Vagus nerve stimulation for epilepsy: Randomized comparison of three stimulation paradigms

Abstract

Vagus nerve stimulation (VNS) is an effective adjunctive treatment for intractable epilepsy. However, the optimal range of device duty-cycles [on/(on + off times)] is poorly understood. The authors performed a multicenter, randomized trial of three unique modes of VNS, which varied primarily by duty-cycle. The results indicate that the three duty-cycles were equally effective. The data support the use of standard duty-cycles as initial therapy.

Electrical stimulation devices in the treatment of epilepsy

“…Later, he studied 64 patients, randomized to different duty cycles (14, 28, and 50%). All duty cycles were equally effective as initial settings but when non-responders had their duty cycles increased, the number of responders increased, supporting his earlier findings [19].…”

“…The usual settings are 30 s ''on'' and 5 min ''off'' which translates to a duty cycle of about 10%. When a patient does not respond to the targeted ''dose'' of stimulation, it is reasonable to reduce the interval between stimuli: i.e., increase the duty cycle [19,20] to the commonly referred to as ''rapid cycling''; there is, however, relatively few data regarding the impact of higher duty cycles on seizure control. DeGiorgio retrospectively analyzed the VNS settings of 154 patients.…”

Neuromodulation in refractory epilepsy: Brazilian specialists consensus

“…Thus, duty cycles may be changed, with shorter duration of stimulation, at shorter intervals. Some reports suggest that, although conventional duty cycles are more effective than rapid cycles in the initial treatment, non-responders may experience significant improvement in seizure control when the duty cycle is increased 22 .…”

Vagus nerve pain referred to the craniofacial region. A case report and literature review with implications for referred cardiac pain

“…5 These can be easily adjusted by the managing physi cian. Painful side effects of VNS were reported in nine studies [5][6][7][8][9][10][11][12][13] (Table 1). The most common site of pain reported was the throat followed by the jaw, neck, teeth and ear.…”