scholarly journals The long-term outcome of children with refractory epilepsy after a vagal nerve stimulator implantation: CHU Sainte-Justine experience

2015 ◽  
Vol 42 (S1) ◽  
pp. S7-S7
Author(s):  
ML Kaseka ◽  
LS Carmant ◽  
E Desplats ◽  
L Crevier ◽  
P Major ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Hospitalization Rate ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Nerve Stimulator ◽  
Vagal Nerve Stimulator ◽  
The Impact

Background: Debate persists in Canada about the cost and benefit of vagal nerve stimulation in patients with refractory epilepsy. The aim of our study was to evaluate the impact of a vagal nerve stimulator on the seizure frequency and the admission rate of children with refractory epilepsies over five years of follow-up. Methods: 52 patients were implanted between 2000-2013. Of these, 37 were followed at CHU Sainte-Justine and 21 kept seizure diaries. Seizure frequency was compared to the baseline at 6 months, 12 months, 24 months and 60 months of follow up using a multivariate ANOVA analysis. The hospitalization rate was calculated as the mean difference between the number of hospitalizations prior to and after the implantation. Results: Seizure frequency decreased by 58% at 6 months, by 61% at 12 months, by 53% at 24 months and by 63% at 60 months of follow up respectively compared to the baseline (p<0.001). The hospitalization rate decreased by 50.87% after surgery (p<0.001). Conclusion: In our population, vagal nerve stimulation has a sustained impact on seizure frequency and hospitalization rates. This supports previous data from our group and others on cost-effectiveness of the technique in children with refractory epilepsy.

Efficacy and safety of corpus callosotomy after vagal nerve stimulation in patients with drug-resistant epilepsy

2018 ◽  
Vol 128 (1) ◽  
pp. 277-286 ◽  
Author(s):  
Jennifer Hong ◽  
Atman Desai ◽  
Vijay M. Thadani ◽  
David W. Roberts
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Case Series ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Class Iii ◽  
Corpus Callosotomy ◽  
Few Data ◽  
Medically Refractory Epilepsy

OBJECTIVEVagal nerve stimulation (VNS) and corpus callosotomy (CC) have both been shown to be of benefit in the treatment of medically refractory epilepsy. Recent case series have reviewed the efficacy of VNS in patients who have undergone CC, with encouraging results. There are few data, however, on the use of CC following VNS therapy.METHODSThe records of all patients at the authors' center who underwent CC following VNS between 1998 and 2015 were reviewed. Patient baseline characteristics, operative details, and postoperative outcomes were analyzed.RESULTSTen patients met inclusion criteria. The median follow-up was 72 months, with a minimum follow-up of 12 months (range 12–109 months). The mean time between VNS and CC was 53.7 months. The most common reason for CC was progression of seizures after VNS. Seven patients had anterior CC, and 3 patients returned to the operating room for a completion of the procedure. All patients had a decrease in the rate of falls and drop seizures; 7 patients experienced elimination of drop seizures. Nine patients had an Engel Class III outcome, and 1 patient had a Class IV outcome. There were 3 immediate postoperative complications and 1 delayed complication. One patient developed pneumonia, 1 developed transient mutism, and 1 had persistent weakness in the nondominant foot. One patient presented with a wound infection.CONCLUSIONSThe authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.

Efficacy of Vagal Nerve Stimulation in Children with Medically Refractory Epilepsy

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1353-1358 ◽  
Author(s):  
Ravish V. Patwardhan ◽  
Benjamin Stong ◽  
E. Martina Bebin ◽  
Jan Mathisen ◽  
Paul A. Grabb
Keyword(s):  
Quality Of Life ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Seizure Type ◽  
Seizure Reduction ◽  
Medically Refractory Epilepsy

ABSTRACT OBJECTIVE The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in children with medically refractory epilepsy. METHODS Thirty-eight children aged 11 months to 16 years underwent implantation of vagal nerve stimulators. Age of seizure onset, duration of epilepsy, and seizure type and frequency were recorded preoperatively. Age at implantation, length of follow-up, seizure type and frequency, and change in quality of life (QOL) were recorded postoperatively. Changes in QOL were assigned a QOL score by the caretakers on a visual analog scale of −1 (much worse) to +1 (much improved). RESULTS The median follow-up period was 12 months (range, 10–18 mo). Eleven (29%), 15 (39%), 5 (13%), and 7 (18%) children had greater than 90% reduction, 50 to 90% reduction, less than 50% reduction, and no reduction in seizure frequency, respectively. For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonicoclonic (45%). The mean change in QOL score was 0.61. Eighty-six percent of the children had QOL scores of 0.5 (improved) or higher. Follow-up of at least 6 months was associated with greater seizure reduction (P = 0.05) and higher QOL score (P &lt; 0.01). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (P &lt; 0.05). The age of the child and duration of epilepsy were not associated with greater or lesser degrees of seizure reduction. CONCLUSION VNS provided improvements in seizure control for the majority of children regardless of age. QOL was improved in the majority of children with VNS. VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus.

scholarly journals Hyperglycemia With Use of Vagal Nerve Stimulator

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A386-A386
Author(s):  
Jessica Castellanos-Diaz ◽  
Morolake Amole ◽  
Swapna Surabhi ◽  
Sushma Kadiyala
Keyword(s):  
Blood Glucose ◽  
Nerve Stimulation ◽  
Blood Glucose Concentration ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Nerve Stimulator ◽  
Output Current ◽  
Diabetes Clinic ◽  
Vagal Nerve Stimulator ◽  
History Of

