Clinical course of young patients with Dravet syndrome after vagal nerve stimulation

Zamponi, Nelia; Passamonti, Claudia; Cappanera, Silvia; Petrelli, Cristina

doi:10.1016/j.ejpn.2010.09.003

Cited by 58 publications

(42 citation statements)

References 24 publications

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“…These results are consistent with previous observations: similarly to a few, a recent retrospective study on DS [4] reported a 30–60% reduction of epileptic events with positive effects on cognition and alertness. In contrast to that study, our patient also showed some benefit from the magnet activation.…”

Section: Discussionsupporting

confidence: 93%

Effect of Vagus Nerve Stimulation in an Adult Patient with Dravet Syndrome: Contribution to Sudden Unexpected Death in Epilepsy Risk Reduction?

et al. 2012

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We report on a patient who developed, from 5 months of age, multiple seizure types, including myoclonic, associated with severe psychomotor delay, leading to the diagnosis of Dravet syndrome. Over the years, he developed refractory epilepsy and was implanted with a vagus nerve stimulator at the age of 19. After 3 months, he experienced a progressive improvement of partial and generalized seizures, with a >90% reduction, and better alertness. This meaningful clinical improvement is discussed in the light of the sudden unexpected death in epilepsy risk, which is high in this setting, and seems remarkably diminished in our patient in view of the reduction of generalized convulsions.

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Section: Discussionsupporting

confidence: 93%

Effect of Vagus Nerve Stimulation in an Adult Patient with Dravet Syndrome: Contribution to Sudden Unexpected Death in Epilepsy Risk Reduction?

et al. 2012

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“…Sixteen Class III studies were identified regarding the efficacy of VNS for seizure treatment in children (see table e-1 for study details). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] This group of studies included 2 reports of patients with tuberous sclerosis 16,17 and one report of patients with Dravet syndrome. 18 Ten of 16 studies included subjects through age 18 18 One study of 11 patients with tuberous sclerosis had a mean age of 14, and the range of ages included was 2-35, with 2 subjects older than 19 (27 and 35).…”

Section: Analysis Of Evidencementioning

confidence: 99%

Evidence-Based Guideline Update: Vagus Nerve Stimulation for the Treatment of Epilepsy

et al. 2013

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Epilepsy Resources and UpdatesIn 1997, the US Food and Drug Administration (FDA) approved vagus nerve stimulation (VNS) as adjunctive therapy for reducing the frequency of seizures in patients >12 years with partial-onset seizures refractory to antiepileptic medications. OBJECTIVE: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years. METHODS: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology. RESULTS: VNS is associated with a >50% seizure reduction in 55% (95% confidence interval [CI] 50%-59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%-64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ~7% from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time. RECOMMENDATIONS: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation. Neurology® 2013;81:1-7 GLOSSARY: AAN = American Academy of Neurology; AE = adverse effect; BDI = Beck Depression Inventory; CI = confidence interval; FDA = US Food and Drug Administration; JME = juvenile myoclonic epilepsy; LGS = Lennox-Gastaut syndrome; SUDEP = sudden unexpected death in epilepsy; VNS = vagus nerve stimulation.

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“…79 A slight improvement in alertness and communicative skills was also observed in young patients with Dravet syndrome by VNS. 80 The most common device-related complications were infection or lead breakage. 81 The sudden unexplained death in epilepsy rate in VNS patients drops from 5.5 per 1000 over the first two years, a rate comparable to that of other epilepsy cohorts, to 1.7 per 1000 thereafter.…”

Section: Vns For Epilepsymentioning

confidence: 99%

Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial

Chen

Flanagan

Samadani

2013

Neurological Research

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Objectives-Traumatic brain injury has a high morbidity and mortality in both civilian and military populations. Blast and other mechanisms of traumatic brain injury damage the brain by causing neurons to disconnect and atrophy. Such traumatic axonal injury can lead to persistently vegetative and minimally conscious states, for which limited treatment options exist, including physical, occupational, speech and cognitive therapies.More than 60,000 patients have received vagus nerve stimulation for epilepsy and depression. In addition to decreased seizure frequency and severity, patients report enhanced mood, reduced daytime sleepiness independent of seizure control, increased slow wave sleep, and improved cognition, memory, and quality of life.Early stimulation of the vagus nerve accelerates the rate and extent of behavioral and cognitive recovery after fluid percussion brain injury in rats.Methods-We recently obtained FDA approval for a pilot prospective randomized crossover trial to demonstrate objective improvement in clinical outcome by placement of a vagus nerve stimulator in patients who are recovering from severe traumatic brain injury. Our hypothesis is that stimulation of the vagus nerve results in increased cerebral blood flow and metabolism in the forebrain, thalamus and reticular formation, which promotes arousal and improved consciousness, thereby improving outcome after traumatic brain injury resulting in minimally conscious or persistent vegetative states.Discussion-If this study demonstrates that vagus nerve stimulation can safely and positively impact outcome, then a larger randomized prospective crossover trial will be proposed.

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Clinical course of young patients with Dravet syndrome after vagal nerve stimulation

Cited by 58 publications

References 24 publications

Effect of Vagus Nerve Stimulation in an Adult Patient with Dravet Syndrome: Contribution to Sudden Unexpected Death in Epilepsy Risk Reduction?

Effect of Vagus Nerve Stimulation in an Adult Patient with Dravet Syndrome: Contribution to Sudden Unexpected Death in Epilepsy Risk Reduction?

Evidence-Based Guideline Update: Vagus Nerve Stimulation for the Treatment of Epilepsy

Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial

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