Vagus Nerve Stimulation for Electrographic Status Epilepticus in Slow-Wave Sleep

Does emergent implantation of a vagal nerve stimulator stop refractory status epilepticus in children?

“…Howell reported an emergent VNS in a 14 years old child presenting with refractory SE during FIRES with no improvement over 15 days after VNS implantation (the patient died on day 29). A recent report by Carosella [16] reported the successful VNS in a young child aging 12 years, presenting with continuous spike and waves during slow-waves sleep (CSWSS). The VNS resolved the CSWSS, remaining the child seizures free for more than one year and improving his intellectual skills.…”

Vagus nerve stimulation for generalized epilepsy with febrile seizures plus (GEFS+) accompanying seizures with impaired consciousness

“…Morris et al [10] reported a post-VNS implantation seizure reduction of approximately 50% in 36.8% of patients at year 1, in 43.2% at year 2, and in 42.7% at year 3 after VNS. VNS is also an effective and well-tolerated treatment for patients with Lennox-Gastaut syndrome (LGS), Dravet syndrome, and epilepsy with myoclonic-astatic seizures, and other kind of epileptic encephalopathy (Table 1) [11], [12], [13], [14], [15], [16], [17], [18]. The initial parameters were set at an output current of 0.25 mA, a signal frequency of 30 Hz, a pulse width of 250–500 ms, stimulation “on”-time 30 s, and stimulation “off”-time 300 s, with the output current generally increased to 2–3 mA as tolerated [4].…”

Changes in sleep patterns after vagus nerve stimulation, deep brain stimulation or epilepsy surgery: Systematic review of the literature

“…Carrosela et al [9] reported the case of a patient with deep sleep status epilepticus in which there was an improvement in the perception of well-being, also finding an association between the decrease in the number of crises with improvement in cognition, language, school performance and decrease in irritability. In the study by Galli et al [10], quality of life was evaluated, finding an improvement related to decreased sleep latency as measured by the Multiple Sleep Latency Test (MSLT).…”

“…Objective evaluation using polysomnography showed a relationship between sleep disturbances and VNS in 16 studies [3,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24]. During the ON period [9,14,19], the discharge frequency and the configuration with fast cycling (ON/OFF) [13,18] were associated with an increase in the apnoeahypopnoea index (AHI), the number of awakenings [14], and a decrease in respiratory effort and tidal without alteration in the AHI [3,15,20]. In all cases, the occurrence of apnoea was correlated with the ON period of the stimulator, and turning it off, or adjusting the setting with decreased stimulation parameters achieved an adequate control of respiratory symptoms in most patients [8,11,17], others required positive pressure ventilation [15,22].…”