Prevention of Intractable Partial Seizures by Intermittent Vagal Stimulation in Humans: Preliminary Results

Penry, J. Kiffin; Dean, Jesse C.

doi:10.1111/j.1528-1157.1990.tb05848.x

Cited by 397 publications

(209 citation statements)

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“…1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005.…”

Section: Department Of Internal Medicine Texas Tech University Healtmentioning

confidence: 99%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

115

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Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fi bers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation. (VNS) to control refractory epilepsy in 1990. 1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005. VNS are currently under investigation for treatment of anxiety, obesity, bulimia, migraines, Alzheimer disease, chronic pain syndromes, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. 2 Vagus nerve stimulation can cause side effects involving the upper airway, lower respiratory tract, and upper gastrointestinal tract. These devices can decrease airfl ow, oxygen saturation, and respiratory amplitude during sleep. 3 Most patients with VNS have an increase in their apnea-hypopnea index (AHI) after implantation. 4 One-third of these patients develop mild obstructive sleep apnea post treatment, 4,5 and a minority of patients develop severe obstructive sleep apnea secondary to VNS therapy. 6 More than 50,000 patients have had VNS implants to date, and it is important for sleep medicine specialists to recognize the sleep disordered breathing and other respiratory complications related to VNS devices. We recently helped care for a patient who developed obstructive sleep apnea (OSA) after implantation of a VNS and then required discontinuation of the VNS. Our review of literature while attempting to answer some clinically relevant questions pertaining to this patient led to this review. This article focuses on six questions pertinent to the management of these patients and reviews the literature on sleep-related and respiratory complications associated with vagus nerve stimulators. mETHODSWe conducted a literature search with ...

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Section: Department Of Internal Medicine Texas Tech University Healtmentioning

confidence: 99%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

115

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“…Over the last three decades, excitation of the central nervous system in the form of deep brain stimulation via thin cylindrical electrodes or induction coupled stimulation of the vagus nerve has become an effective and accepted form of therapy for a variety of neurological diseases (Benabid et al 1994;Benabid et al 1996;Siegfried and Lipitz 1994;Penry and Dean 1990;Uthman et al 1990). Patients with epilepsy frequently undergo surgery for the placement of subdural monitoring electrodes to help with seizure localization.…”

Section: Introductionmentioning

confidence: 99%

Studies of stimulus parameters for seizure disruption using neural network simulations

et al. 2007

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A large scale neural network simulation with realistic cortical architecture has been undertaken to investigate the effects of external electrical stimulation on the propagation and evolution of ongoing seizure activity. This is an effort to explore the parameter space of stimulation variables to uncover promising avenues of research for this therapeutic modality. The model consists of an approximately 800 μm × 800 μm region of simulated cortex, and includes seven neuron classes organized by cortical layer, inhibitory or excitatory properties, and electrophysiological characteristics. The cell dynamics are governed by a modified version of the Hodgkin-Huxley equations in single compartment format. Axonal connections are patterned after histological data and published models of local cortical wiring. Stimulation induced action potentials take place at the axon initial segments, according to threshold requirements on the applied electric field distribution. Stimulation induced action potentials in horizontal axonal branches are also separately simulated. The calculations are performed on a 16 node distributed 32-bit processor system. Clear differences in seizure evolution are presented for stimulated versus the undisturbed rhythmic activity. Data is provided for frequency dependent stimulation effects demonstrating a plateau effect of stimulation efficacy as the applied frequency is increased from 60 Hz to 200 Hz. Timing of the stimulation with respect to the underlying rhythmic activity demonstrates a phase dependent sensitivity. Electrode height and position effects are also presented. Using a dipole stimulation electrode arrangement, clear orientation effects of the dipole with respect to the model connectivity is also demonstrated. A sensitivity analysis of these results as a function of the stimulation threshold is also provided.

