Vagal Nerve Stimulation in Refractory Epilepsy

Murphy, Jerome V.; Torkelson, Richard; Dowler, Irene; Simon, Stephen D.; Hudson, Sara

doi:10.1001/archpedi.157.6.560

Cited by 126 publications

(22 citation statements)

References 26 publications

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“…These results were similar to those of earlier studies, in which 30% of patients had a >75% decrease in seizure frequency 6 months after VNS implantation (1) and 45% achieved a >50% reduction (2, 4-6). Although not statistically significant, we found that this reduction in seizure rate tended to be inversely related to seizure duration before VNS implantation and to the mean age at starting VNS therapy (2, 7). VNS also tended to be tolerated better and to be more effective in younger patients.…”

Section: Discussionsupporting

confidence: 91%

“…Due to the possible unfavorable effects of multiple anti-epileptic drugs on development, VNS is of particular interest in children and adolescents; over 25% of the approximately 30,000 patients receiving vagus nerve stimulator implants to date have been children and adolescents younger than 18 yr of age (1). Moreover, VNS has shown a higher degree of efficacy and tolerance in children than in adults (2). …”

Section: Introductionmentioning

confidence: 99%

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Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

et al. 2007

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We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved altertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

et al. 2007

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“…When a patient no longer responds to AED treatment, the disease state is categorized as refractory epilepsy. The only treatment options for patients with refractory epilepsy are invasive procedures such as vagal nerve stimulation (Murphy, 2003), hemispherectomy (Obrador & Larramendi, 1953; Chandra et al, 2008), or complete removal of affected areas (resection) (Penfield & Baldwin, 1952; Schramm & Clusmann, 2008). Studies have shown refractory epilepsy coincides with increased expression of P-glyprotein or multi-drug resistance efflux pumps, which may limit therapeutic concentrations of AEDs from entering the brain (Tishler et al, 1995; Lazarowski et al, 2007).…”

Section: Existing Pharmacological Therapies For Cns Disordersmentioning

confidence: 99%

Targeting the neurovascular unit for treatment of neurological disorders

VanGilder

Rosen

Barr

et al. 2011

Pharmacology & Therapeutics

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Drug discovery for CNS disorders has been restricted by the inability for therapeutic agents to cross the blood-brain barrier (BBB). Moreover, current drugs aim to correct neuron cell signaling, thereby neglecting pathophysiological changes affecting other cell types of the neurovascular unit (NVU). Components of the NVU (pericytes, microglia, astrocytes, and neurons, and basal lamina) act as an intricate network to maintain the neuronal homeostatic microenvironment. Consequently, disruptions to this intricate cell network lead to neuron malfunction and symptoms characteristic of CNS diseases. A lack of understanding in NVU signaling cascades may explain why current treatments for CNS diseases are not curative. Current therapies treat symptoms by maintaining neuron function. Refocusing drug discovery to sustain NVU function may provide a better method of treatment by promoting neuron survival. In this review, we will examine current therapeutics for common CNS diseases, describe the importance of the NVU in cerebral homeostasis and discuss new possible drug targets and technologies that aim to improve treatment and drug delivery to the diseased brain.

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“…found that 45% of the children with VNS experienced greater than 50% reduction in seizure frequency at six months, with 18% of the children being seizure-free. [19] Rossignol and colleagues followed a cohort of 28 adolescents and children implanted with VNS, for nonsurgical refractory epilepsy, and reported that 68% experienced greater than 50% reduction in seizure frequency at two years, with 14% being seizure-free. [26] Rychlicki et al .…”

Section: Methodsmentioning

confidence: 99%

“…[21931] Patel and Edwards have reported that in all cases of VNS pocket infections, removal of the device is necessary to achieve a cure. [24] Some authors, however, suggest that IV antibiotics without hardware removal may be an option for the management of these cases.…”

Section: Methodsmentioning

confidence: 99%

Vagal nerve stimulation for pharmacoresistant epilepsy in children

Hauptman¹,

Mathern²

2012

Surg Neurol Int

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Vagus nerve stimulation (VNS) is an adjunctive treatment for adult patients with pharmacoresistant epilepsy. Little is known about VNS therapy for children with epilepsy. This article will: (1) Review the contemporary medical literature related to VNS therapy in children with epilepsy, (2) describe the experience of VNS treatment in 153 children less than 18 years of age, in the University of California, Los Angeles (UCLA) Pediatric Epilepsy Surgery Program, from 1998 to 2012, and (3) describe the surgical technique used for VNS implantation at UCLA. Review of the literature finds that despite different etiologies and epilepsy syndromes in children, VNS appears to show a similar profile of efficacy for seizure control compared to adults, and low morbidity and mortality. The UCLA experience is similar to that reported in the literature for children. VNS constitutes about 21% of our pediatric epilepsy surgery volume. We have implanted VNS in infants as young as six months of age and the most common etiology is the Lennox-Gastaut Syndrome. About 5% of the patients are seizure-free with VNS therapy and there is a low rate of surgically related complications. The UCLA surgical approach emphasizes minimal direct manipulation of the vagus nerve and adequate wire loops, to prevent a lead fracture. In summary, VNS is a viable palliative treatment for medically refractory epilepsy in children, with outcomes and complications equal to adult patients. Being a small child is not a contraindication for VNS therapy, if needed for refractory epilepsy.

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Vagal Nerve Stimulation in Refractory Epilepsy

Cited by 126 publications

References 26 publications

Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

Targeting the neurovascular unit for treatment of neurological disorders

Vagal nerve stimulation for pharmacoresistant epilepsy in children

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