Vagal nerve stimulation in children under 12 years old with medically intractable epilepsy

Healy, Sarah; Lang, J.; Naudé, Johann te Water; Gibbon, Frances; Leach, Paul

doi:10.1007/s00381-013-2143-3

Cited by 20 publications

(6 citation statements)

References 20 publications

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“…In addition, indirect costs (for example: lost productivity) account for about half of the total costs. Among the direct costs of healthcare, outpatient costs are prevalent in more stable patients, whereas hospital costs are prevalent in patients with higher frequency of seizures [ 23 , 36 , 37 , 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

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

Marras

Colicchio

Palma

et al. 2020

IJERPH

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Background: Vagus nerve stimulation (VNS) is a palliative treatment for medical intractable epileptic syndromes not eligible for resective surgery. Health technology assessment (HTA) represents a modern approach to the analysis of technologies used for healthcare. The purpose of this study is to assess the clinical, organizational, financial, and economic impact of VNS therapy in drug-resistant epilepsies and to establish the congruity between costs incurred and health service reimbursement. Methods: The present study used an HTA approach. It is based on an extensive detailed bibliographic search on databases (Medline, Pubmed, Embase and Cochrane, sites of scientific societies and institutional sites). The HTA study includes the following issues: (a) social impact and costs of the disease; (b) VNS eligibility and clinical results; (c) quality of life (QoL) after VNS therapy; (d) economic impact and productivity regained after VNS; and (e) costs of VNS. Results: Literature data indicate VNS as an effective treatment with a potential positive impact on social aspects and on quality of life. The diagnosis-related group (DRG) financing, both on national and regional levels, does not cover the cost of the medical device. There was an evident insufficient coverage of the DRG compared to the full cost of implanting the device. Conclusions: VNS is a palliative treatment for reducing seizure frequency and intensity. Despite its economic cost, VNS should improve patients’ quality of life and reduce care needs.

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Section: Resultsmentioning

confidence: 99%

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

Marras

Colicchio

Palma

et al. 2020

IJERPH

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“…Despite adequate treatment with antiseizure drugs, about one-third of the patients, mostly children, prove to be resistant to current medications and are therefore considered to have a drug-resistant epilepsy (DRE). When resective surgery was not feasible, vagus nerve stimulation (VNS) was proposed as an alternative treatment for this cohort of patients, showing a significant reduction in seizure frequency and duration [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Over the last decade, an increasing number of experimental and clinical evidence has suggested the hypothesis of an inflammatory genesis for epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Effect of Vagus Nerve Stimulation on Blood Inflammatory Markers in Children with Drug-Resistant Epilepsy: A Pilot Study

et al. 2022

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Background: Since one of the suggested mechanisms of action of VNS on epilepsy is the reduction of central inflammation, we carried out a comprehensive analysis of blood inflammatory markers in children considered for VNS surgery. Materials and methods: Five pediatric patients were studied. An extensive analysis of blood inflammatory markers was performed before surgery (T0) and six weeks after VNS implantation (T1). An epileptological outcome was obtained according to the McHugh score. Results: The variations of IgA, IgE, IgG, CD19, and PTX3 displayed a tendency toward a positive statistical correlation between T0 and T1. According to McHugh score, the patients were divided into Group 1 (i.e., Class I) and Group 2 (i.e., Classes II and III). IL-1β and PTX-3 tended to decrease more in Group 1, while TNF-α decreased in Group 2 (−56.65%) and slightly increased (+3.61%) in Group 1 at T1 without statistical correlation. Conclusions: The variation of IL-1β and PTX-3 seem to be related to a better outcome; thus, they do not reach statistical significance. A larger series of patients is needed to determine whether biochemical changes could relay with the clinical improvement of epilepsy.

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“…Vagus nerve stimulation (VNS) is an effective therapy for partial or pharmacologically refractory epilepsy [ 1 , 2 ] and depression [ 3 ] and a potential therapeutic approach, under active clinical research in a number of other clinical applications, such as supraventricular arrhythmias and heart failure (HF) [ 4 – 6 ]. In heart failure therapy, two ways for delivering VNS exist.…”

Section: Introductionmentioning

confidence: 99%

A novel controller based on state-transition models for closed-loop vagus nerve stimulation: Application to heart rate regulation

et al. 2017

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Vagus nerve stimulation (VNS) is an established adjunctive therapy for pharmacologically refractory epilepsy and depression and is currently in active clinical research for other applications. In current clinical studies, VNS is delivered in an open-loop approach, where VNS parameters are defined during a manual titration phase. However, the physiological response to a given VNS configuration shows significant inter and intra-patient variability and may significantly evolve through time. VNS closed-loop approaches, allowing for the optimization of the therapy in an adaptive manner, may be necessary to improve efficacy while reducing side effects. This paper proposes a generic, closed-loop control VNS system that is able to optimize a number of VNS parameters in an adaptive fashion, in order to keep a control variable within a specified range. Although the proposed control method is completely generic, an example application using the cardiac beat to beat interval (RR) as control variable will be developed in this paper. The proposed controller is based on a state transition model (STM) that can be configured using a partially or a fully-connected architecture, different model orders and different state-transition algorithms. The controller is applied to the adaptive regulation of heart rate and evaluated on 6 sheep, for 13 different targets, using partially-connected STM with 10 states. Also, partially and fully-connected STM defined by 30 states were applied to 7 other sheep for the same 10 targets. Results illustrate the interest of the proposed fully-connected STM and the feasibility of integrating this control system into an implantable neuromodulator.

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Vagal nerve stimulation in children under 12 years old with medically intractable epilepsy

Abstract: This study suggests that VNS is a safe and effective adjuvant therapy in children under 12 years old, with over half reporting significant benefit. Further studies are needed to enable preoperative selection of patients in order to maximise the potential benefit.

Cited by 20 publications

References 20 publications

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

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

Effect of Vagus Nerve Stimulation on Blood Inflammatory Markers in Children with Drug-Resistant Epilepsy: A Pilot Study

A novel controller based on state-transition models for closed-loop vagus nerve stimulation: Application to heart rate regulation

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