Treatment of Medically Refractory Epilepsy: A Review Of Vagus Nerve Stimulator

Background: Septo-Optic Dysplasia is a rare disorder with developmental malformations that was first reported by De Morsier.SOD associated with refractory epilepsy has not been well studied. We report six cases with SOD in patients with malformation of cortical development(MCD) and medically refractory epilepsy that underwent video-EEG telemetry. Methods: Six cases of SOD plus were admitted to the Epilepsy Monitoring Unit at London Health Sciences Centre because of medically refractory epilepsy. Functional hemispherectomy in one patient resulted in significant reduction of her seizures while insertion of a vagus nerve stimulator was not successful in controlling seizures in another patient. Right temporal resection for one patient resulted in about 60% reduction in her seizures. The remaining three patients were not surgical candidates and they remained on antiepileptic drugs. Results: MCD was present in 4/6 patients. Bilateral optic nerve hypoplasia was found in 50% of the patients. EEG was abnormal in all cases(6/6).Intractable epilepsy was found in 6/6 patients. Conclusions: SOD plus was associated with medically refractory epilepsy.

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Vagus Nerve Stimulator: A Breakthrough for Refractory Epilepsy in Pakistan

Pakistan Journal of Medicine and Dentistry ◽

10.36283/pjmd10-4/019 ◽

2021 ◽

Keyword(s):

Vagus Nerve ◽

Refractory Epilepsy ◽

Nerve Stimulator ◽

Vagus Nerve Stimulator

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Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130116 ◽

2013 ◽

Vol 71 (11) ◽

pp. 902-906 ◽

Cited By ~ 6

Author(s):

Vera C Terra ◽

Ricardo Amorim ◽

Carlos Silvado ◽

Andrea Juliao de Oliveira ◽

Carmen Lisa Jorge ◽

...

Keyword(s):

Refractory Epilepsy ◽

Palliative Surgery ◽

Nerve Stimulator ◽

Neurologic Disorder ◽

Palliative Procedure ◽

Spontaneous Seizures ◽

Vagus Nerve Stimulator ◽

Low Incidence ◽

Patients With Epilepsy ◽

Medically Refractory Epilepsy

Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects. In this paper we discuss the recommendations for VNS use as suggested by the Brazilian League of Epilepsy and the Scientific Department of Epilepsy of the Brazilian Academy of Neurology Committee of Neuromodulation.

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Complete removal of vagus nerve stimulator generator and electrodes

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.9.peds0810 ◽

2010 ◽

Vol 5 (2) ◽

pp. 191-194 ◽

Cited By ~ 14

Author(s):

Martin Ortler ◽

Claudia Unterhofer ◽

Judith Dobesberger ◽

Edda Haberlandt ◽

Eugen Trinka

Keyword(s):

Vagus Nerve ◽

Vagus Nerve Stimulation ◽

Palliative Treatment ◽

Refractory Epilepsy ◽

Complete Removal ◽

Nerve Stimulator ◽

Left Behind ◽

Vocal Cord Paresis ◽

Vagus Nerve Stimulator ◽

Microsurgical Techniques

Vagus nerve stimulation has become widely used in the palliative treatment of refractory epilepsy. Removal of a vagus nerve stimulator may be desirable or even necessary due to lack of efficacy, intolerable side effects, signs of infection, or failure of the device. Unless the lead or the helical electrodes are defective, only the generator is explanted and the electrodes are usually left behind for fear of damaging nerve or surrounding structures. The authors review their experience with complete removal of the stimulating electrodes and pacemaker-like generator device in 9 consecutive patients, 3 of whom were children. Using microsurgical techniques, the authors were able to completely remove the stimulator, including electrodes in all patients. All nerves remained morphologically intact. One case of temporary and one of permanent clinically silent ipsilateral vocal cord paresis were observed.

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