Long-term vagus nerve stimulation in the treatment of Lennox–Gastaut syndrome

Kostov, Konstantin Hrisimirov; Kostov, Hrisimir; Taubøll, Erik

doi:10.1016/j.yebeh.2009.07.038

Cited by 58 publications

(63 citation statements)

References 16 publications

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“…We found 4 Class III studies that evaluated seizures in patients with LGS (table e-1). [19][20][21][22] In 2 studies, ages ranged from 5 to 19 years. 19,22 In the third study, the mean age was 13 years (range 4-52), and 18 of 30 subjects were under 18 years 20 ; in the remaining study, the age at the time of implantation was not stated.…”

Section: Clinical Contextmentioning

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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Section: Clinical Contextmentioning

confidence: 99%

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

et al. 2013

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“…We found 4 Class III studies that evaluated seizures in patients with LGS (table e-1). [19][20][21][22] In 2 studies, ages ranged from 5 to 19 years. 19,22 In the third study, the mean age was 13 years (range 4-52), and 18 of 30 subjects were younger than 18 years 20 ; in the remaining study, the age at the time of implantation was not stated.…”

mentioning

confidence: 99%

Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy

Morris¹,

Gloss²,

Buchhalter³

et al. 2013

Neurology

354

211

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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 In 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 of age with partialonset seizures refractory to antiepileptic medications.1 A 1999 American Academy of Neurology (AAN) technology assessment concluded that VNS is indicated for patients .12 years with medically intractable partial seizures who are not candidates for potentially curative surgical resections such as lesionectomies or mesial temporal lobectomies. The authors also recommended that patients undergo a thorough epilepsy evaluation to rule out nonepileptic conditions or treatable symptomatic epilepsies before implantation of a vagus nerve stimulator. At that time, evidence was insufficient to recommend VNS for epilepsy in young children or for seizures associated with Lennox-Gastaut syndrome (LGS). Since the 1999 AAN assessment, the FDA has approved VNS for the adjunctive long-term treatment of chronic or recurrent depression in patients .18 years who are experiencing a major depressive episode and have not had an adequate response to 4 or more adequate antidepressant treatments.1 Moreover, there are new reports of long-term efficacy and VNS use in pediatric epilepsy and other seizure types and syndromes. We evaluated this evidence using the AAN guideline methodology.

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“…Bu başarı oranları seçilen hasta grubuna ve mental retardasyonlarının ciddiyetine göre değişmektedir (23,24). Bu konudaki çoğu çalışma heterojen tip epileptik hastaları içermekle birlikte, spesifik olarak LGS ve fokal epilepsilerin ele alındığı çalışmalar da mevcuttur (2,8,22,25). Bizim çalışmamızda hastaların geneline bakıldığında ilk yıldaki 11 hastanın nöbetlerindeki azalma %42 iken ikinci yılda nöbet frekansındaki azalma %43 olarak bulunmuştur.…”

Section: Discussionunclassified

The Effect of Vagal Nerve Stimulation on the Quality of Life in Pediatric Cases

Tekin¹,

Köse²,

Gökben³

et al. 2017

jpr

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Materials and Methods:Eleven pharmacoresistant epileptic children implanted with the VNS therapy device between 2010-2014 were included in this prospective longitudinal study. Clinical assessment for the Diagnostic and Statistical Manual of Mental Disorders-IV psychiatric disorders, schedule for affective disorders, and schizophrenia for school children were applied. Childhood Depression Inventory (CDI), Beck Depression Inventory (BDI) were filled. Child Behavior Checklist (CBCL) and the Pediatric Quality of Life Inventory (PedsQL) were filled in by parents before the implantation. All of these tests were repeated in the first and second year of implantation. Results: Mean age at the first implantation of the VNS therapy device was 11.5 (2.5-16). Mean age was 13.9 (2.5-18) years. Mean duration of epilepsy prior to VNS implantation was 6.6 years, and VNS usage period was 30.4 months (10-96).International League Against Epilepsy classification of predominant seizure type was partial in seven, and generalized in four patients. Decrease in the number of seizures was 42% and 43% in the first and the second year respectively. While four of 11 patients had no psychopathology, different problems were determined in seven patients. There was no statistically significant difference between the scores of CDI/BDI, scores of CBCL and PedsQL prior to implantation, and also did not differ 1 year and 2 years after implantation. Conclusion: VNS is partially effective in controlling drug-resistant epilepsy. Although a positive effect on depression and quality of life is reported in literature, the results of this study were not statistically significant. We think that the scores of depression inventory should gradually decrease in years as it is reported for seizure frequency.

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Long-term vagus nerve stimulation in the treatment of Lennox–Gastaut syndrome

Cited by 58 publications

References 16 publications

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

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

Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy

The Effect of Vagal Nerve Stimulation on the Quality of Life in Pediatric Cases

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