Vagus nerve stimulation therapy for treatment-resistant epilepsy: A 15-year experience at a single institution

Galbarriatu, Lara; Pomposo, Iñigo; Aurrecoechea, J.; Marinas, Ainhoa; Agundez, Marta; Gómez, Juan Camilo; Acera, Marian; M, Martínez; Valle, Elena Dalla; Maestro, Iratxe; Mateos, Beatriz; Cabrera, A; Fernández, José R.; Iturri, F.; Garamendi, Íñigo

doi:10.1016/j.clineuro.2015.06.023

Cited by 34 publications

(11 citation statements)

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“…In our series no substantial changes in AED schedule were performed and most patients were on active treatment with sodium channel blockers before and after the implantation of the VNS. Nearly half of patients were responders, and this result is concordant with our historical series of patients that underwent VNS implantation [17].…”

Section: Discussionsupporting

confidence: 88%

“…Consecutive patients with drug-resistant epilepsy [16] who were scheduled to undergo implantation of the VNS Therapy 1 System (Implantable Pulse Generator model 103, lead model 304; Cyberonics, Inc., Houston, TX, USA) at the Comprehensive Epilepsy Center at Cruces University Hospital (Bilbao, Spain) over a twoyear period (2011-2013) were recruited [17].…”

Section: Patient Selectionmentioning

confidence: 99%

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Cardiovascular autonomic and hemodynamic responses to vagus nerve stimulation in drug-resistant epilepsy

Garamendi

Acera

Agundez

et al. 2017

Seizure

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Section: Discussionsupporting

confidence: 88%

Section: Patient Selectionmentioning

confidence: 99%

Cardiovascular autonomic and hemodynamic responses to vagus nerve stimulation in drug-resistant epilepsy

Garamendi

Acera

Agundez

et al. 2017

Seizure

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“…Epilepsy and seizures can have dramatic effects on cardiac function, through the ANS. While some authors have concluded that VNS seems not to change decreased HRV in drug-resistant epilepsy patients [35], others have reported that VNS improves HRV shortly after implantation via the extensive innervation of the vagus nerve into the sinoatrial and atrioventricular nodes [3,8,36]. However, cardiac autonomic dysfunction related to VNS in epilepsy patients is rare (0.1%) [37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Cardiac autonomic modulation in drug-resistant epilepsy patients after vagus nerve stimulation therapy

Constantinescu

Matei

Constantinescu

et al. 2020

Neurol Neurochir Pol.

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The positive effect of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy is considered to be mediated by the afferent pathways of the vagus nerve, but the efferent pathways may influence the cardiac autonomic activity.Aim of the study. To assess the effects of VNS on cardiac autonomic modulation in epilepsy patients, over three months of neurostimulation.Clinical rationale for the study. Linear and non-linear heart rate variability (HRV) analysis can provide information on the sympathovagal balance and reveal particularities of the central control of the autonomic cardiovascular function.Materials and Methods. Using Biopac Acquisition System, we analysed HRV parameters in resting condition and during sympathetic and parasympathetic activation tests in five patients with drug-resistant epilepsy, who underwent VNS procedure.Results. During the sympathetic and vagal activation tests, all five patients presented normal responses of cardiac autonomic activity, reflected in RMSSD, HFnu and LF/HF dynamics in both HRV evaluations. No bradycardia, cardiac arrhythmia or orthostatic hypotension was registered during the two evaluations. Conclusions.Our results indicate that VNS appears not to alter the cardiac autonomic function after three months of neurostimulation. HRV analysis is a useful tool for evaluating cardiac autonomic modulation in epilepsy patients during VNS therapy. Clinical Implications.Patients with decreased HRV should be periodically monitored. Cardiac changes in patients with epilepsy are important because of the additional risk of arrhythmias mediated through the autonomic dysfunction.

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“…Stress, nutrition, and exercise affect vagal nerve tone [73,74,75]. Stimulation of the vagus nerve produces analgesic [76], anti-inflammatory [72], antidepressant-anxiolytic [77], and antiepileptic [78] effects. Antidepressant and anxiolytic drugs also affect vagal tone [79].…”

Section: The Microbiome As a New Psychiatric Treatment Optionmentioning

confidence: 99%

Therapeutic Potential of the Microbiome in the Treatment of Neuropsychiatric Disorders

2019

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The search for rational treatment of neuropsychiatric disorders began with the discovery of chlorpromazine in 1951 and continues to evolve. Day by day, new details of the intestinal microbiota–brain axis are coming to light. As the role of microbiota in the etiopathogenesis of neuropsychiatric disorders is more clearly understood, microbiota-based (or as we propose, “fecomodulation”) treatment options are increasingly discussed in the context of treatment. Although their history dates back to ancient times, the importance of psychobiotics and fecal microbiota transplantation (FMT) has only recently been recognized. Despite there being few preclinical and clinical studies, the evidence gathered to this point suggests that consideration of the microbiome in the treatment of neuropsychiatric disorders represents an area of significant therapeutic potential. It is increasingly hoped that such treatment options will be more reliable in terms of their side effects, cost, and ease of implementation. However, there remains much to be researched. Questions will be answered through germ-free animal experiments and randomized controlled trials. In this article, the therapeutic potential of microbiota-based options in the treatment of neuropsychiatric disorders is discussed in light of recent research.

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Vagus nerve stimulation therapy for treatment-resistant epilepsy: A 15-year experience at a single institution

Cited by 34 publications

References 50 publications

Cardiovascular autonomic and hemodynamic responses to vagus nerve stimulation in drug-resistant epilepsy

Cardiovascular autonomic and hemodynamic responses to vagus nerve stimulation in drug-resistant epilepsy

Cardiac autonomic modulation in drug-resistant epilepsy patients after vagus nerve stimulation therapy

Therapeutic Potential of the Microbiome in the Treatment of Neuropsychiatric Disorders

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