Preview

Epilepsy and paroxysmal conditions

Advanced search

Efficacy and safety of vagal nerve stimulation in patients with pharmacoresistant epilepsy

https://doi.org/10.17749/2077-8333.2019.11.1.27-36

Full Text:

Abstract

Stimulation of the vagal nerve is an effective treatment option in patients with pharmacoresistant epilepsy. Objective: to analyze the efficacy and safety of the Vagal Nerve Stimulation (VNS) procedure in patients suffering from pharmacoresistant epilepsy. Materials and Methods: The study included 13 patients with pharmacoresistant epilepsy, aged 5 to 38 years. Results: among these patients, 25% reported a decrease in the number of epileptic seizures within one-month time after the first session of VNS. The efficacy of the treatment improved with a prolonged use of the VNS-therapy. Despite the long duration of the current pharmacoresistant form of epilepsy in most patients, a decrease in the severity of epileptic seizures and post-seizure disorientation was noted. Side effects of VNS-therapy were recorded in 38.5% of patients; in those, a correction of VNS parameters was performed. This approach allowed us to maintain the effective VNS-therapy and correct the arising side effects. Conclusion: vagal stimulation is an effective non-pharmacological option in patients with pharmacoresistant therapy who have contraindications for surgical treatment. The VNS-therapy reduces the occurrence rate of epileptic seizures by >50% in 20-50% of patients. The VNS therapy has a good long-term efficacy in patients of any age. Stimulation of the vagal nerve is usually well tolerated.

About the Authors

I. G. Areshkina
Voino-Yasenetskii Krasnoyarsk State Medical University
Russian Federation

MD, PhD Student, Assistant at the Department of Medical Genetics and Clinical Neurophysiology, IPO

Author ID (SCOPUS) 55413907300

1 Partizana Zheleznyaka Str., Krasnoyarsk 660022, Russia



D. V. Dmitrenko
Voino-Yasenetskii Krasnoyarsk State Medical University
Russian Federation

MD, PhD, Head of the Neurological Center for Epileptology and Neurogenetics, University Hospital; Head of the Department of Medical Genetics and Clinical Neurophysiology, IPO

1 Partizana Zheleznyaka Str., Krasnoyarsk 660022, Russia



N. A. Shnayder
Bechterev National Medical Research Center of Psychiatry and Neurology
Russian Federation

MD, PhD, Professor, Leading Scientific Officer, Department of Neurology and Personal Psychiatric Care

Elibrary ID: 185359; SPIN-код: 6517-0279; Researcher ID: M-7084-2014; Scopus ID: 24503222300

3 Bechterev Str., St Petersburg, 192019, Russia



E. A. Narodova
Voino-Yasenetskii Krasnoyarsk State Medical University
Russian Federation

MD, PhD, Assistant at the Department of Nervous Diseases and Medical Rehabilitation

Scopus ID: 57203353014

1 Partizana Zheleznyaka Str., Krasnoyarsk 660022, Russia



References

1. Gusev E.I., Gekht A. B., Hauzer V. I. Epidemiology of epilepsy in the Russian Federation. Modern epileptology. Proceedings of the International Conference. Saint Petersburg, 23-25 May 2011. (in Russian).

2. Hauser W. A. The descriptive epidemiology of epilepsy. Comprehensive epileptology. Proceedings of the conference Saint Petersburg. May 2011; 23-25.

3. Karlov V. A. Epilepsiya u detey i vzroslykh. zhenshchin i muzhchin. Moscow. 2010; 518-526, 707-717. (in Russian).

4. Spencer D. D., Nguyen D. K., Sivaraju A. Invasive EEG in presurgical evaluation of epilepsy. In: Shorvon S., Perucca E., Engel J. Jr, eds. The treatment of epilepsy, 4th edn. Oxford: John Wiley & Sons. 2015; 733-55.

5. Kuba R., Brazdil M., Kalina M., Prochazka T., Hovorka J., Nezadal T., et al. Vagus nerve stimulation: longitudinal follow-up of patients treated for 5 years. Seizure. 2008; 18: 269-74.

6. Van Ness P. C. Therapy for the epilepsies. Arch. Neurol. 2002; 59: 732-735

7. Binnie C. D. Vagus nerve stimulation for epilepsy: a review. Seizure. 2000; 9 (3): 161-169.

8. Wheless J. W., Maggio V. Vagus nerve stimulation therapy in patients younger than 18 years. Neurology. 2002; 59 (4): 21-25.

