Vagus Nerve Stimulation in Children with Refractory Seizures Associated with Lennox–Gastaut Syndrome

Frost, Michael; Gates, John R.; Helmers, Sandra L.; Wheless, James W.; Levisohn, Paul M.; Tardo, Carmelo; Conry, Joan A.

doi:10.1046/j.1528-1157.2001.23900.x

Cited by 215 publications

(197 citation statements)

References 29 publications

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“…Typically, these symptoms abate with time or alteration of the stimulation parameters. 2,3,19,36,44,50 Significant or permanent injuries to the vagus nerve or development of dysphagia following implantation were rare (< 0.5%) in our series, and the rate is comparable to rates reported for other series (≤ 4%). The rate of infection was under 3%, which is comparable to rates reported in most large series (0%-8%) and similar to those reported for other implantable devices.…”

Section: Complications and Cosmetic Considerationssupporting

confidence: 85%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

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Object The authors undertook this study to analyze the efficacy of vagus nerve stimulation (VNS) in a large consecutive series of children 18 years of age and younger with treatment-resistant epilepsy and compare the safety and efficacy in children under 12 years of age with the outcomes in older children. Methods The authors retrospectively reviewed 141 consecutive cases involving children (75 girls and 66 boys) with treatment-resistant epilepsy in whom primary VNS implantation was performed by the senior author between November 1997 and April 2008 and who had at least 1 year of follow-up since implantation. The patients' mean age at vagus nerve stimulator insertion was 11.1 years (range 1–18 years). Eighty-six children (61.0%) were younger than 12 years at time of VNS insertion (which constitutes off-label usage of this device). Results Follow-up was complete for 91.8% of patients and the mean duration of VNS therapy in these patients was 5.2 years (range 25 days–11.4 years). Seizure frequency significantly improved with VNS therapy (mean reduction 58.9%, p < 0.0001) without a significant reduction in antiepileptic medication burden (median number of antiepileptic drugs taken 3, unchanged). Reduction in seizure frequency of at least 50% occurred in 64.8% of patients and 41.4% of patients experienced at least a 75% reduction. Major (3) and minor (6) complications occurred in 9 patients (6.4%) and included 1 deep infection requiring device removal, 1 pneumothorax, 2 superficial infections treated with antibiotics, 1 seroma/hematoma treated with aspiration, persistent cough in 1 patient, severe but transient neck pain in 1 patient, and hoarseness in 2 patients. There was no difference in efficacy or complications between children 12 years of age and older (FDA-approved indication) and those younger than 12 years of age (off-label usage). Linear regression analyses did not identify any demographic and clinical variables that predicted response to VNS. Conclusions Vagus nerve stimulation is a safe and effective treatment for treatment-resistant epilepsy in young adults and children. Over 50% of patients experienced at least 50% reduction in seizure burden. Children younger than 12 years had a response similar to that of older children with no increase in complications. Given the efficacy of this device and the devastating effects of persistent epilepsy during critical developmental epochs, randomized trials are needed to potentially expand the indications for VNS to include younger children.

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Section: Complications and Cosmetic Considerationssupporting

confidence: 85%

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Elliott¹,

Rodgers²,

Bassani³

et al. 2011

PED

170

104

View full text Add to dashboard Cite

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“…Other studies have demonstrated similar favorable responses of seizures associated with Lennox-Gastaut to VNS. 60,61 Nonetheless, the wide range of response rates in the pediatric population demands a better understanding of which patients will respond best to VNS.…”

Section: Vns For Refractory Seizures In the Pediatric Populationmentioning

confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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“…Egy 47 beteg adatainak elemzésén alapuló vizsgálat szerint a jó rohamkimenetel prediktorának a corticalis malformatio és bilateralis EEG-eltérések hiányát találták VNS-implantáció után [27]. Ennek némileg ellentmond az a megfi gyelés, hogy Lennox-Gastaut-szindrómában és az abban jelleg-zetes tónusos axiális rohamokban nagyobb hatékonysá-got mértek [28].…”

Section: Nervusvagus-stimulációunclassified

Invazív neuromoduláció a gyógyszerrezisztens epilepsziák kezelésében

2015

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A neuromoduláció az orvostudománynak egy új, igen dinamikusan fejlődő területe, ami azt vizsgálja, hogy az elektromos, kémiai vagy mechanikai behatások mi módon változtatják meg a központi és a perifériás idegrendszer műkö-dését. Ugyanakkor egy reverzibilis terápiás módszer, aminek segítségével a gyógyszeresen már nem befolyásolható mozgászavarok, neuropathiás fájdalmak, epilepsziák, bizonyos pszichiátriai kórképek vagy akár a súlyos spasticitas, hólyag-és székletürítési zavarok, ischaemiás szívbetegség okozta panaszok és tünetek jelentősen javulnak és ezzel szignifi kánsan javítható a betegek életminősége. A neuromodulációnak két nagy területe a noninvazív és az invazív neuromoduláció. A noninvazív neuromodulációhoz tartozik a repetitív transcranialis mágneses ingerlés, az egyenáramú stimuláció (direct current stimulation) és a transcutan elektromos neurostimuláció. Az invazív neuromodulációhoz sorolandó módszerek a mély agyi stimuláció, a motorosagykéreg-stimuláció, a gerincvelő-stimuláció, a peri fériásideg-stimuláció, a sacralisideg-ingerlés és a subcutan stimuláció. A cikkben áttekintjük az epilepszia-sebé-szetben napjainkban alkalmazott neuralis interface technológiákat. Orv. Hetil., 2015, 156(52), 2103-2109.Kulcsszavak: epilepszia, neuromoduláció, mély agyi stimuláció, vagusideg-stimuláció, gerincvelői ingerlés, reszponzív neurostimuláció Invasive neuromodulation in the treatment of drug-resistant epilepsiesNeuromodulation is one of the most developing new disciplines of medical science, which examines how electrical, chemical and mechanical interventions can modulate or change the functioning of the central and peripheral nervous system. Neuromodulation is a reversible form of therapy which uses electrical or mechanical stimulation or centrallydelivered drugs to modulate the abnormal function of the central nervous system in pain, spasticity, epilepsy, movement and psychiatric disorders, and certain cardiac, incontinency, visual and auditory diseases. Neuromodulation therapy has two major branches. Non-invasive neuromodulation includes transcranial magnetic simulation, direct current stimulation and transcutaneous electric nerve stimulation. Invasive neuromodulation includes deep brain stimulation, cortical stimulation, spinal cord stimulation, peripheral nerve stimulation, sacral nerve simulation, and subcutan stimulation. In this article the authors overview the apparently available neural interface technologies in epilepsy surgery.

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Vagus Nerve Stimulation in Children with Refractory Seizures Associated with Lennox–Gastaut Syndrome

Cited by 215 publications

References 29 publications

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases

Vagus Nerve Stimulation for Epilepsy and Depression

Invazív neuromoduláció a gyógyszerrezisztens epilepsziák kezelésében

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