Vagus nerve stimulation for focal seizures

Panebianco, Mariangela; Rigby, Alexandra; Marson, Anthony G

doi:10.1002/14651858.cd002896.pub3

Cited by 16 publications

(9 citation statements)

References 75 publications

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“…Overall, this supported the decision in favor of alternative, non‐pharmacological treatment approaches. This can be epilepsy surgery 10 or neuromodulatory treatment approaches (eg, VNS, 11 DBS, 12 RNS, 13 or FCS 14 ).…”

Section: Discussionmentioning

confidence: 99%

Value of ultralong‐term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report

Hirsch,

Novitskaya,

Schulze‐Bonhage

2023

Epilepsia Open

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Treatment decisions in epilepsy critically depend on information on the course of the disease, its severity and options for specific local interventions. We here report a patient with pharmacoresistant non‐lesional temporal lobe epilepsy with evidence for predominant right temporal epileptogenesis. While seizure frequency had been grossly underestimated for many years, ultralong‐term monitoring with a subcutaneous EEG device revealed actual seizure frequency (66 over 11 months vs. 4 patient‐documented seizures), providing objective data on treatment efficacy and additional supportive lateralizing information that played a decisive role for the choice of surgical treatment, which had been rejected by the patient prior to this information.

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Section: Discussionmentioning

confidence: 99%

Value of ultralong‐term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report

Hirsch,

Novitskaya,

Schulze‐Bonhage

2023

Epilepsia Open

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“…The identification of ASMs having synergetic effects with VNS is of major importance. This finding would improve treatment response, reduce adverse effects, and increase the quality of life in patients with epilepsy [ 22 , 32 ]. In addition, VNS could potentially reduce behavioral adverse effects of ASM due to its mood improving properties.…”

Section: Introductionmentioning

confidence: 99%

Synergistic effects of vagus nerve stimulation and antiseizure medication

Winter,

Sandner,

Glaser

et al. 2023

J Neurol

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Introduction Vagus nerve stimulation (VNS) is an effective, non-pharmacological therapy for epileptic seizures. Until now, favorable combinations of different groups of antiseizure medication (ASM) and VNS have not been sufficiently addressed. The aim of this study was to identify the synergistic effects between VNS and different ASMs. Methods We performed an observational study of patients with epilepsy who were implanted with VNS and had a stable ASM therapy during the first 2 years after the VNS implantation. Data were collected from the Mainz Epilepsy Registry. The efficacy of VNS depending on the concomitantly used ASM group/individual ASMs was assessed by quantifying the responder rate (≥ 50% seizure reduction compared to the time of VNS implantation) and seizure freedom (absence of seizures during the last 6 months of the observation period). Results One hundred fifty one patients (mean age 45.2 ± 17.0 years, 78 females) were included in the study. Regardless of the used ASM, the responder rate in the whole cohort was 50.3% and the seizure freedom was 13.9%. Multiple regression analysis showed that combination of VNS with synaptic vesicle glycoprotein (SV2A) modulators (responder rate 64.0%, seizure freedom 19.8%) or slow sodium channel inhibitors (responder rate 61.8%, seizure freedom 19.7%) was associated with a statistically significant better responder rate and seizure freedom than combinations of VNS and ASM with other mechanism of action. Within these ASM groups, brivaracetam showed a more favorable effect than levetiracetam, whereas lacosamide and eslicarbazepine were comparable in their effects. Conclusion Our data suggest that the combination of VNS with ASMs belonging to either SV2A modulators or slow sodium channel inhibitors could be optimal to achieve a better seizure control following VNS. However, these preliminary data require further validation under controlled conditions.

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“…A clinically relevant increase in QoL 1 and 2 years after implantation was also described in a small Turkish sample of seven DRE patients treated with VNS 9. A Cochrane review from 2022 reported that VNS leads to small QoL increases, however, they only included studies with a maximum follow-up of 20 weeks 10. DBS also leads to a clinically relevant increase in QoL both 1 and 5 years after implantation.…”

Section: Introductionmentioning

confidence: 82%

“…After 5 years 38% of the 9 patients who were still participating were considered responders 17. A Cochrane review from 2022 shows an OR of 1.93 (95% CI 1.1 to 3.4) for the responder rate across all included studies 10…”

Section: Introductionmentioning

confidence: 99%

QUality of life and Economic evaluation after neuroSTimulation for Epilepsy (QUESTE) in adolescents and adults with drug-resistant epilepsy: protocol for a multicentre, prospective observational cohort study in The Netherlands

et al. 2023

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IntroductionEpilepsy is one of the most common chronic neurological disorders. Antiseizure medication (ASM) is the first choice of treatment, however, 30% of epilepsy patients are drug-resistant. For these patients, neuromodulation can be an option, especially when epilepsy surgery is not possible or did not lead to seizure freedom. Epilepsy is associated with reduced quality of life (QoL), which heavily depends on seizure control.The most recent Cochrane reviews have shown that vagus nerve stimulation and deep brain stimulation of the anterior nucleus of the thalamus, lead to a responder rate OR of, respectively, 1.93 and 1.20. The question arises if neuromodulation for drug-resistant epilepsy (DRE) will be more cost-effective than sole treatment with ASM. The current study aims to determine the change in QoL after neuromodulation. Secondarily, we will aim to study the cost-effectiveness of these treatments.Methods and analysisThis prospective cohort study aims at including 100 patients aged 16 or above who will be referred for neuromodulation, from January 2021 to January 2026. After informed consent, QoL and other relevant parameters will be assessed at baseline, 6 months, 1, 2 and 5 years after surgery. Data on seizure frequency will be derived from patient charts. We expect that DRE patients will report better QoL after neuromodulation. Even if they would still report seizures, the treatment can be seen as useful. This is especially true when patients can participate in society again to a greater extent than before treatment.Ethics and disseminationThe board of directors of participating centres all gave permission for this study to commence. The medical ethics committees decided that this study does not fall under the Medical Research Involving Human Subjects Act (WMO). The findings of this study will be presented at (inter)national conferences and in peer-reviewed journals.Trial registration numberNL9033.

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Vagus nerve stimulation for focal seizures

Cited by 16 publications

References 75 publications

Value of ultralong‐term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report

Value of ultralong‐term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report

Synergistic effects of vagus nerve stimulation and antiseizure medication

QUality of life and Economic evaluation after neuroSTimulation for Epilepsy (QUESTE) in adolescents and adults with drug-resistant epilepsy: protocol for a multicentre, prospective observational cohort study in The Netherlands

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