Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials

2012 ◽  
Vol 32 (3) ◽  
pp. E14 ◽  
Author(s):  
John D. Rolston ◽  
Dario J. Englot ◽  
Doris D. Wang ◽  
Tina Shih ◽  
Edward F. Chang
Keyword(s):  
Vagus Nerve ◽  
Vagus Nerve Stimulation ◽  
Randomized Trials ◽  
Seizure Control ◽  
Partial Epilepsy ◽  
Anterior Nucleus ◽  
Randomized Controlled ◽  
Positive Results ◽  
Deep Brain ◽  
Stimulation Of

Epilepsy is a devastating disease, often refractory to medication and not amenable to resective surgery. For patients whose seizures continue despite the best medical and surgical therapy, 3 stimulation-based therapies have demonstrated positive results in prospective randomized trials: vagus nerve stimulation, deep brain stimulation of the thalamic anterior nucleus, and responsive neurostimulation. All 3 neuromodulatory therapies offer significant reductions in seizure frequency for patients with partial epilepsy. A direct comparison of trial results, however, reveals important differences among outcomes and surgical risk between devices. The authors review published results from these pivotal trials and highlight important differences between the trials and devices and their application in clinical use.

Vagus nerve stimulation for partial and generalized epilepsy from infancy to adolescence

2012 ◽  
Vol 10 (3) ◽  
pp. 200-205 ◽  
Author(s):  
Eric M. Thompson ◽  
Susan E. Wozniak ◽  
Colin M. Roberts ◽  
Amy Kao ◽  
Valerie C. Anderson ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Pediatric Patients ◽  
Medication Use ◽  
Partial Epilepsy ◽  
Seizure Duration ◽  
Antiepileptic Medication ◽  
Generalized Epilepsy

Object Vagus nerve stimulation (VNS) is approved by the FDA for the treatment of partial epilepsy in patients older than 12 years. Authors of the current study performed a large retrospective analysis and comparison of VNS outcomes in children with an age ≥ and < 12 years, including those with partial and generalized epilepsy. Methods A retrospective review of the records of pediatric patients (age < 18 years) who had undergone primary VNS system implantation between 2001 and 2010 by a single pediatric neurosurgeon was undertaken. Considered data included demographics, epilepsy type (partial vs generalized), seizure frequency, seizure duration, postictal period duration, and antiepileptic medication use. Results One hundred forty-six patients (49% female) were followed up for a mean of 41 months after VNS implantation. Thirty-two percent of patients had partial epilepsy and 68% had generalized epilepsy. After VNS system implantation, seizure frequency was reduced in 91% of patients, seizure duration in 50%, postictal period in 49%, and antiepileptic medication use in 75%. There was no significant difference in age, sex, or duration of follow-up according to epilepsy type. Neither was there any significant difference in seizure frequency reduction, seizure duration, postictal period, medication use, overall clinical improvement, or improvement in quality of life based on an age ≥ or < 12 years or epilepsy type. Conclusions Vagus nerve stimulation reduced both seizure frequency and antiepileptic medication use in the majority of pediatric patients regardless of sex, age cohort, or epilepsy type. Vagus nerve stimulation also reduced seizure duration and postictal period in approximately half of the pediatric patients. Contrary to expectation, children with partial epilepsy do not benefit from VNS at higher rates than those with generalized epilepsy.

Vagus nerve stimulation therapy in partial epilepsy: a review

2016 ◽  
Vol 116 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Mariangela Panebianco ◽  
Chiara Zavanone ◽  
Sophie Dupont ◽  
Domenico A. Restivo ◽  
Antonino Pavone
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Partial Epilepsy

scholarly journals Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

2018 ◽  
Vol 45 (2) ◽  
pp. E5 ◽  
Author(s):  
James J. Zhou ◽  
Tsinsue Chen ◽  
S. Harrison Farber ◽  
Andrew G. Shetter ◽  
Francisco A. Ponce
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Refractory Epilepsy ◽  
Open Loop ◽  
Electric Stimulation Therapy ◽  
Anterior Nucleus ◽  
The Past ◽  
Centromedian Nucleus ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVEThe field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present).METHODSA PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: (“epilepsy” [MeSH] OR “seizures” [MeSH] OR “kindling, neurologic” [MeSH] OR epilep* OR seizure* OR convuls*) AND (“deep brain stimulation” [MeSH] OR “deep brain stimulation” OR “DBS”) OR (“electric stimulation therapy” [MeSH] OR “electric stimulation therapy” OR “implantable neurostimulators” [MeSH]).RESULTSThe authors identified 41 studies that met the criteria for inclusion. The anterior nucleus of the thalamus, centromedian nucleus of the thalamus, and hippocampus were the most frequently evaluated targets. Among the 41 articles, 19 reported on stimulation of the anterior nucleus of the thalamus, 6 evaluated stimulation of the centromedian nucleus of the thalamus, and 9 evaluated stimulation of the hippocampus. The remaining 7 articles reported on the evaluation of alternative DBS targets, including the posterior hypothalamus, subthalamic nucleus, ventral intermediate nucleus of the thalamus, nucleus accumbens, caudal zone incerta, mammillothalamic tract, and fornix. The authors evaluated each study for overall epilepsy response rates as well as adverse events and other significant, nonepilepsy outcomes.CONCLUSIONSLevel I evidence supports the safety and efficacy of stimulating the anterior nucleus of the thalamus and the hippocampus for the treatment of medically refractory epilepsy. Level III and IV evidence supports stimulation of other targets for epilepsy. Ongoing research into the efficacy, adverse effects, and mechanisms of open-loop DBS continues to expand the knowledge supporting the use of these treatment modalities in patients with refractory epilepsy.

scholarly journals Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

2018 ◽  
Vol 42 (2) ◽  
pp. 287-296 ◽  
Author(s):  
Tim A. M. Bouwens van der Vlis ◽  
Olaf E. M. G. Schijns ◽  
Frédéric L. W. V. J. Schaper ◽  
Govert Hoogland ◽  
Pieter Kubben ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Anterior Nucleus ◽  
Drug Resistant Epilepsy ◽  
Deep Brain ◽  
Stimulation Of
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