Vagus nerve stimulation: Outcome and predictors of seizure freedom in long-term follow-up

Ghaemi, Kazem; Elsharkawy, Alaa Eldin; Schulz, Reinhard; Hoppe, Matthias; Polster, Tilman; Pannek, H. W.; Ebner, Alois

doi:10.1016/j.seizure.2010.03.002

Cited by 73 publications

(76 citation statements)

References 27 publications

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“…There were 14 publications that used this standard, and of the 1378 patients studied, a mean of 50.9% (range 18.4%-67%) showed a 50% or greater decrease in seizure frequency. 1,2,4,5,[8][9][10][11]15,[24][25][26][27][28] Five of the remaining studies used the mean or median frequency reduction from baseline. 3,14,17,22,23 The mean seizure reduction in these investigations was 42.8% (range 28%-66%).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies additionally included data on the percentage of patients achieving freedom from seizures, typically quoted at the 1-year time frame. 9,15,19,28 Of these studies, seizure freedom was reported at a mean of 14.0% (range 9%-27%). …”

Section: Resultsmentioning

confidence: 99%

“…Ghaemi et al 15 retrospectively reviewed 144 patients and a minimum of 2 years of follow-up data. They demonstrated seizure freedom in 6.9% and a 50% or greater seizure reduction in 61.8%.…”

Section: Class III Evidencementioning

confidence: 99%

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Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Connor¹,

Nixon²,

Nanda³

et al. 2012

FOC

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Object The authors conducted a study to evaluate the published results of vagal nerve stimulation (VNS) for medically refractory seizures according to evidence-based criteria. Methods The authors performed a review of available literature published between 1980 and 2010. Inclusion criteria for articles included more than 10 patients evaluated, average follow-up of 1 or more years, inclusion of medically refractory epilepsy, and consistent preoperative surgical evaluation. Articles were divided into 4 classes of evidence according to criteria established by the American Academy of Neurology. Results A total of 70 publications were reviewed, of which 20 were selected for review based on inclusion and exclusion criteria. There were 2 articles that provided Class I evidence, 7 that met criteria for Class II evidence, and 11 that provided Class III evidence. The majority of evidence supports VNS usage in partial epilepsy with a seizure reduction of 50% or more in the majority of cases and freedom from seizure in 6%–27% of patients who responded to stimulation. High stimulation with a gradual increase in VNS stimulation over the first 6 weeks to 3 months postoperatively is well supported by Class I and II data. Predictors of positive response included absence of bilateral interictal epileptiform activity and cortical malformations. Conclusions Vagal nerve stimulation is a safe and effective alternative for adult and pediatric populations with epilepsy refractory to medical and other surgical management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Connor¹,

Nixon²,

Nanda³

et al. 2012

FOC

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“…The success of the surgery depends among others factors, of the years that carry the patient with the crises, the type of underlying injury, and the affected lobe. The total control of the post-surgery crises ranging from 50-80% [8][9][10][11].…”

Section: How Many Multidisciplinary Epilepsy Units Are Requires In Ammentioning

confidence: 99%

Calculation of the Need of Multidisciplinary Units of Epilepsy in America

Valencia¹

2016

J Epilepsy

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“…Besides age, unilateral EEG epileptiform activity was also correlated with a higher chance of seizure freedom 43 . 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 .…”

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confidence: 98%

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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Vagus nerve stimulation: Outcome and predictors of seizure freedom in long-term follow-up

Abstract: VNS implantation may render patients with some forms of cortical dysgenesis (parietooccipital polymicrogyria, macrogyria) seizure-free. Patients with unilateral IEDs and earlier implantation achieved the most benefit from VNS.

Cited by 73 publications

References 27 publications

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Calculation of the Need of Multidisciplinary Units of Epilepsy in America

The role of vagus nerve stimulation in refractory epilepsy

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