Abstract Introduction: In patient with diabetes and refractory epilepsy requiring vagal nerve stimulator (VNS), glycemic management can be challenging. Clinical experience is limited in this scenario. Case Report: A 67-year-old male, BMI 30 kg/m2, with history of type 2 diabetes and hemispheric hemangioma complicated by seizure disorder is referred to our diabetes clinic for evaluation of persistent hyperglycemia. The patient reports 25-year history of seizures that have been difficult to control with antiepileptic drugs alone and eventually requiring VNS placement. Patient has normal kidney (eGFR &gt; 60mL/min) and liver function. His antiepileptic drug regimen consisted of gabapentin and as needed lorazepam. He was never on glucocorticoids. Glycated hemoglobin (HgA1c) at our initial evaluation was 10.1%. His anti-glycemic regimen consisted of glipizide monotherapy. Fasting and pre-prandial blood glucose were in the 200-400mg/dL range with occasional values higher than 500mg/dL. This was confirmed with 14-day continuous glucose monitoring that showed average blood glucose of 287mg/dL with 100 percent above target (higher than 180 mg/dL). We optimized therapy by adding once daily glargine, pioglitazone and continued glipizide. At follow up visit, HgA1c still remained high at 10.5%, despite medication adherence. Patient emphasized that hyperglycemia was related to VNS use and given documented hyperglycemia with blood glucose range 500–600 mg/dL when on higher output current of 2 milliamps, his neurologist approved a trial off VNS for 4 weeks. His glucose improved to average less than 200 mg/dL and HgA1c decreased to 9.1% on the same anti-glycemic regimen. Device was re-started due to recurrence of seizures, however the output current and “on time” were reduced to minimal effective range for optimizing seizure therapy while avoiding hyperglycemia. Subsequent HgA1C improved to 8.7%. Discussion: VNS is a FDA approved device for epilepsy and depression. It works by intermittent stimulation or “on/off” periods. In animal studies, elevation of blood glucose was noted with afferent stimulation. Conversely, efferent activation lowers blood glucose. There are limited human studies on the effects of vagal nerve stimulation on glycemic control. The few available, showed variation in blood glucose based on output current and length of on/off period. This should be factored in during glycemic evaluation and management and close collaboration with neurology is essential. Reference: (1) Strauss H, et al. Cervical Vagal Nerve Stimulation Impairs Glucose Tolerance and Suppresses Insulin Release in Conscious Rats. Physiological Reports 2018; 6(24): 1–9 (2) Strauss H, et al. Effect of Vagus Nerve Stimulation on Blood Glucose Concentration in Epilepsy Patients - Importance of Stimulation Parameters. Physiological Reports 2019; 7(14): 1–10

scholarly journals Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy

2013 ◽  
Vol 71 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Murilo S. Meneses ◽  
Samanta F. B. Rocha ◽  
Cristiane Simão ◽  
Heraldo Nei Hardt Laroca dos Santos ◽  
Cleudi Pereira ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Palliative Treatment ◽  
Refractory Epilepsy ◽  
Therapeutic Option ◽  
Treatment Objective

INTRODUCTION: Refractory epilepsy accounts for 20 to 30% of epilepsy cases and remains a challenge for neurologists. Vagus nerve stimulation (VNS) is an option for palliative treatment. OBJECTIVE: It was to study the efficacy and tolerability of VNS in patients implanted with a stimulator at the Curitiba Institute of Neurology (INC). METHODS: A case study of six patients with refractory epilepsy submitted to a VNS procedure at the INC in the last four years was described and discussed. RESULTS: Mean age at time of implantation was 29 years. Mean follow-up was 26.6 months. Seizure frequency decreased in all patients (40-50% (n=2) and >80% (n=4)). Three patients no longer required frequent hospitalizations. Two patients previously restricted to wheelchairs started to walk, probably because of improved mood. CONCLUSION: In this population, VNS proved to be a sound therapeutic option for treating refractory epilepsy.

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

2012 ◽  
Vol 32 (3) ◽  
pp. E12 ◽  
Author(s):  
David E. Connor ◽  
Menarvia Nixon ◽  
Anil Nanda ◽  
Bharat Guthikonda
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Epileptiform Activity ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Class I ◽  
Class Iii ◽  
Surgical Evaluation ◽  
Pediatric Populations ◽  
Medically Refractory Epilepsy

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.

Vagal nerve stimulation for medically refractory epilepsy in Angelman syndrome: a series of three cases

2018 ◽  
Vol 34 (3) ◽  
pp. 395-400
Author(s):  
Krystal L. Tomei ◽  
Christine Y. Mau ◽  
Michael Ghali ◽  
Jayoung Pak ◽  
Ira M. Goldstein
Keyword(s):  
Nerve Stimulation ◽  
Angelman Syndrome ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Medically Refractory Epilepsy

Effect of Vagal Nerve Stimulation on Systemic Inflammation and Cardiac Autonomic Function in Patients with Refractory Epilepsy

2007 ◽  
Vol 14 (6) ◽  
pp. 331-336 ◽  
Author(s):  
Lucy Barone ◽  
Gabriella Colicchio ◽  
Domenico Policicchio ◽  
Francesca Di Clemente ◽  
Antonio Di Monaco ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Nerve Stimulation ◽  
Autonomic Function ◽  
Refractory Epilepsy ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Cardiac Autonomic Function
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