Vagus nerve stimulation: a 20-year Australian experience

Yates, Charles; Riney, Kate; Malone, Stephen M.; Shah, Ubaid; Coulthard, Liam G.; Campbell, Robert M.; Wallace, Geoff; Wood, Martin

doi:10.1007/s00701-021-05046-0

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…In those patients, a >50% seizure reduction was reported in 25.8% of their patient cohort at 1 year, and 5.2% were seizure-free with vagus nerve stimulator [46]. Long-term outcomes in pediatric patients with VNS for refractory epilepsy suggests even better efficacy, with approximately 50% of patients experiencing 50% or greater reduction in seizure frequency, and overall good patient tolerance of therapy [47]. The ketogenic diet is a high fat, low carbohydrate diet that has shown success for aiding in management of refractory epilepsy.…”

Section: Managementmentioning

confidence: 99%

Epilepsy in Cerebral Palsy: A Brief Narrative Review

Patil¹,

Weber²

2022

OBM Neurobiol

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Cerebral palsy is defined as “A group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems [1].” Between 30-40% of people with cerebral palsy also have epilepsy [2-4]. Some of the risk factors for developing epilepsy include low birth weight, low APGAR scores, seizures in the neonatal period and first year of life, positive imaging findings, severity of cerebral palsy, intellectual disability and spasticity. Children with epilepsy and cerebral palsy often experience their first seizure before 2 years of age, and may have a higher risk for refractory epilepsy and status epilepticus. Anti-seizure medications are the mainstay of treatment, and are typically chosen based upon the epilepsy syndrome, seizure type, side effect profile and EEG findings. If two or more anti-seizure medications fail to control seizures, early evaluation for surgical options, which could potentially be curative, should be pursued. This review article examines the pathophysiology of cerebral palsy and epilepsy, summarizes recent literature about risk factors for developing epilepsy, clinical and EEG features, treatment outcomes in children with epilepsy and CP, and discusses management strategies.

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Section: Managementmentioning

confidence: 99%

Epilepsy in Cerebral Palsy: A Brief Narrative Review

Patil¹,

Weber²

2022

OBM Neurobiol

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mentioning

confidence: 99%

“…5,6 Conservative estimates suggest that half of patients experience at least a 50% reduction in seizures and 18% experience seizure freedom, while other studies report benefit in 76% to 91% of patients. 4,[7][8][9][10] Studies in younger children are ongoing. 11 An incomplete understanding of the mechanism of action and the unknown ideal indications for VNS contribute to large outcome variability.…”

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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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