Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis

Batson, Sarah; Shankar, Rohit; Conry, Joan A.; Boggs, Jane G.; Radtke, Rodney A.; Mitchell, Stephen; Barion, Francesca; Murphy, Joanna; Danielson, Vanessa

doi:10.1007/s00415-022-10967-6

Cited by 24 publications

(21 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While VNS has helped tens of thousands of patients with chronic disease (primarily refractory epilepsy), a persistent challenge is the therapy’s lack of precision. Response rates range between 50-70% (Englot et al, 2015; Toffa et al, 2020; Batson et al, 2022) and side effects are common, including cough, voice alteration, laryngeal spasms, and local pain Ben-Menachem, 2001. Additionally, it can take up to 12 months of adjusting stimulation parameters before peak effectiveness is reached (LivaNova, 2020).…”

Section: Introductionmentioning

confidence: 99%

Using neural biomarkers to personalize dosing of vagus nerve stimulation

Berthon,

Wernisch,

Stoukidi

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Vagus nerve stimulation (VNS) is an established therapy for treating a variety of chronic diseases, such as epilepsy, depression, obesity, and for stroke rehabilitation. However, lack of precision and side-effects have hindered its efficacy and extension to new conditions. Objective: To achieve a better understanding of the relationship between VNS parameters and neural and physiological responses to enable the design of personalized dosing procedures to improve precision and efficacy of VNS therapies. Methods: We used biomarkers from recorded evoked neural activity and short-term physiological responses (throat muscle, cardiac and respiratory activity) to understand the response to a wide range of VNS parameters in anaesthetised pigs. Using signal processing, Gaussian processes (GP) and parametric regression models we analyse the relationship between VNS parameters and neural and physiological responses. Results: Firstly, we observe inter-subject variability for both neural and physiological responses. Secondly, we illustrate how considering multiple stimulation parameters in VNS dosing can improve the efficacy and precision of VNS therapies. Thirdly, we describe the relationship between different VNS parameters and the evoked neural activity and show how spatially selective electrodes can be used to improve fibre recruitment. Fourthly, we provide a detailed exploration of the relationship between the activations of neural fibre types and different physiological effects, and show that recordings of evoked neural activity are powerful biomarkers for predicting the short-term physiological effects of VNS. Finally, based on these results, we discuss how recordings of evoked neural activity can help design VNS dosing procedures that optimize short-term physiological effects safely and efficiently. Conclusion: Understanding of evoked neural activity during VNS provide powerful biomarkers that could improve the precision, safety and efficacy of VNS therapies.

show abstract

Section: Introductionmentioning

confidence: 99%

Using neural biomarkers to personalize dosing of vagus nerve stimulation

Berthon,

Wernisch,

Stoukidi

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Acute and chronic deep brain stimulation (DBS), as well as vagus nerve stimulation (VNS), are epilepsy therapies (236,(246)(247)(248). Combining neurostimulation and ASM may be more effective in controlling seizures than either alone (249).…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Autonomic dysfunction in epilepsy mouse models with implications for SUDEP research

et al. 2023

View full text Add to dashboard Cite

Epilepsy has a high prevalence and can severely impair quality of life and increase the risk of premature death. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in drug-resistant epilepsy and most often results from respiratory and cardiac impairments due to brainstem dysfunction. Epileptic activity can spread widely, influencing neuronal activity in regions outside the epileptic network. The brainstem controls cardiorespiratory activity and arousal and reciprocally connects to cortical, diencephalic, and spinal cord areas. Epileptic activity can propagate trans-synaptically or via spreading depression (SD) to alter brainstem functions and cause cardiorespiratory dysfunction. The mechanisms by which seizures propagate to or otherwise impair brainstem function and trigger the cascading effects that cause SUDEP are poorly understood. We review insights from mouse models combined with new techniques to understand the pathophysiology of epilepsy and SUDEP. These techniques include in vivo, ex vivo, invasive and non-invasive methods in anesthetized and awake mice. Optogenetics combined with electrophysiological and optical manipulation and recording methods offer unique opportunities to study neuronal mechanisms under normal conditions, during and after non-fatal seizures, and in SUDEP. These combined approaches can advance our understanding of brainstem pathophysiology associated with seizures and SUDEP and may suggest strategies to prevent SUDEP.

show abstract

“…Additionally, the surgery is effective in only ca. 62% [ 1 , 2 , 35 , 37 , 38 ]. Each surgery is also a very invasive and risky procedure [ 1 , 2 , 8 , 37 , 38 , 39 , 40 ].…”

Section: Study Backgroundmentioning

confidence: 99%

“…Epilepsy affects over 1% of population, which has been estimated as the number between 50 and 65 million people world wide [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Additionally.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally. around 40% of epilepsy-affected patients suffer its drug-resistant version, which significantly limits potential treatment methods [ 1 , 2 , 3 , 5 , 8 ]. It affects the life quality of people affected with it in a significant way, as the seizures occur unexpectedly and can cause various physical injuries or even death [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of a Morphological Filter for Removing Spikes from the Epileptic Brain Signals to Improve Identification Ripples

Al-Bakri

Martínek

Pelc

et al. 2022

Sensors

View full text Add to dashboard Cite

Epilepsy is a very common disease affecting at least 1% of the population, comprising a number of over 50 million people. As many patients suffer from the drug-resistant version, the number of potential treatment methods is very small. However, since not only the treatment of epilepsy, but also its proper diagnosis or observation of brain signals from recordings are important research areas, in this paper, we address this very problem by developing a reliable technique for removing spikes and sharp transients from the baseline of the brain signal using a morphological filter. This allows much more precise identification of the so-called epileptic zone, which can then be resected, which is one of the methods of epilepsy treatment. We used eight patients with 5 KHz data set and depended upon the Staba 2002 algorithm as a reference to detect the ripples. We found that the average sensitivity and false detection rate of our technique are significant, and they are ∼94% and ∼14%, respectively.

show abstract

Efficacy and safety of VNS therapy or continued medication management for treatment of adults with drug-resistant epilepsy: systematic review and meta-analysis

Cited by 24 publications

References 71 publications

Using neural biomarkers to personalize dosing of vagus nerve stimulation

Using neural biomarkers to personalize dosing of vagus nerve stimulation

Autonomic dysfunction in epilepsy mouse models with implications for SUDEP research

Implementation of a Morphological Filter for Removing Spikes from the Epileptic Brain Signals to Improve Identification Ripples

Contact Info

Product

Resources

About