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“…La utilización racional de esta técnica está basada en una serie de hechos experimentales en los que se demuestra la inhibición y bloqueo de las crisis epilépticas focales o generalizadas en diferentes animales de experimentación 22,44,59.67.83.86 . A partir de estos estudios, y a finales de los ochenta, diversos autores comienzan a utilizar este tipo de estimulación en epilepsias rebeldes refractarias al tratamiento farmacológico, demostrándose en sus resultados preliminares la efectividad de la misma 58,63,74 Con posterioridad diferentes estudios multicéntricos randomizados han confirmado los esperanzadores resultados iniciales 6,76 . Hasta la fecha, y una vez aprobada su utilización como tratamiento alternativo y paliativo por la Food and Drug Administration estadounidense, son ya un número considerable de pacientes a los que se les ha implantado el estimulador vagal.…”

Section: Introductionunclassified

Estimulación eléctrica vagal en el tratamiento de la epilepsia rebelde: Situación actual

2008

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ResumenLa estimulación intermitente vagal es una técnica de neuroestimulación de reciente incorporación en el tratamiento de pacientes con epilepsia refractaria al tratamiento farmacológico convencional. Hasta el momento presente y, a pesar de algunos resultados dispares, se ha mostrado como una alternativa eficaz y segura en el tratamiento de estos pacientes. El presente trabajo de revisión pretende acercar la técnica quirúrgica de implantación, comentar las indicaciones y resultados obtenidos hasta la actualidad, y profundizar en los posibles mecanismos de acción de este tipo de estimulación, para finalmente realizar una aproximación crítica a la misma, intentando puntualizar cúales han sido los problemas e inconvenientes que han impedido la utilización generalizada de esta alternativa quirúrgica antiepilép-tica.PALABRAS CLAVE: Epilepsia. Estimulación eléctrica vagal. Seguridad y eficacia. Mecanismos de acción. Vagus nerve stimulation for the treatment of refractory epilepsy. State of the art SummaryThe vagus nerve stimulation (VNS) therapy is a new neurostimulation technique used for treating pharmacoresistant epilepsy. It can be considered an effective and safe alternative for the treatment of refractory epilepsy patients. In the present review, we describe the surgical implantation technique, its indications and results achieved until now. We will also summarize the possible mechanisms of action of VNS therapy. Finally, we will comment on the difficulties and inconvenients that did not allow this antiepileptic surgical technique to become more widely used.KEY WORDS: Epilepsy. Vagus nerve stimulation. Save and efficacy. Action mechanisms. IntroducciónLa epilepsia es una patología que afecta al 1% de la población general y que podría ser considerada en términos globales como el segundo trastorno neurológico en cuanto a incidencia y prevalencia 60 . Esta enfermedad tiene importantes repercusiones psicológicas y económicas tanto en el paciente que la sufre como en la sociedad que tiene que sufragar los gastos que la misma supone. Además, estos factores se ven aumentados por los efectos secundarios en la esfera cognitiva, caracterológica y emocional, que con frecuencia complican los tratamientos con fármacos antiepilépticos a largo plazo. Es por ello que se hace imperiosa la necesidad de buscar e investigar nuevas modalidades de tratamiento efectivo no farmacológico.El final del siglo XX ha supuesto un avance importante en el tratamiento de las epilepsias. Sin embargo, a pesar de la proliferación actual de estudios que han aumentado el conocimiento sobre las causas de la epilepsia y que han posibilitado la introducción de nuevos fármacos antiepilépticos, se puede afirmar que todavía un 30-40% de los pacientes no tienen un control satisfactorio de sus crisis 11.13.71 . En función de ello se calcula que en Estados Unidos, los pacientes tratados correctamente sin un control adecuado de las crisis podrían estar entre 150.000 y 300.000. Extrapolando estos datos, en España serían unos 20.000-40.000 pacientes. Alreded...

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Prevention of Intractable Partial Seizures by Intermittent Vagal Stimulation in Humans: Preliminary Results

Cited by 397 publications

References 8 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Studies of stimulus parameters for seizure disruption using neural network simulations

Estimulación eléctrica vagal en el tratamiento de la epilepsia rebelde: Situación actual

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