Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy

Martí, Ana Suller; Mirsattari, Seyed M.; MacDougall, Keith W.; Steven, David; Parrent, Andrew G.; Ribaupierre, Sandrine de; Andrade, Andrea; Diosy, David; McLachlan, Richard S.; Burneo, Jorge G.

doi:10.1016/j.yebeh.2020.107253

Cited by 21 publications

(23 citation statements)

References 42 publications

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“…In fact, the effectiveness of VNS therapy was explored in some specific indications, such as genetic generalized epilepsy (GGE), 13 Lennox–Gastaut syndrome (LGS), 42 – 44 and Dravet syndrome (DS). 15 , 45 After VNS therapy, 64.7% ( n = 11) responders of patients with GGE and 41.4% ( n = 12) responders of patients with LGS were found.…”

Section: Discussionmentioning

confidence: 99%

“… 15 , 45 After VNS therapy, 64.7% ( n = 11) responders of patients with GGE and 41.4% ( n = 12) responders of patients with LGS were found. 13 Another study on LGS showed that the efficacy of VNS therapy was considerable, in which 113 patients with LGS were reviewed and yielded a 55% responder rate. 44 Response rates of patients with LGS who underwent VNS implantation respectively reached 55%, 67.7%, and 65% at 6, 12 and 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…VNS is a minimally invasive and controllable treatment for patients with epilepsy, and there are approximately 45%–65% responders (⩾50% reduction in seizure frequency) after VNS therapy. 8 – 12 In addition, indications, 13 – 15 safety, and side effects 16 , 17 of VNS therapy have been internationally validated and acknowledged. Some patient-related and epilepsy-related predictors with an impact on the prognosis of VNS therapy have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Liu

Xiong

Wang

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE. Methods: We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness. Results: A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders ( p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS ( p = 0.010, p = 0.003, respectively). Conclusion: VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Liu

Xiong

Wang

et al. 2022

Therapeutic Advances in Chronic Disease

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“…VNS was initially approved for use in patients >12 years of age and later as an adjunctive treatment for partial DRE in patients ≥4 years of age 41,42 . In addition, some studies have shown that VNS is effective for generalized DRE 43–45 . The pulse generator is activated 2 weeks after operation.…”

Section: Vnsmentioning

confidence: 99%

Neuromodulation in drug‐resistant epilepsy: A review of current knowledge

Xue

Chen

Bai

et al. 2022

Acta Neuro Scandinavica

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Nearly 1% of the global population suffers from epilepsy. Drug‐resistant epilepsy (DRE) affects one‐third of epileptic patients who are unable to treat their condition with existing drugs. For the treatment of DRE, neuromodulation offers a lot of potential. The background, mechanism, indication, application, efficacy, and safety of each technique are briefly described in this narrative review, with an emphasis on three approved neuromodulation therapies: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT‐DBS), and closed‐loop responsive neurostimulation (RNS). Neuromodulatory approaches involving direct or induced electrical currents have been developed to lessen seizure frequency and duration in patients with DRE since the notion of electrical stimulation as a therapy for neurologic diseases originated in the early nineteenth century. Although few people have attained total seizure independence for more than 12 months using these treatments, more than half have benefitted from a 50% drop in seizure frequency over time. Although promising outcomes in adults and children with DRE have been achieved, challenges such as heterogeneity among epilepsy types and etiologies, optimization of stimulation parameters, a lack of biomarkers to predict response to neuromodulation therapies, high‐level evidence to aid decision‐making, and direct comparisons between neuromodulatory approaches remain. To solve these existing gaps, authorize new kinds of neuromodulation, and develop personalized closed‐loop treatments, further research is needed. Finally, both invasive and non‐invasive neuromodulation seems to be safe. Implantation‐related adverse events for invasive stimulation primarily include infection and pain at the implant site. Intracranial hemorrhage is a frequent adverse event for DBS and RNS. Other stimulation‐specific side‐effects are mild with non‐invasive stimulation.

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“…As reported, approximately 50% of patients with epilepsy benefit from a ≥50% reduction in seizure frequency after 1 year of VNS implantation, with an increasing benefit over time ( 9 ). In addition, VNS is effective for some specific conditions of epilepsy, such as genetic generalized epilepsy ( 10 ), Lennox–Gastaut syndrome ( 11 ), and refractory postencephalitic epilepsy ( 12 ). The efficacy of VNS on PTE has also been suggested ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Vagus nerve stimulation for refractory posttraumatic epilepsy: Efficacy and predictors of seizure outcome

et al. 2022

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BackgroundTraumatic brain injury (TBI) has been recognized as an important and common cause of epilepsy since antiquity. Posttraumatic epilepsy (PTE) is usually associated with drug resistance and poor surgical outcomes, thereby increasing the burden of the illness on patients and their families. Vagus nerve stimulation (VNS) is an adjunctive treatment for medically refractory epilepsy. This study aimed to determine the efficacy of VNS for refractory PTE and to initially evaluate the potential predictors of efficacy.MethodsWe retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PTE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (≥50% or <50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS efficacy.ResultsIn total, forty-five patients with refractory PTE who underwent VNS therapy were enrolled. Responders were found in 64.4% of patients, and 15.6% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 37.8, 44.4, 60, and 67.6% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, generalized interictal epileptic discharges (IEDs) were found to be a negative predictor (OR: 4.861, 95% CI: 1.145–20.632) of VNS efficacy.ConclusionThe results indicated that VNS therapy was effective in refractory PTE patients and was well tolerated over a 1-year follow-up period. Patients with focal or multifocal IEDs were recognized to have better efficacy after VNS therapy.

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Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy

Cited by 21 publications

References 42 publications

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

Neuromodulation in drug‐resistant epilepsy: A review of current knowledge

Vagus nerve stimulation for refractory posttraumatic epilepsy: Efficacy and predictors of seizure outcome

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