FC34.2 Vagus nerve stimulation: Results after 6 years follow-up

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.

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Long term effect of vagus nerve stimulation in pediatric intractable epilepsy: an extended follow-up

Child s Nervous System ◽

10.1007/s00381-015-3004-z ◽

2016 ◽

Vol 32 (4) ◽

pp. 641-646 ◽

Cited By ~ 24

Author(s):

Ayse Serdaroglu ◽

Ebru Arhan ◽

Gökhan Kurt ◽

Atilla Erdem ◽

Tugba Hirfanoglu ◽

...

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Intractable Epilepsy ◽

Term Effect ◽

Long Term Effect

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Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320924361 ◽

2020 ◽

Vol 34 (7) ◽

pp. 609-615

Author(s):

Jesse Dawson ◽

Navzer D. Engineer ◽

Cecília N. Prudente ◽

David Pierce ◽

Gerard Francisco ◽

...

Keyword(s):

Ischemic Stroke ◽

Vagus Nerve ◽

Upper Limb ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Exercise Program ◽

Home Exercise ◽

Home Exercise Program

Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

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Follow - up of neuropediatric patients treated with vagus nerve stimulation

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.1922 ◽

2017 ◽

Vol 381 ◽

pp. 683

Author(s):

P.M. Preto Mimura ◽

I.B. Farias ◽

L. Seguti Ferreira ◽

A.L. Barbosa

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation

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Older Age and Longer Epilepsy Duration Do Not Predict Worse Seizure Reduction Outcome after Vagus Nerve Stimulation

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1607396 ◽

2017 ◽

Vol 79 (02) ◽

pp. 152-158 ◽

Cited By ~ 6

Author(s):

Jitka Kocvarova ◽

Zdenek Novak ◽

Irena Dolezalova ◽

Michal Svoboda ◽

Milan Brazdil ◽

...

Keyword(s):

Intellectual Disability ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Older Patients ◽

Age Groups ◽

Seizure Reduction ◽

Follow Up Care ◽

Patients With Epilepsy

Introduction We analyzed the results of vagus nerve stimulation (VNS) on older patients and patients with long-lasting epilepsy and included severely intellectually disabled patients. Patients and Methods A total of 103 adults with VNS implanted from 2005 to 2014 were studied. The responder rates, that is, the percentage of VNS patients who responded to VNS, classified as seizure reduction ≥ 50% (50R) and seizure reduction ≥ 90% (90R), were compared in defined age groups (< 40 and ≥ 40 years, and < 50 and ≥ 50 years) and epilepsy duration groups (< 20 and ≥ 20 years, < 30 and ≥ 30 years, and < 40 and ≥ 40 years) at the 1-year follow-up visit and the last follow-up visit (at least 2 years after surgery). The age distributions and responder rates were also studied in patients with an intellectual disability. Results The analysis did not confirm a significantly lower 50R or 90R rate in patients ≥ 40, ≥ 50, or ≥ 60 years when compared with their younger counterparts, but the 50R rate increase during follow-up care was the lowest in patients ≥ 50 and ≥ 60 years. The highest percentage of patients with an intellectual disability in the group < 40 years of age did not adversely affect the 50R rate. Longer epilepsy duration was not confirmed as a negative predictor of VNS outcome. There was a significantly higher 50R rate in patients with epilepsy duration ≥ 20 years (at the last follow-up visit) and a higher 90R rate in patients with epilepsy duration ≥ 30 years (at the 1-year follow-up visit). The increase in the 50R rate during follow-up care was lower in patients with epilepsy durations ≥ 30 and ≥ 40 years. Conclusions The study did not find worse VNS outcomes, as defined by the 50R or 90R rate, in older adult patients or in patients with a longer epilepsy duration. The increasing stimulation effect over time is less marked in older patients and in patients with longer epilepsy duration.

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Vagus Nerve Stimulation for Intractable Seizures: One Year Follow-Up

Journal of Neuroscience Nursing ◽

10.1097/01376517-199312000-00007 ◽

1993 ◽

Vol 25 (6) ◽

pp. 362-366 ◽

Cited By ~ 17

Author(s):

Janice E. Michael ◽

Karen Wegener ◽

Donald W. Barnes

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Intractable Seizures ◽

One Year

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A.6 Vagus Nerve Stimulation in patients with therapy resistant generalized epilepsy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.268 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S15-S15

Author(s):

AS Suller Marti ◽

SM Mirsattari ◽

KW MacDougall ◽

D Steven ◽

A Parrent ◽

...

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Hospital Admissions ◽

Focal Epilepsy ◽

Limited Information ◽

Best Response ◽

History Of ◽

Generalized Epilepsy

Background: For patients with generalized epilepsy who do not respond to anti-seizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox Gastaut Syndrome(LGS) and genetic generalized epilepsy(GGE). Methods: We identified patients with a diagnosis of Lennox-Gastaut Syndrome or Genetic Generalized Epilepsy, who underwent VNS implantation, between1997 and July 2018. Results: A total of 46 patients were included in this study with a history of therapy resistant generalized epilepsy. The mean age at implantation was 24 years(IQR= 17.8-31 years) and 50%(n=23) were female. The most common etiologies were GGE in 37%(n=17) and LGS in 63%(n=29). Median follow-up since VNS implantation was 63 months(IQR:31-112.8months). 41.7%(n=12) of the LGS group became responders, and 64.7%(n=11) in the GGE group. The best response in seizure reduction was seen in generalized tonic-clonic seizures. There was a reduction of seizure-related hospital admissions from 89.7%(N=26) pre-implantation, to 41.4%(N=12) post-implantation (p<0.0001). The frequency of side effects due to the stimulation was similar in both groups(62.1% in LGS and 61.1% in GGE). Conclusions: VNS is an effective treatment in patients with therapy resistant generalized epilepsy, especially GGE.

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10505 ◽

2011 ◽

Vol 7 (5) ◽

pp. 491-500 ◽

Cited By ~ 83

Author(s):

Robert E. Elliott ◽

Shaun D. Rodgers ◽

Luigi Bassani ◽

Amr Morsi ◽

Eric B. Geller ◽

...

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Senior Author ◽

Consecutive Series ◽

Older Children ◽

Treatment Resistant ◽

Off Label

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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