Vagus nerve stimulation: effectiveness and tolerability in patients with epileptic encephalopathies

Cersósimo, Ricardo; Bartuluchi, Marcelo; Santos, Cecilia De los; Bonvehi, Irene; Pomata, Hugo; Caraballo, Roberto

doi:10.1007/s00381-010-1314-8

Cited by 33 publications

(27 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Data related to infants are sparse, and limited to either small proportions of larger case series, or small case reports of up to six infants. [22][23][24][25][26] Because epileptic spasms are the more common single seizure type to occur in infancy, this condition was assessed in isolation. West syndrome is characterized by an electroclinical triad of (1) epileptic spasms, (2) hypsarrhythmia on EEG study, and (3) developmental stagnation or regression.…”

Section: Approach To Therapy and Interventions In Infantile-onset Seimentioning

confidence: 99%

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

et al. 2015

View full text Add to dashboard Cite

Summary Evidence‐based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or “state of the art” interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video‐EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile‐onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide,...

show abstract

Section: Approach To Therapy and Interventions In Infantile-onset Seimentioning

confidence: 99%

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

et al. 2015

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Son yıllarda çocukluk yaş grubunda yapılan çalışmalarda nöbet sıklığındaki azalma %16 ile %65 arası değişmektedir (1)(2)(3)(4). Konuyla ilgili yapılan çalışmalarda genellikle dirençli semptomatik jeneralize ve fokal epilepsiler ile epileptik ensefalopatili hastalar karışık olarak değerlendirilmiştir (5)(6)(7).…”

Section: Introductionunclassified

“…Konuyla ilgili yapılan çalışmalarda genellikle dirençli semptomatik jeneralize ve fokal epilepsiler ile epileptik ensefalopatili hastalar karışık olarak değerlendirilmiştir (5)(6)(7). Az sayıda çalışmada parsiyel epilepsi ve epileptik ensefalopatiler [Lennox-Gastaut sendromu (LGS), West sendromu] izole değerlendirilmiştir (2,4,(8)(9)(10).…”

Section: Introductionunclassified

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

Tekin¹,

Köse²,

Gökben³

et al. 2017

jpr

View full text Add to dashboard Cite

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.

show abstract

Vagus nerve stimulation: effectiveness and tolerability in patients with epileptic encephalopathies

Abstract: VNS is an effective and well-tolerated treatment for patients with epileptic encephalopathies EEs, improving QOL and neuropsychological performance.

Cited by 33 publications

References 29 publications

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

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

Contact Info

Product

Resources

About