Vagus Nerve Stimulation for the Treatment of Epilepsy

González, Hernán F J; Yengo‐Kahn, Aaron M.; Englot, Dario J.

doi:10.1016/j.nec.2018.12.005

Cited by 136 publications

(115 citation statements)

References 64 publications

(102 reference statements)

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“…Although our study focused on acoustic‐voice metrics vs other measures like laryngeal stroboscopy, endoscopy, electromyography, or questionnaire‐based assessments, Lundy 78 reported increased jitter with increasing frequency of stimulation and Charous et al 79 showed that jitter and shimmer measures increased at rest and during VNS. González et al 80 cited four studies that included adverse effects of VNS on voice: hoarseness, cough, paresthesia, throat pain, dyspnea, headache, and infection when used for seizure control 68,81‐83 . Moreover, when data from these studies were combined to represent a total sample size of 546 participants, by far, the most prominent adverse effect was hoarseness (31.8%, 173.5/546), followed by paresthesia (9.3%, 50.8/546), cough (9.2%, 50.3/546), throat pain (8.3%, 45.3/546), dyspnea (8.1%, 35/432), headache (7.4%, 40.4/546), and infection (2.9%, 14.8/511) (see footnote ).…”

Section: Discussionmentioning

confidence: 99%

Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing

Kochilas

Cacace

Arnold

et al. 2020

Laryngoscope Investig Oto

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Objective: In individuals with chronic tinnitus, our interest was to determine whether daily low-level electrical stimulation of the vagus nerve paired with tones (paired-VNSt) for tinnitus suppression had any adverse effects on motor-speech production and physiological acoustics of sustained vowels. Similarly, we were also interested in evaluating for changes in pure-tone thresholds, word-recognition performance, and minimum-masking levels.Both voice and hearing functions were measured repeatedly over a period of 1 year. Study design: Longitudinal with repeated-measures.Methods: Digitized samples of sustained frontal, midline, and back vowels (/e/, /o/, /ah/) were analyzed with computer software to quantify the degree of jitter, shimmer, and harmonic-to-noise ratio contained in these waveforms. Pure-tone thresholds, monosyllabic word-recognition performance, and MMLs were also evaluated for VNS alterations. Linear-regression analysis was the benchmark statistic used to document change over time in voice and hearing status from a baseline condition.Results: Most of the regression functions for the vocal samples and audiometric variables had slope values that were not significantly different from zero. Four of the nine vocal functions showed a significant improvement over time, whereas three of the pure tone regression functions at 2-4 kHz showed some degree of decline; all changes observed were for the left ear, all were at adjacent frequencies, and all were ipsilateral to the side of VNS. However, mean pure-tone threshold changes did not exceed 4.29 dB from baseline and therefore, would not be considered clinically significant. In some individuals, larger threshold shifts were observed. No significant regression/slope effects were observed for word-recognition or MMLs.Meeting information: Portions of this study were presented at

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Section: Discussionmentioning

confidence: 99%

Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing

Kochilas

Cacace

Arnold

et al. 2020

Laryngoscope Investig Oto

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“…VNS is one of the most common neuromodulation-based therapies available. The VNS system consists of a battery-powered pulse generator implanted below the clavicle and a lead that is wrapped around the left vagus nerve in the carotid sheath [11]. Although complete seizure freedom with VNS insertion is rare, it is often beneficial in reducing seizure frequency and improving QOL [12].…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Vagus Nerve Stimulation in Lennox-Gastaut Syndrome

et al. 2019

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Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies and frequently patients with this syndrome respond poorly to antiepileptic drugs. The aim of this study was to evaluate the treatment outcomes of vagus nerve stimulation (VNS) in LGS patients with drug-resistant epilepsy. Methods: We analyzed the clinical files, collected over 5 years, of children with LGS who received VNS treatment. Results: Seven children were included in this study (four males, three females; mean age of VNS insertion 12.4±3.5 years). All the patients had generalized tonic seizures and there were various other seizure types including myoclonic seizures, atonic seizures, and atypical absence seizures. Although two patients had normal imaging, five patients had abnormalities on imaging, including pachygyria, cortical dysplasia, kernicterus, and a chromosomal anomaly. Comparing the baseline seizure frequency to the frequency after the VNS surgery, the seizure frequency at the last follow-up showed a decrease of 57.2% (0% to 100%) on average (P=0.028) and one patient achieved seizure free status. Only two children were given additional antiepileptic drugs with the aim of managing their seizures. There was no mortality or complications related to the VNS therapy except one case requiring intensive care unit admission due to pneumonia. Comparing the results before and after VNS surgery, the VNS therapy also had a tendency to have a positive effect on quality of life (P=0.066). Conclusion: In LGS patients with drug resistant epilepsy who are not candidates for a corpus callosotomy or resective surgery, VNS could be an effective, low-risk adjunct therapy for decreasing seizure frequency.

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“…NIs are used in neuroprosthetic systems aiming to restore sensorimotor function after damage to the nervous system, as well as in neuromodulation systems aiming to treat diseases through the alteration of regulatory neural signals. Applications of NIs implanted in the peripheral nervous system include: restoring movement after paralysis (1); creating prosthetic limbs with intuitive control and sensory feedback(2); and treating conditions such as bladder dysfunction(3), epilepsy(4), hypertension(5), as well as inflammatory and autoimmune disorders(6). Despite their potential benefits, widespread implementation of NIs in the peripheral nervous system still faces several obstacles, including damage to neural tissue, a lack of long-term stability, and low signal resolution(7).…”

Section: Introductionmentioning

confidence: 99%

Automatic Three-Dimensional Reconstruction of Fascicles in Peripheral Nerves from Histological Images

Tovbis

Zariffa

Agur

et al. 2020

Preprint

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AbstractComputational studies can be used to support the development of peripheral nerve interfaces, but currently use simplified models of nerve anatomy, which may impact the applicability of simulation results. To better quantify and model neural anatomy across the population, we have developed an algorithm to automatically reconstruct accurate peripheral nerve models from histological cross-sections. We acquired serial median nerve cross-sections from human cadaveric samples, staining one set with hematoxylin and eosin (H&E) and the other using immunohistochemistry (IHC) with anti-neurofilament antibody. We developed a four-step processing pipeline involving registration, fascicle detection, segmentation, and reconstruction. We compared the output of each step to manual ground truths, and additionally compared the final models to commonly used extrusions, via intersection-over-union (IOU). Fascicle detection and segmentation required the use of a neural network and active contours in H&E-stained images, but only simple image processing methods for IHC-stained images. Reconstruction achieved an IOU of 0.42±0.07 for H&E and 0.37±0.16 for IHC images, with errors partially attributable to global misalignment at the registration step, rather than poor reconstruction. This work provides a quantitative baseline for fully automatic construction of peripheral nerve models. Our models provided fascicular shape and branching information that would be lost via extrusion.

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Vagus Nerve Stimulation for the Treatment of Epilepsy

Cited by 136 publications

References 64 publications

Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing

Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing

Treatment Outcomes of Vagus Nerve Stimulation in Lennox-Gastaut Syndrome

Automatic Three-Dimensional Reconstruction of Fascicles in Peripheral Nerves from Histological Images

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