Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: Long-term outcomes and predictors of response

Elliott, Robert E.; Morsi, Amr; Kalhorn, Stephen P.; Marcus, Joshua; Sellin, Jonathan N.; Kang, Matthew M.; Silverberg, Alyson; Rivera, Edwin; Geller, Eric B.; Carlson, Chad; Devinsky, Orrin; Doyle, Werner

doi:10.1016/j.yebeh.2010.10.017

Cited by 303 publications

(241 citation statements)

References 34 publications

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“…Two randomized, double-blind clinical trials have shown a statistically significant decrease in seizure frequency by VNS [3][4][5]. Several long-term follow-up studies have further established the efficacy and safety of VNS [6][7][8][9]. A meta-analysis of VNS efficacy has shown that seizure reduction ranges from 0 to 100 % (mean 45 %), and varies considerably across patients [10].…”

Section: Introductionmentioning

confidence: 99%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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Currently, the mechanism of action of vagus nerve stimulation (VNS) is not fully understood, and it is unclear which factors determine a patient's response to treatment. Recent preclinical experiments indicate that activation of the locus coeruleus noradrenergic system is critical for the antiepileptic effect of VNS. This study aims to evaluate the effect of VNS on noradrenergic signaling in the human brain through a noninvasive marker of locus coeruleus noradrenergic activity: the P3 component of the event-related potential. We investigated whether VNS differentially modulates the P3 component in VNS responders versus VNS nonresponders. For this purpose, we recruited 20 patients with refractory epilepsy who had been treated with VNS for at least 18 months. Patients were divided into 2 groups with regard to their reduction in mean monthly seizure frequency: 10 responders (>50 %) and 10 nonresponders (≤50 %). Two stimulation conditions were compared: VNS OFF and VNS ON. In each condition, the P3 component was measured during an auditory oddball paradigm. VNS induced a significant increase of the P3 amplitude at the parietal midline electrode, in VNS responders only. In addition, logistic regression analysis showed that the increase of P3 amplitude can be used as a noninvasive indicator for VNS responders. These results support the hypothesis that activation of the locus coeruleus noradrenergic system is associated with the antiepileptic effect of VNS. Modulation of the P3 amplitude should be further investigated as a noninvasive biomarker for the therapeutic efficacy of VNS in patients with refractory epilepsy.

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Section: Introductionmentioning

confidence: 99%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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“…Therefore, VNS therapy is well tolerated, with adverse effects predominantly induced by stimulation and generally reversible. Irreversible nerve damage, in turn, is usually rare 44 . Whereas studies report rates of 1% to 5% of hardware malfunction 4 , these estimates are highly variable.…”

Section: Adverse Effectsmentioning

confidence: 99%

“…In a series of 400 patients, the only predictive factor was focal change in the EEG (p = 0,004), apart from a tendency toward better results in focal epilepsy (p = 0.09) 44 . However, when analyzing different seizure types, generalized seizures were significantly associated with higher rates of seizure freedom during the first year, when compared to partial seizures 42 .…”

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confidence: 94%

The role of vagus nerve stimulation in refractory epilepsy

Oliveira

Francisco

Demartini

et al. 2017

Arq. Neuro-Psiquiatr.

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Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.Keywords: vagus nerve stimulation; epilepsy. RESUMOA estimulação vagal é uma terapia paliativa utilizada no tratamento de pacientes com epilepsia refratária que não são candidatos à cirurgia ressectiva ou naqueles com evolução insatisfatória após o procedimento cirúrgico. Seu mecanismo de ação ainda não foi completamente elucidado mas possivelmente envolve a modulação do locus coeruleus, tálamo e circuito límbico através de projeções noradrenérgicas e serotoninérgicas. Atualmente há evidência suficiente para corroborar o uso desta terapia em pacientes com epilepsia focal e outros tipos de crise, com resultados que, apesar de não imediatos, melhoram progressivamente no longo prazo. Os eventos adversos são, em sua maioria, relacionados à estimulação e auto-limitados. Perspectivas futuras para aumentar a eficácia e reduzir os efeitos colaterais como a utilização de baterias com maior durabilidade, estimulação transcutânea e identificação de fatores prognósticos devem ser investigadas. Palavras-chave: estimulação do nervo vago; epilepsia.Epilepsy is one of the most common chronic neurologic diseases and affects at least 50 million people worldwide 1 . Although much has been understood about its causes, epilepsy is still extremely stigmatizing and many patients are victims of prejudice and social exclusion. The quality of life of those affected by the disease is remarkably compromised due to seizures, antiepileptic drugs (AED), cognitive impairment and physical limitations.Those who do not achieve adequate seizure control, even with multiple AED trials, are considered refractory. Currently, medically resistant epilepsy is regarded as a worldwide health issue as it is endured by approximately one third of epileptic patients. The financial burden is substantial and, among all health costs of uncontrolled patients, nearly 50% are related to epilepsy care costs 2 . For these individuals, whose treatment is generally complex, epilepsy surgery may be indicated and can provide up to 80% seizure control, depending on distinct aspects such as time of follow-up and epileptic focus localization. Figure 1 illustrates the therapy ...

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“…In patients with drug-resistant epilepsy, the chance of achieving seizure freedom with subsequent antiepileptic drug treatments is modest [1] . Compared with other palliative treatments [2][3][4] such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS), conventional open surgery is a better treatment option [5,6] .…”

Section: Introductionmentioning

confidence: 99%

“…In contrast to other palliative [2,3] treatments such as vagus nerve stimulation (30%-63% reduction of >50% of seizures) [4][5][6] , multiple subpial transection [32] , callosotomy [33] , or deep brain stimulation of the anterior nucleus of the thalamus (54% reduction of >50% of seizures) [6] , SEEG-guided RF-TC is a focal treatment targeted selectively at the epileptogenic zone (as is radiosurgery) [34,35] . Furthermore, SEEG-guided RF-TC efficacy is a predictor of outcome in patients who undergo conventional open surgery [17] .…”

Section: Introductionmentioning

confidence: 99%

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in patients with drug-resistant focal epilepsy

2017

Transl. Neurosci. Clin.

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For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography (SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation (RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.Citation Xu CW, Zhou WJ. Stereoelectroencephalography guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy. Transl. Neurosci. Clin. 2017, 3(1): 40-47.

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Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: Long-term outcomes and predictors of response

Cited by 303 publications

References 34 publications

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

The role of vagus nerve stimulation in refractory epilepsy

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in patients with drug-resistant focal epilepsy

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