Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Abstract

Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects. In this paper we discuss the recommendations for VNS use as suggested by the Brazilian League of Epilepsy and the Scientific Department of Epilepsy of the Brazilian Academy of Neurology Committee of Neuromodulation.Keywords: epilepsy, palliative procedures, vagus nerve stimulation. ResuMOAs epilepsias compreendem uma família de doenças neurológicas e sistêmicas que se apresentam com crises espontâneas repetitivas, sendo a doença neurológica crônica mais frequente. Em pacientes com epilepsias refratárias ao tratamento medicamentoso, as opções terapêuticas são restritas a cirurgia ablativa, estudos experimentais com novas drogas antiepilépticas ou cirurgias paliativas. A estimulação do nervo vago (VNS) é um procedimento paliativo disponível, cujo mecanismo de ação é ainda desconhecido, mas com eficácia estabelecida em pacientes com epilepsias refratárias ao tratamento medicamentoso, apresentando baixos índices de efeitos colaterais. Neste artigo apresentamos o posicionamento do Comitê de Neuromodulação da Liga Brasileira de Epilepsia e do Departamento Científico de Epilepsia da Academia Brasileira de Neurologia sobre as indicações de uso do VNS Palavras-chave: epilepsia, procedimentos paliativos, estimulação do nervo vago.

Treatment of epilepsy by stimulation of the vagus nerve from Head‐and‐Neck surgical point of view

“…The main advantage of the newly proposed technique is the reduction of the side‐effect rate. For example, hoarseness was reported to be the most common complaint in children in 28% of cases . We were able to reduce this rate to 4.2%.…”

The therapeutic dilemma of vagus nerve stimulator-induced sleep disordered breathing

“…Vagus nerve stimulation (VNS) is a effective adjuvant therapy for refractory epilepsy and reduces the frequency of multiple seizure types. [ 1 2 ] However, there are several reports in the literature of VNS implantation causing disturbances of breathing in sleep. [ 3 4 5 6 7 8 9 ] We present a clinically challenging case of a 14-year-old female with VNS-induced sleep disordered breathing (SDB) in whom adjustment of VNS parameters (decreasing VNS output current) was effective in reducing the apnea–hypopnea index (AHI), but worsened seizure frequency.…”

Vagus Nerve Stimulator in a Patient with Adenylosuccinate Lyase Deficiency: a Case Report

“…A third possibility is that VNS leads to changes in blood flow and metabolism in several brain regions; this has been shown in research involving single-photon emission computed tomography and positron emission tomography imaging. 9 Hauptman et al demonstrated good efficacy and safety of VNS in the pediatric population in a paper published in 1999. 10 Since that time, a robust body of literature has developed supporting the use of VNS devices in children with refractory epilepsy.…”