9. Bailey P, Bremer F. A sensory cortical representation of the vagus nerve: with a note on the effects of low blood pressure on the cortical electrogram. J Neurophysiol. 1938; 1: 405-12.

10. Shahwan A., Bailey C., Maxiner W., Harvey A. S. Vagus nerve stimulation for refractory epilepsy in children: More to VNS then seizure frequency reduction. Epilepsia. 2009; Sept., 50 (5): 1220-1228.

11. Rutecki P. Anatomical, physiological, and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia. 1990; 31 (2): 1-6.

12. Naritoku D. K., Terry W. J., Helfert R. W. Regional induction of fosimmunoreactivity in the brain by anticonvulsant stimulation of the vagus nerve. Epilepsy Res. 1995; 22: 53-62.

13. Amar A. P., Elder J. B., Apuzzo M. L.J. Vagal Nerve Stimulation for Seizures. Textbook of Stereotactic and Functional Neurosurgery. Ed. by A. M. Lozano, P. L. Gildenberg, R. R. Tasker. Springer, 2009; 2801-2822.

14. Zabara J. Inhibition of experimental seizures in canines by repetitive vagal stimulation. Epilepsia. 1992; 33 1005-1012.

15. Englot D. J., Chang E. F., Auguste K. I. Efficacy of vagus nerve stimulation for epilepsy by patient age, epilepsy duration, and seizure type. Neurosurg Clin N Am. 2011; 22: 443-8.

16. Kuba R., Brazdil M., Novak Z., Chrastina J., Rektor I. Effect of vagal nerve stimulation on patients with bitemporal epilepsy. Eur J Neurol. 2003; 10: 91-4.

17. Baaj A. A., Benbadis S. R., Tatum W. O., Vale F. L. Trends in the use of vagus nerve stimulation for epilepsy: analysis of a nationwide database. Neurosurg Focus. 2008; 25: E10.

18. O’Reardon J.P., Cristancho P., Peshek A. D. Vagus nerve stimulation (VNS) and treatment of depression: to the brainstemand beyond. Psychiatry. May 2006; 3 (5): 54-63.

19. Alexopoulos A. V., Kotagal P., Loddenkemper T., et al. Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure. Oct 2006; 15 (7): 491-503.

20. Blount J. P., Tubbs R. S., Kankirawatana P. Vagus nerve stimulation in children less than 5 years old. Childs Nerv. Syst. 2006; 22: 1167-1169.

21. Amar A. P., Levy M. L., Mc Comb J. G., Apuzzo M. L.J. Vagus nerve stimulation for control of intractable seizures in childhood. Pediat. Neurosurg. 2001; 34: 218-223.

22. Binks A. P., Paydarfar D., Schachter S. C., et al. High strength stimulation of the vagus nerve in awake humans: a lack of cardiorespiratory effects. Respir Physiol Sep. 2001; 127 (2-3): 125-33.

23. Shaffer M. J., Jakson C. E., Szabo C. A., Vagal nerve stimulation: clinical and electrophysiological effect on vocal fold function. Ann Otol Rhinol Laryngol. Jan 2005; 114 (1 Pt 1): 7-14.

24. Tubbs R. S., Killingsworth C. R., Rollins D. L., Smith W. M., Ideker R. E., Wellons J. C., Vagus nerve stimulation for induced spinal cord seizures: Insights into seizure cessation. J Neurosurg. 2005; 102: 213-7.

25. Elliott R. E., Morsi A., Geller E. B., Carlson C. C., Devinsky O., Doyle W. K. Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent. Vagus Nerve Stimulation. Neurosurgery. 2011; 69: 1210-1217.

26. Elliott R. E., Morsi A., Tanweer O., Grobelny B., Geller E., Carlson C., Devinsky O., Doyle W. K. Efficacy of vagus nerve stimulation over time: Review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS >10years. Epilepsy & Behavior. 2011; 20 (3): 478-483.

27. Spanaki M. V., Allen L. S., Mueller W. M., Morris III G.L. Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center. Seizure. 2004; 13 (8): 587-90.

28. Labar D. Vagus nerve stimulation for 1 year in 269 patients on unchanged antiepileptic drugs. Seizure. 2004; 13: 392-8.

