Vagus nerve stimulation therapy in partial epilepsy: a review

Abstract

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked epileptic seizures. The majority of people given a diagnosis of epilepsy have a good prognosis, but 20-30 % will develop drug-resistant epilepsy. Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with medically refractory epilepsy. It consists of chronic intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator (Neuro-Cybernetic Prosthesis). In 1997, the Food and Drug Administration approved VNS as adjunctive treatment for medically refractory partial-onset seizures in adults and adolescents. This article reviews the literature from 1988 to nowadays. We discuss thoroughly the anatomy and physiology of vagus nerve and the potential mechanisms of actions and clinical applications involved in VNS therapy, as well as the management, safety, tolerability and effectiveness of VNS therapy. VNS for partial seizures appears to be an effective and well tolerated treatment in adult and pediatric patients. People noted improvements in feelings of well-being, alertness, memory and thinking skills, as well as mood. The adverse effect profile is substantially different from the adverse effect profile associated with antiepileptic drugs, making VNS a potential alternative for patients with difficulty tolerating antiepileptic drug adverse effects. Despite the passing years and the advent of promising neuromodulation technologies, VNS remains an efficacy treatment for people with medically refractory epilepsy. Past and ongoing investigations in other indications have provided signals of the therapeutic potential in a wide variety of conditions.

Monoaminergic Mechanisms in Epilepsy May Offer Innovative Therapeutic Opportunity for Monoaminergic Multi-Target Drugs

“…Subsequent experimental studies provided firm evidence that the noradrenergic system modifies seizure activity. Nowadays, vagus nerve stimulation (VNS) is an adjunctive treatment for resistant epilepsy and depression (Panebianco et al, 2016). …”

Research progress of vagus nerve stimulation in the treatment of epilepsy

“…In the treatment of epilepsy including children and adults, VNS treatment has been proved safe and effective . Thus, the FDA has approved that VNS can be used in children over 4 years old recently .…”

“…In the treatment of epilepsy including children and adults, VNS treatment has been proved safe and effective. 26 Thus, the FDA has approved that VNS can be used in children over 4 years old recently. [27][28][29][30][31] The VNS treatments do not only reduce the frequency of seizures but also reduce the psychological burden of children.…”

WONOEP APPRAISAL: The many facets of epilepsy networks

“…In the context of epilepsy, it is important to understand the genetics and cell signaling aspects of underpinning seizures and additional morbidities, but this does not subsume all other approaches to treatment. For example, stimulation approaches have been developed in animals 23,[32][33][34][35][36][37] and the clinic [24][25][26] to detect seizures and acutely and directly modulate neural firing. Electrical stimulation approaches are used in animals and humans.…”