Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration

Colicchio, Gabriella; Policicchio, Domenico; Barbati, Giulia; Cesaroni, Elisabetta; Fuggetta, Filomena; Meglio, Mario; Papacci, Fabio; Rychlicki, F.; Scerrati, Massimo; Zamponi, Nelia

doi:10.1007/s00381-009-1069-2

Cited by 62 publications

(64 citation statements)

References 31 publications

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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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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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“…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 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).…”

mentioning

confidence: 99%

“…In the pooled analysis of 481 children, the responder rate was 55% (95% confidence interval [CI] 51%-59%), but there was significant heterogeneity in the data. Two of the 16 studies 11,13 were not included in the analysis because either they did not provide information about responder rate or they included a significant number (.20%) of adults in their population. The pooled seizure freedom rate was 7% (95% CI 5%-10%).…”

mentioning

confidence: 99%

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

Morris¹,

Gloss²,

Buchhalter³

et al. 2013

Neurology

354

203

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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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“…However, unblinded trials suggest that VNS is effective in multifocal epilepsy: for example, there was a 75% seizure reduction after 3 years in one trial of adults and pediatric patients. 4 Unblinded studies also support the use of VNS in epilepsy from causes such as Lennox-Gastaut syndrome, tuberous sclerosis, postinfections, and others. 25 The data from the RNS system and DBS of the ANT are still developing, and as of yet the results have not addressed these alternative etiologies directly.…”

Section: Choice Of Therapymentioning

confidence: 93%

Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials

Rolston¹,

Englot²,

Wang³

et al. 2012

FOC

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Epilepsy is a devastating disease, often refractory to medication and not amenable to resective surgery. For patients whose seizures continue despite the best medical and surgical therapy, 3 stimulation-based therapies have demonstrated positive results in prospective randomized trials: vagus nerve stimulation, deep brain stimulation of the thalamic anterior nucleus, and responsive neurostimulation. All 3 neuromodulatory therapies offer significant reductions in seizure frequency for patients with partial epilepsy. A direct comparison of trial results, however, reveals important differences among outcomes and surgical risk between devices. The authors review published results from these pivotal trials and highlight important differences between the trials and devices and their application in clinical use.

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Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration

Abstract: The best responder could be a young lesional epileptic patient; after 3 years of follow-up, the percentage of responders is still in progress.

Cited by 62 publications

References 31 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

Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials

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