, 2000).…”

Section: Introductionmentioning

confidence: 99%

Increase in 20–50Hz (gamma frequencies) power spectrum and synchronization after chronic vagal nerve stimulation

Marrosu¹,

Santoni²,

Puligheddu³

et al. 2005

Clinical Neurophysiology

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Objective: Though vagus nerve stimulation (VNS) is an important option in pharmacoresistant epilepsy, its mechanism of action remains unclear. The observation that VNS desynchronised the EEG activity in animals suggested that this mechanism could be involved in VNS antiepileptic effects in humans. Indeed VNS decreases spiking bursts, whereas its effects on the EEG background remain uncertain. The objective of the present study is to investigate how VNS affects local and inter regional syncronization in different frequencies in pharmacoresistent partial epilepsy. Methods: Digital recordings acquired in 11 epileptic subjects 1 year and 1 week before VNS surgery were compared with that obtained 1 month and 1 year after VNS activation. Power spectrum and synchronization were then analyzed and compared with an epileptic group of 10 patients treated with AEDs only and with 9 non-epileptic patients. Results: VNS decreases the synchronization of theta frequencies (P!0.01), whereas it increases gamma power spectrum and synchronization (!0.001 and 0.01, respectively). Conclusions: The reduction of theta frequencies and the increase in power spectrum and synchronization of gamma bands can be related to VNS anticonvulsant mechanism. In addition, gamma modulation could also play a seizure-independent role in improving attentional performances. Significance: These results suggest that some antiepileptic mechanisms affected by VNS can be modulated by or be the reflection of EEG changes. q

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“…Hornig et al 29 , en un estudio sobre 19 niños, obtuvieron una mejoría de la frecuencia de crisis de un 50% en diez de ellos, y en seis la reducción fue superior al 90%. Otros autores enfatizan sobre los buenos resultados en la reducción de las crisis, que en algunos casos llegan a más del 90% en niños con síndrome de Lennox-Gastaut 30,47 .…”

Section: Resultados En El Control De Las Crisisunclassified

Estimulación eléctrica vagal en el tratamiento de la epilepsia rebelde: Situación actual

2008

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ResumenLa estimulación intermitente vagal es una técnica de neuroestimulación de reciente incorporación en el tratamiento de pacientes con epilepsia refractaria al tratamiento farmacológico convencional. Hasta el momento presente y, a pesar de algunos resultados dispares, se ha mostrado como una alternativa eficaz y segura en el tratamiento de estos pacientes. El presente trabajo de revisión pretende acercar la técnica quirúrgica de implantación, comentar las indicaciones y resultados obtenidos hasta la actualidad, y profundizar en los posibles mecanismos de acción de este tipo de estimulación, para finalmente realizar una aproximación crítica a la misma, intentando puntualizar cúales han sido los problemas e inconvenientes que han impedido la utilización generalizada de esta alternativa quirúrgica antiepilép-tica.PALABRAS CLAVE: Epilepsia. Estimulación eléctrica vagal. Seguridad y eficacia. Mecanismos de acción. Vagus nerve stimulation for the treatment of refractory epilepsy. State of the art SummaryThe vagus nerve stimulation (VNS) therapy is a new neurostimulation technique used for treating pharmacoresistant epilepsy. It can be considered an effective and safe alternative for the treatment of refractory epilepsy patients. In the present review, we describe the surgical implantation technique, its indications and results achieved until now. We will also summarize the possible mechanisms of action of VNS therapy. Finally, we will comment on the difficulties and inconvenients that did not allow this antiepileptic surgical technique to become more widely used.KEY WORDS: Epilepsy. Vagus nerve stimulation. Save and efficacy. Action mechanisms. IntroducciónLa epilepsia es una patología que afecta al 1% de la población general y que podría ser considerada en términos globales como el segundo trastorno neurológico en cuanto a incidencia y prevalencia 60 . Esta enfermedad tiene importantes repercusiones psicológicas y económicas tanto en el paciente que la sufre como en la sociedad que tiene que sufragar los gastos que la misma supone. Además, estos factores se ven aumentados por los efectos secundarios en la esfera cognitiva, caracterológica y emocional, que con frecuencia complican los tratamientos con fármacos antiepilépticos a largo plazo. Es por ello que se hace imperiosa la necesidad de buscar e investigar nuevas modalidades de tratamiento efectivo no farmacológico.El final del siglo XX ha supuesto un avance importante en el tratamiento de las epilepsias. Sin embargo, a pesar de la proliferación actual de estudios que han aumentado el conocimiento sobre las causas de la epilepsia y que han posibilitado la introducción de nuevos fármacos antiepilépticos, se puede afirmar que todavía un 30-40% de los pacientes no tienen un control satisfactorio de sus crisis 11.13.71 . En función de ello se calcula que en Estados Unidos, los pacientes tratados correctamente sin un control adecuado de las crisis podrían estar entre 150.000 y 300.000. Extrapolando estos datos, en España serían unos 20.000-40.000 pacientes. Alreded...

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Left Vagus Nerve Stimulation in Children With Refractory Epilepsy: An Update

Cited by 127 publications

References 0 publications

Vagus Nerve Stimulation for Epilepsy and Depression

Vagus Nerve Stimulation for Epilepsy and Depression

Increase in 20–50Hz (gamma frequencies) power spectrum and synchronization after chronic vagal nerve stimulation

Estimulación eléctrica vagal en el tratamiento de la epilepsia rebelde: Situación actual

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