Vagus nerve stimulation during pregnancy: an instructive case

Salerno, Grazia Gabriella; Passamonti, Claudia; Cecchi, A; Zamponi, Nelia

doi:10.1007/s00381-015-2897-x

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Although device functioning was not optimal during the critical period of organogenesis, no morphologic abnormalities of the fetus were detected. 11…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

Chrastina

Doležalová

Novák

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Vagus nerve stimulation (VNS) has been employed worldwide as an adjunctive therapy in drug-resistant epilepsy patients. However, the mechanisms of VNS action potentially increase the risk of obstetric complications. The study presents the long-term single-center experience with pregnancies and childbirth in women with VNS for refractory epilepsy based on prospectively collected epileptologic data and a retrospective analysis of pregnancy, childbirth, and data about long-term child development. Material and Methods From a group of patients with VNS implanted for refractory epilepsy between October 1999 and January 2018, all the women of childbearing age (younger than 40 years) were identified. After checking their hospital records for data about any pregnancies, the women with confirmed childbirth during active VNS stimulation and their general practitioners were interviewed based on a prepared questionnaire regarding their gynecologic history, the course of pregnancy and childbirth, gestational week, birth weight and length, any congenital anomalies of the child, and the child's psychomotor development, school performance, and somatic health problems. Results From the group of 257 patients implanted with VNS for refractory epilepsy, 4 women (1.5%) became pregnant and gave birth (all on polypharmacotherapy). The mean interval from VNS implantation to birth was 44.3 months. Slight seizure worsening during the last trimester was reported in one woman. In one patient, acute caesarean section was required due to placental separation. Planned birth induction and caesarean section were used in the other two women because of their seizure disorder. No malfunction of the stimulation system was detected during pregnancy or after birth. No congenital malformations were observed. The two children who were of school age at the time of this study require special schooling. Conclusions The study results confirmed a high rate of obstetric interventions in patients with VNS. Although no teratogenic effect of VNS has been proven, the higher incidence of children exposed to VNS needing special education requires attention.

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“…Although device functioning was not optimal during the critical period of organogenesis, no morphologic abnormalities of the fetus were detected. 11…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

Chrastina

Doležalová

Novák

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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“…Pilot studies in animal models also failed to find teratogenic effects of VNS . A potential benefit of VNS during gestation is the possibility of AEDs reduction in number or dosage, as seen in patient 4 . One concern with VNS could be the possible effect of a malfunctioning system, but a case was reported with suboptimal device functioning detected during the organogenesis period with no morphological abnormalities of the fetus .…”

Section: Discussionmentioning

confidence: 99%

“…A potential benefit of VNS during gestation is the possibility of AEDs reduction in number or dosage, as seen in patient 4 . One concern with VNS could be the possible effect of a malfunctioning system, but a case was reported with suboptimal device functioning detected during the organogenesis period with no morphological abnormalities of the fetus . On the other hand, VNS could safely continue functioning during delivery, either during vaginal birth or during cesarean section.…”

Section: Discussionmentioning

confidence: 99%

“…There have been no later clinical studies regarding efficacy and adverse events among pregnant patients with VNS. Only nine cases of pregnancies receiving VNS therapy for epilepsy have been reported from 1998 (six from pregnancies during clinical studies and three others during clinical practice, with unremarkable and healthy deliveries including one set of twins) and one more in a woman with drug‐resistant depression . Seven outcomes were positive and three negative (two elective abortive procedures, one of them based on abnormal fetal development attributed to AEDs, and a possible spontaneous abortion).…”

Section: Introductionmentioning

confidence: 99%

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VNS and pregnancy: A multicentric experience of four cases

et al. 2017

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“… 23 VNS has been used successfully as a treatment for medically refractory epilepsy in pregnant women, and physicians have concluded that VNS is a viable option for treatment during pregnancy. 24 , 25 As a non-pharmacological treatment, VNS seems to be beneficial for seizure control in the expecting mother, and there is no evidence of harm to the developing fetus. To date, no large clinical trials have been performed to assess whether VNS has a long-term effect on the developing fetus.…”

Section: Current Clinical Uses Of Vnsmentioning

confidence: 99%

A review of vagus nerve stimulation as a therapeutic intervention

Johnson

Wilson

2018

JIR

382

289

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In this review, we provide an overview of the US Food and Drug Administration (FDA)-approved clinical uses of vagus nerve stimulation (VNS) as well as information about the ongoing studies and preclinical research to expand the use of VNS to additional applications. VNS is currently FDA approved for therapeutic use in patients aged >12 years with drug-resistant epilepsy and depression. Recent studies of VNS in in vivo systems have shown that it has anti-inflammatory properties which has led to more preclinical research aimed at expanding VNS treatment across a wider range of inflammatory disorders. Although the signaling pathway and mechanism by which VNS affects inflammation remain unknown, VNS has shown promising results in treating chronic inflammatory disorders such as sepsis, lung injury, rheumatoid arthritis (RA), and diabetes. It is also being used to control pain in fibromyalgia and migraines. This new preclinical research shows that VNS bears the promise of being applied to a wider range of therapeutic applications.

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Vagus nerve stimulation during pregnancy: an instructive case

Abstract: A confirmation of VNS safety may increase its use during pregnancy, thus reducing possible systemic effects of antiepileptic drugs and antidepressants on the women and the baby.

Cited by 16 publications

References 6 publications

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience

VNS and pregnancy: A multicentric experience of four cases

A review of vagus nerve stimulation as a therapeutic intervention

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