Efficacy and Safety of Treatment with Transcutaneous Vagus Nerve Stimulation in 17 Patients with Refractory Epilepsy Evaluated by Electroencephalogram, Seizure Frequency, and Quality of Life

Abstract This trial was designed to test the safety and effectiveness of transcutaneous auricular vagus nerve stimulation (ta-VNS) for patients with refractory epilepsy. Pre-trial：144 patients were randomly assigned to ta-VNS group (n=98) or transcutaneous auricular non-vagus nerve stimulation (tn-VNS) control group (n=46). Treatment was conducted twice per day for 24 weeks. After 8, 16 and 24 weeks of treatment，the patients were evaluated according to the Modified Engel Scale (four classes). After 8 weeks，according to the medical ethic design, patients in tn-VNS group were switched into ta-VNS group uniquely. After 8 weeks’ treatment 41.0% and 27.5% of patients from ta-VNS and tn-VNS groups, respectively, experienced reduction in seizure frequency that reached I, II and III levels according to the standards of the Modified Engel Scale compared with the baselines, indicating significant difference in seizure reduction between the two groups. After 24 weeks of treatment, ta-VNS patients had a 47.7% reduction, and tn-VNS, with an additional 16 weeks of treatment, reached 47.5% in reduction. After 8 weeks’ treatment, the percentages of average seizure frequency in ta-VNS and tn-VNS were reduced by 42.6% and 11.5% respectively, providing a statistically significant difference in the results between the two groups (P<0.05). In addition, there were significant improvements in electroencephalograph (EEG) and the quality of daily life of the patients after treatment. The results show that this ta-VNS treatment can effectively reduce the frequency of seizures and improve the patient's quality of life. This may be an effective treatment for refractory epilepsy. At the same time，it is also safe，economic, and widely applicable.

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Vagus Nerve Stimulation in Patients With Refractory Epilepsy: a case series

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v28i04.1701 ◽

2019 ◽

Vol 28 (04) ◽

pp. 230-234

Author(s):

Bruno Toshio Takeshita ◽

Carolina Oldoni ◽

Rafaella Do Rosario Tacla ◽

Karina Slompo ◽

Camilla Von Steinkirch ◽

...

Keyword(s):

Quality Of Life ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Refractory Epilepsy ◽

Therapeutic Option ◽

Statistical Significance ◽

Case Series ◽

Attention And Memory

Approximately 33% of patients with epilepsy do not respond to treatment with a single antiepileptic drug. Many of these patients can benefit from neurosurgical treatment. However, not all patients are candidates for surgery, and in these cases vagus nerve stimulation (VNS) presents as a good therapeutic option. Objectives: Evaluation of efficiency, tolerability and safety in the control of seizures after VNS implantation in patients from a reference hospital. Methods: cross-sectional study examined 20 patients who underwent implantation of the VNS in our facilities between 2007 and 2014. Proportions and chi-square test were applied (statistical significance level set to p ≤ 0.05). Results: Mean follow-up was 31.3 months. Seizure frequency decreased in 55% of the patients. Among them, 11 patients believed that VNS had improved their quality of life. The mean reduction reported by other patients was 78.3%. More than 30% reported no adverse effects. About 70% of patients no longer required hospitalizations and 95% reported reduction in the number of hospitalizations. Conclusion: In this population, VNS proved to be a good option in the treatment of refractory epilepsy and also in providing a significant improvement in quality of life, (reduction of seizures and hospitalizations), mood, attention and memory, which directly reflects on their social and cognitive.

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The role of vagus nerve stimulation in the treatment of refractory epilepsy: clinical outcomes and impact on quality of life

Neurología (English Edition) ◽

10.1016/j.nrleng.2019.04.004 ◽

2021 ◽

Author(s):

C. Martorell-Llobregat ◽

P. González-López ◽

E. Luna ◽

M. Asensio-Asensio ◽

R. Jadraque-Rodríguez ◽

...

Keyword(s):

Quality Of Life ◽

Vagus Nerve ◽

Clinical Outcomes ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Refractory Epilepsy

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2013000100006 ◽

2013 ◽

Vol 71 (1) ◽

pp. 25-30 ◽

Cited By ~ 4

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.

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Non-invasive vagus nerve stimulation significantly improves quality of life in patients with persistent postural-perceptual dizziness

Journal of Neurology ◽

10.1007/s00415-018-8894-8 ◽

2018 ◽

Vol 265 (S1) ◽

pp. 63-69 ◽

Cited By ~ 7

Author(s):

Ozan E. Eren ◽

Filipp Filippopulos ◽

Kristina Sönmez ◽

Ken Möhwald ◽

Andreas Straube ◽

...

Keyword(s):

Quality Of Life ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Non Invasive

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Health Technology Assessment Report on Vagus Nerve Stimulation in Drug-Resistant Epilepsy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176150 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6150

Author(s):

Carlo Efisio Marras ◽

Gabriella Colicchio ◽

Luca De Palma ◽

Alessandro De Benedictis ◽

Giancarlo Di Gennaro ◽

...

Keyword(s):

Quality Of Life ◽

Health Technology Assessment ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Technology Assessment ◽

Vagus Nerve Stimulation ◽

Palliative Treatment ◽

Health Technology ◽

Drug Resistant

Background: Vagus nerve stimulation (VNS) is a palliative treatment for medical intractable epileptic syndromes not eligible for resective surgery. Health technology assessment (HTA) represents a modern approach to the analysis of technologies used for healthcare. The purpose of this study is to assess the clinical, organizational, financial, and economic impact of VNS therapy in drug-resistant epilepsies and to establish the congruity between costs incurred and health service reimbursement. Methods: The present study used an HTA approach. It is based on an extensive detailed bibliographic search on databases (Medline, Pubmed, Embase and Cochrane, sites of scientific societies and institutional sites). The HTA study includes the following issues: (a) social impact and costs of the disease; (b) VNS eligibility and clinical results; (c) quality of life (QoL) after VNS therapy; (d) economic impact and productivity regained after VNS; and (e) costs of VNS. Results: Literature data indicate VNS as an effective treatment with a potential positive impact on social aspects and on quality of life. The diagnosis-related group (DRG) financing, both on national and regional levels, does not cover the cost of the medical device. There was an evident insufficient coverage of the DRG compared to the full cost of implanting the device. Conclusions: VNS is a palliative treatment for reducing seizure frequency and intensity. Despite its economic cost, VNS should improve patients’ quality of life and reduce care needs.

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