Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center

Spanaki, Marianna V.; Allen, Linda; Mueller, Wade; Morris, George L.

doi:10.1016/j.seizure.2004.01.009

Cited by 76 publications

(52 citation statements)

References 9 publications

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“…45,93 Although sudden, unexplained deaths have occurred in patients undergoing VNS for epilepsy at higher rates than in the general population, rates of sudden, unexplained death and overall mortality have been found equivalent to those of other cohorts undergoing treatment for refractory epilepsy. 51,53 CONCLUSION Chronic, intermittent VNS as an adjunct to AED has been well documented as a treatment option for patients with refractory seizures that provides a significant reduction in seizure frequency and severity, as well as an improvement in QOL. VNS is associated with a low rate of perioperative complications, and the majority of side effects are stimulation-dependent and thus reversible.…”

Section: Stimulation-relatedmentioning

confidence: 99%

“…In fact, one study noted a delayed effect of VNS in six patients who did not respond to 12 months of VNS therapy but who experienced reductions in seizure frequency 4 -6 years later. 53 These delayed improvements appeared to be unrelated to changes in AED regimens. 54 Adjustments in device settings may play a large role; however, only a trend of an association between these changes and seizure frequency was found in one study.…”

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confidence: 99%

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Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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Section: Stimulation-relatedmentioning

confidence: 99%

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confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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“…39,[53][54][55][56] In fact, one study noted that six patients considered to be nonresponders after 12 months of VNS therapy began to experience reductions in seizure frequency 4 to 6 years later. 57 The mechanisms by which this effect might be mediated remain highly speculative, but appear to be unrelated to changes in AED regimens. 58 Gradual adjustments to stimulation parameters may be responsible for much of these improvements, although the adjustment process is highly individualized and impedes the direct comparison of parameters between studies.…”

Section: Clinical Outcome Of Vns In Adults With Refractory Epilepsymentioning

confidence: 99%

“…Although sudden, unexplained deaths have occurred in patients undergoing VNS for epilepsy at higher rates than in the general population, rates of sudden, unexplained death and overall mortality have been found to compare favorably to those of other cohorts undergoing treatment for refractory epilepsy. 55,57,91 CONCLUSION Chronic, intermittent VNS as an adjunct to AED, has been well documented as a treatment option for patients with refractory seizures that provides a significant reduction in seizure frequency and severity, as well as an improvement in QOL. VNS is associated with a low rate of perioperative complications, and the majority of side effects are stimulation-dependent and thus reversible.…”

Section: Stimulation-relatedmentioning

confidence: 99%

Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

2009

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal anti-epileptic drug therapy. Chronic, intermittent vagus nerve stimulation has been proven to be an effective option for many patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, vagus nerve stimulation, as an adjunct to medical therapy, may result in significant improvements in quality of life. Vagus nerve stimulation is generally well-tolerated, as device implantation is associated with a low rate of perioperative complications, and the majority of side effects are stimulation-dependent and thus reversible.

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“…Vagal nerve stimulation has been used for the past decade. 26) Electrical stimulation of the brain has been proposed to replace surgical resection using the anterior nucleus of the thalamus or the hippocampus as the stimulation target. However, clinical studies have not achieved satisfactory results.…”

Section: Introductionmentioning

confidence: 99%

Application of Focal Cerebral Cooling for the Treatment of Intractable Epilepsy

Fujii

Fujioka

Oku

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Epilepsy is usually treated with medication, but adequate seizure control is still not achieved in over 30% of epilepsy patients, even with the best available agents. Surgical treatment is also performed for such patients, but is not always successful. Focal cooling of the brain using a thermoelectric device has recently been evaluated as an alternative to epilepsy surgery. Brain cooling was first proposed approximately 50 years ago as an effective method for suppressing epileptic discharges (EDs). Recent studies indicate that focal cooling of the brain to a cortical surface temperature of 209 C to 259 C terminates EDs without inducing irreversible neurophysiological dysfunctions or neuronal damage in the brain tissue. Several mechanisms have been proposed for the antiepileptic effects of focal cooling, including reduction in neurotransmitter release, alternation of activation-inactivation kinetics in voltage-gated ion channels, and the slowing of catabolic processes. Developments in the implantable cooling device with closed-loop cooling systems for seizure detection and focal cooling have been promoted in the field of neuromodulation, but several aspects remain uncharacterized concerning the hardware. Recent advances in precision devices have enabled the optimization of the implantable local cooling system, which may become clinically applicable in the near future.

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Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center

Abstract: In this retrospective study, the effectiveness of VNS therapy increased over time. Physicians should be aware that response to VNS therapy may be delayed for some patients.

Cited by 76 publications

References 9 publications

Vagus Nerve Stimulation for Epilepsy and Depression

Vagus Nerve Stimulation for Epilepsy and Depression

Vagus Nerve Stimulation in the Treatment of Refractory Epilepsy

Application of Focal Cerebral Cooling for the Treatment of Intractable Epilepsy

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