Vagus nerve stimulation for refractory epilepsy: A Belgian multicenter study

Herdt, Veerle De; Boon, Paul; Ceulemans, Berten; Hauman, Henri; Lagae, Lieven; Legros, Benjamin; Sadzot, Bernard; Bogaert, Patrick Van; Rijckevorsel, Kenou van; Verhelst, Hélène; Vonck, Kristl

doi:10.1016/j.ejpn.2007.01.008

Cited by 127 publications

(95 citation statements)

References 26 publications

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“…Four studies additionally included data on the percentage of patients achieving freedom from seizures, typically quoted at the 1-year time frame. 9,15,19,28 Of these studies, seizure freedom was reported at a mean of 14.0% (range 9%-27%). …”

Section: Resultsmentioning

confidence: 99%

“…There were 14 publications that used this standard, and of the 1378 patients studied, a mean of 50.9% (range 18.4%-67%) showed a 50% or greater decrease in seizure frequency. 1,2,4,5,[8][9][10][11]15,[24][25][26][27][28] Five of the remaining studies used the mean or median frequency reduction from baseline. 3,14,17,22,23 The mean seizure reduction in these investigations was 42.8% (range 28%-66%).…”

Section: Resultsmentioning

confidence: 99%

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Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Connor¹,

Nixon²,

Nanda³

et al. 2012

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Object The authors conducted a study to evaluate the published results of vagal nerve stimulation (VNS) for medically refractory seizures according to evidence-based criteria. Methods The authors performed a review of available literature published between 1980 and 2010. Inclusion criteria for articles included more than 10 patients evaluated, average follow-up of 1 or more years, inclusion of medically refractory epilepsy, and consistent preoperative surgical evaluation. Articles were divided into 4 classes of evidence according to criteria established by the American Academy of Neurology. Results A total of 70 publications were reviewed, of which 20 were selected for review based on inclusion and exclusion criteria. There were 2 articles that provided Class I evidence, 7 that met criteria for Class II evidence, and 11 that provided Class III evidence. The majority of evidence supports VNS usage in partial epilepsy with a seizure reduction of 50% or more in the majority of cases and freedom from seizure in 6%–27% of patients who responded to stimulation. High stimulation with a gradual increase in VNS stimulation over the first 6 weeks to 3 months postoperatively is well supported by Class I and II data. Predictors of positive response included absence of bilateral interictal epileptiform activity and cortical malformations. Conclusions Vagal nerve stimulation is a safe and effective alternative for adult and pediatric populations with epilepsy refractory to medical and other surgical management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Connor¹,

Nixon²,

Nanda³

et al. 2012

FOC

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show abstract

“…After a full description of the procedure was provided and explained, all patients gave written informed consent. During this period, the stimulation parameters were individually adjusted by a previously described standard ramping-up scheme [6,8]. Stimulation parameters were gradually changed in order to achieve maximal therapeutic effect with minimal side effects.…”

Section: Patientsmentioning

confidence: 99%

“…Two randomized, double-blind clinical trials have shown a statistically significant decrease in seizure frequency by VNS [3][4][5]. Several long-term follow-up studies have further established the efficacy and safety of VNS [6][7][8][9]. A meta-analysis of VNS efficacy has shown that seizure reduction ranges from 0 to 100 % (mean 45 %), and varies considerably across patients [10].…”

Section: Introductionmentioning

confidence: 99%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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Currently, the mechanism of action of vagus nerve stimulation (VNS) is not fully understood, and it is unclear which factors determine a patient's response to treatment. Recent preclinical experiments indicate that activation of the locus coeruleus noradrenergic system is critical for the antiepileptic effect of VNS. This study aims to evaluate the effect of VNS on noradrenergic signaling in the human brain through a noninvasive marker of locus coeruleus noradrenergic activity: the P3 component of the event-related potential. We investigated whether VNS differentially modulates the P3 component in VNS responders versus VNS nonresponders. For this purpose, we recruited 20 patients with refractory epilepsy who had been treated with VNS for at least 18 months. Patients were divided into 2 groups with regard to their reduction in mean monthly seizure frequency: 10 responders (>50 %) and 10 nonresponders (≤50 %). Two stimulation conditions were compared: VNS OFF and VNS ON. In each condition, the P3 component was measured during an auditory oddball paradigm. VNS induced a significant increase of the P3 amplitude at the parietal midline electrode, in VNS responders only. In addition, logistic regression analysis showed that the increase of P3 amplitude can be used as a noninvasive indicator for VNS responders. These results support the hypothesis that activation of the locus coeruleus noradrenergic system is associated with the antiepileptic effect of VNS. Modulation of the P3 amplitude should be further investigated as a noninvasive biomarker for the therapeutic efficacy of VNS in patients with refractory epilepsy.

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“…39 An open-label retrospective study evaluated long-term outcome in seven different epilepsy centers in Belgium: 138 patients with a follow-up of at least 12 months had an overall reduction in mean monthly seizure frequency of 51% and a responder rate of 59%. 40 At Ghent University Hospital, successful treatment of status epilepticus (SE) with VNS was reported. 41 In this case, a 7-year-old girl presented with a refractory nonconvulsive SE.…”

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confidence: 99%

Electrical Stimulation for the Treatment of Epilepsy

et al. 2009

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Summary: Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.

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Vagus nerve stimulation for refractory epilepsy: A Belgian multicenter study

Cited by 127 publications

References 26 publications

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

Electrical Stimulation for the Treatment of Epilepsy

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