Refractory Status Epilepticus in Genetic Epilepsy—Is Vagus Nerve Stimulation an Option?

Specchio, Nicola; Ferretti, Alessandro; Pietrafusa, Nicola; Trivisano, Marina; Calabrese, Costanza; Pavia, Giusy Carfì; Benedictis, Alessandro De; Marras, Carlo Efisio; Palma, Luca De; Vigevano, Federico

doi:10.3389/fneur.2020.00443

Cited by 9 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In these patients, titrating directly to the target dose is possible due to sedation. Specchio et al rapidly titrated VNS at steps of 0.25 mA per day in 2 patients with super refractory status epilepticus [33]. A teen patient was remitted from status in 7 days (32 days total in status) at a dose of 1.75 mA/500lsec, and an infant remitted in 10 days (68 days total in status) at a dose of 1 mA/500lsec.…”

Section: Real-world Examples Of Rapid Titrationmentioning

confidence: 99%

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Tzadok

Verner

Kann

et al. 2022

Epilepsy & Behavior

View full text Add to dashboard Cite

Section: Real-world Examples Of Rapid Titrationmentioning

confidence: 99%

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Tzadok

Verner

Kann

et al. 2022

Epilepsy & Behavior

View full text Add to dashboard Cite

“…Fifteen patients had VNS implantations for srSE in nine articles (Figure 4) [52,[54][55][56][57][58][63][64][65]. In three patients, srSE occurred de novo due to FIRES.…”

Section: Vagus Nerve Stimulation (Vns)mentioning

confidence: 99%

“…** Four patients ([54]; [pt 4] [55]; [pt 3 and pt 4] [56]) were removed from calculation of "Duration of SE before stimulation" as it was not adequately reported. *** 3 patients died of unrelated causes after SE resolved ([57]; [pt 1 and pt 2][58]).…”

mentioning

confidence: 99%

Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus

Stavropoulos,

Pak,

Alarcon

et al. 2023

Brain Sciences

View full text Add to dashboard Cite

Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation. The evaluation of these techniques is limited by the small number of published paediatric cases (n = 25, one with two techniques) in peer-reviewed articles (n = 18). Although neuromodulation strategies have not been tested through randomised, prospective controlled clinical trials, this review presents the existing data and the potential benefits of neuromodulation therapy, suggesting that these techniques, when available, could be considered at earlier stages within the course of srSE intending to prevent long-term neurologic complications. Clinical trials aiming to establish whether early intervention can prevent long-term sequelae are necessary in order to establish the potential clinical value of neuromodulation techniques for the treatment of srSE in children.

show abstract

“…VNS is a minimally invasive and controllable treatment for patients with epilepsy, and there are approximately 45%–65% responders (⩾50% reduction in seizure frequency) after VNS therapy. 8 – 12 In addition, indications, 13 – 15 safety, and side effects 16 , 17 of VNS therapy have been internationally validated and acknowledged. Some patient-related and epilepsy-related predictors with an impact on the prognosis of VNS therapy have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Liu

Xiong

Wang

et al. 2022

Therapeutic Advances in Chronic Disease

View full text Add to dashboard Cite

Background: Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE. Methods: We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness. Results: A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders ( p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS ( p = 0.010, p = 0.003, respectively). Conclusion: VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.

show abstract

Refractory Status Epilepticus in Genetic Epilepsy—Is Vagus Nerve Stimulation an Option?

Cited by 9 publications

References 20 publications

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Contact Info

Product

Resources

About