Vagus Nerve Stimulation as a Treatment for Refractory Epilepsy: A 15-Year Experience in an Italian Tertiary – Care Epilepsy Center

Abstract

Purpose: Vagus Nerve Stimulation (VNS) is indicated in the treatment of pharmacoresistant epilepsy. Albeit its general efficacy, the use of VNS remains undefined concerning two points: i) there are only a few long-term studies, none randomized; ii) there are no clinical markers which allow to predict VNS response. In order to explore these points, we report the long-term outcomes of VNS in 22 patients.Methods: Twenty-two patients with refractory epilepsy, either symptomatic generalized or cryptogenic/symptomatic partial were treated with VNS and monitored up to 15 years (6.5+1.1).Results: No significant adverse events were observed. VNS efficacy was enduring and increased significantly over time. Seizure frequency decreased by 34.3+3.9% after 1 year, 40.3+4.6% after 2 years, 48.0+5.4% after 3 years, 53.4+7.9% after 5 years and 48.1%+5.8 at maximum follow up. Data on syndrome-specificity were not significant (small number of patients in each group).Conclusions: This study confirms sustained efficacy of VNS in epilepsy. Generalized symptomatic and temporal lobe epilepsy seem to be associated to a better outcome to VNS, but additional data are required.

Intraoperative handheld optical coherence tomography forward-viewing probe: physical performance and preliminary animal imaging

“…The OCT probe was developed for the conditions of intraoperative use. Its electrical source has extremely low current output, which is approximately 3 orders of magnitude less than typical current encountered during invasive cardiac pacing (~10 mA) [ 22 ], vagal nerve stimulation (~3 mA) [ 23 ], or deep brain stimulation (3~5 mA) [ 24 ]. In addition, it is relatively easy to sterilize and maintains a small instrument diameter for insertion through small incisions during minimally invasive surgical procedures.…”