VNS parameters for clinical response in Epilepsy

Fahoum, Firas; Boffini, Massimiliano; Kann, Lennart; Faini, Silvia; Gordon, Christopher P.; Tzadok, Michal; Tahry, Riëm El

doi:10.1016/j.brs.2022.05.016

Cited by 31 publications

(29 citation statements)

References 38 publications

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“…For patients with DRE, the target dose combination should be considered as an output current of 1.625 mA at a pulse width of 250lsec, with a signal frequency of 20 Hz [11]. This dose combination is considered as the target dose for this analysis because it is derived from modeling intended to maximize clinical response (in terms of !50 % responder rate), tolerability, and battery life.…”

Section: Rapid Titration Of Vns Therapy Results In Earlier Onset Of R...mentioning

confidence: 99%

“…Control arms were excluded in the database to limit the investigation to findings related to VNS outcomes. Further demographic information on the population can be found in Fahoum et al 2022, in their Table 1 [11].…”

Section: Databasementioning

confidence: 99%

“…No variable selection was performed for this model; the covariates were chosen using the final model of Fahoum et al 2022 except for the dose pace groups, which were selected based on post-market surveillance of VNS titration data and published titration protocols [11,12]. All effects were significant in this Cox PH model; however, the model failed the proportional hazards assumption on certain covariates as well as globally.…”

Section: Cox Models For Time-to-first-responsementioning

confidence: 99%

“…Furthermore, an initial, directional assessment with the goal of seizure reduction and/or improved quality of life could be done at 6 months. Patients with early onset of effect have been demonstrated to have durable response past 12 months [11,21].…”

Section: The Current Weighted Cox Regression Indicates That Rapid Tit...mentioning

confidence: 99%

“…Recommendations by the manufacturer and professional societies for the use of VNS have provided some albeit limited guidance concerning programming of the multiple parameters that comprise VNS ''dosing" [9,10]. Recently, Fahoum et al 2022 [11] explored existing clinical outcomes data associated with programmed VNS parameters to build population-level hypotheses around the target dose of VNS. Analysis of an aggregated database of sponsored trials revealed that over 50 % of patients have taken more than 6 months to reach the target population-level dose of 1.625 mA (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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Rapid titration of VNS therapy reduces time-to-response in epilepsy

Tzadok

Verner

Kann

et al. 2022

Epilepsy & Behavior

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Section: Rapid Titration Of Vns Therapy Results In Earlier Onset Of R...mentioning

confidence: 99%

Section: Databasementioning

confidence: 99%

Section: Cox Models For Time-to-first-responsementioning

confidence: 99%

Section: The Current Weighted Cox Regression Indicates That Rapid Tit...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid titration of VNS therapy reduces time-to-response in epilepsy

Tzadok

Verner

Kann

et al. 2022

Epilepsy & Behavior

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Add‐On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial

Suresh,

Mithani,

Warsi

et al. 2024

Annals of Neurology

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Outcomes following vagus nerve stimulation (VNS) improve over years after implantation in children with drug‐resistant epilepsy. The added value of deep brain stimulation (DBS) instead of continued VNS optimization is unknown. In a prospective, non‐blinded, randomized patient preference trial of 18 children (aged 8–17 years) who did not respond to VNS after at least 1 year, add‐on DBS resulted in greater seizure reduction compared with an additional year of VNS optimization (51.9% vs. 12.3%, p = 0.047). Add‐on DBS also resulted in less bothersome seizures (p = 0.03), but no change in quality of life. DBS may be considered earlier for childhood epilepsy after non‐response to VNS. ANN NEUROL 2024

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Efficacy and safety following two or more years of vagus nerve stimulation (VNS Therapy) in pediatric patients with drug‐resistant epilepsy enrolled in a Russian VNS Registry

Feygina

Yana²,

Dibué

et al. 2023

Brain and Behavior

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Introduction Following approval in 2009 of vagus nerve stimulation (VNS Therapy) for drug‐resistant epilepsy (DRE) in the Russian Federation, this is the first multicenter study across Russia to evaluate the safety and efficacy of adjunctive VNS Therapy. Methods The retrospective, observational registry included 58 pediatric patients with DRE (5–17 years old at implantation) who had ≥2 years of VNS. To ensure a robust evaluation process, changes in seizure frequency were evaluated for all seizure types as well as “most disabling” seizures (defined as seizures accompanied by falls, physical trauma, and/or incontinence in the absence of preventative measures). Results With 2 years of VNS Therapy, 37 of 49 patients (76%) experiencing the most disabling epileptic seizures had a >50% decrease in frequency of such seizures, and 16 (33%) reported no longer experiencing the “most disabling” seizure type. In addition, based on the McHugh Outcome scale, VNS Therapy had a positive outcome on both frequency and severity of all epileptic seizure types, with a >50% decrease in frequency of all epileptic seizure types noted in 37 of 58 patients (64%), and 31% of patients had a Class I outcome, including 11 patients (19%) who achieved seizure freedom. VNS Therapy also had a positive effect on the frequency of status epilepticus: 13 patients (22%) had status epilepticus prior to implantation with a mean rate of 9.4 ± 17.7 events per year (range, 0–52), and after VNS Therapy, only one patient continued to experience status epilepticus (at 1 event per 4–6 months). VNS Therapy had an acceptable safety profile and no adverse events leading to VNS discontinuation were reported. Conclusions The results demonstrate that VNS Therapy is being safely and effectively applied to pediatric patients in the Russian healthcare system.

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VNS parameters for clinical response in Epilepsy

Cited by 31 publications

References 38 publications

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Rapid titration of VNS therapy reduces time-to-response in epilepsy

Add‐On Deep Brain Stimulation versus Continued Vagus Nerve Stimulation for Childhood Epilepsy (ADVANCE): A Partially Randomized Patient Preference Trial

Efficacy and safety following two or more years of vagus nerve stimulation (VNS Therapy) in pediatric patients with drug‐resistant epilepsy enrolled in a Russian VNS Registry

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