29. Ben-Menachem E., Manon-Espaillat R., Ristanovic R., Vagus nerve stimulation for treatment of partial seizures. 1. A controlled study of effect on seizures. First International Vagus Nerve Study Group. Epilepsia. 1994; 35: 616-26.

30. Handforth A., DeGiorgio C.M., Schachter S. C., Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998; 51: 48-55.

31. George RVNSSG, for the Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 1995; 45: 224-30.

32. Morris G. L., Mueller W. M. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. Neurology. 1999; 53: 1731-1735.

33. Gigliotti M. J., Mao G., Dupre´ D.A., Wilberger J. Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy world neurosurgery 120: e1047-e1053, december 2018.

34. Casazza M., Avanzini G., Ferroli P., et al, Vagal nerve stimulation: relationship between outcome and electroclinical seizure pattern. Seizure. 2006; 15 (3): 198-207.

35. Wasade V. S., Schultz L., Mohanarangan K., Gaddam A., Schwalb J. M., Spanaki-Varelas M. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy. Epilepsy & Behavior. 2015; 53: 31-36.

36. Ben-Menachem E., Hellstrom K., Waldton C., Augustinsson L. E. Evaluation of refractory epilepsy treated with vagus nerve stimulation for up to 5 years. Neurology. 1999; 52: 1265-7.

37. Heck C., Helmers S. L., DeGiorgio C. M. Vagus nerve stimulation therapy, epilepsy, and device parameters: scientific basis and recommendations for use. Neurology. 2002; 59 (6 Suppl 4): 31-7.

38. Morris G. L., Gloss D., Buchhalter J., Mack K. J., Nickels K., Harden C. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; 81 (16): 1453-9.

39. Labar D. R. Antiepileptic drug use during the first 12 months of vagus nerve stimulation therapy: a registry study. Neurology. 2002; 59 (6 Suppl 4): 38-43.

40. Amar A. P., Apuzzo M. L., Liu C. Y. Vagus nerve stimulation therapy after failed cranial surgery for intractable epilepsy: results from the Vagus Nerve Stimulation Therapy Patient Outcome Registry. Neurosurgery. 2004; 55: 1086-93.

41. Soleman J., Stein M., Knorr C., Datta A. N., Constantini S., Fried I., Guzman R., Kramer U. Improved quality of life and cognition after early vagal nerve stimulator implantation in children. Epilepsy & Behavior. 2018;88: 139-145.

42. Horowitz G., Amit M., Fried I., Neufeld M. Y., Sharf L., Kramer U. Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center. Eur Arch Otorhirolaryngol. 2012; 270: 355-358.

43. Elliott R. E., Morsi A., Kalhorn S. P., Marcus J., Sellin J., Kang M., Silverberg A., Rivera E., Geller E., Carlson C., Devinsky O., Doyle W. K. Vagus nerve stimulation in 436 consecutive patients with treatment-resistantepilepsy: Long-term outcomes and predictors of response Vagus nerve stimulation in 436 consecutive patients with treatment-resistantepilepsy: Long-term outcomes and predictors of response. Epilepsy & Behavior. 2011; 20: 57-63.

44. Giordano F., Zicca A., Barba C., Guerrini R., Genitori L. Vagus nerve stimulation: surgical technique of implantation and revision and related morbidity. Epilepsia. 2017; 58: 85-90.

45. Hilderinka J., Tjepkema-Cloostermansa M.C., Geertsemab A., Glastra-Zwiersb J., de Vosa C. C. Predicting success of vagus nerve stimulation (VNS) from EEG symmetry. Seizure. 48; 2017: 69-73.

46. Kersing W., Dejonckere P. H., van der Aa H. E. Laryngeal and vocal changes during vagus nerve stimulation in epileptic patients. J Voice Jun. 2002; 16 (2): 251-7.

47. Dominik Z., Daniel J., Heinz G. W. Vocal cord adduction during vagus nerve stimulation for treatment of epilepsy. Neurology. 2000 March 28; 54 (6): 1388-9.

48. Banzett R. B., Guz A., Paydarfar D., Shea S. A., Schachter S. C., Lansing R. W. Cardiorespiratory variables and sensation during stimulation of the left vagus in patients with epilepsy. Epilepsy Res. 1999; 35: 1-11.

49. Milby A. H., Halpern C. H., Baltuch G. H. Vagus nerve stimulation in the treatment of refractory epilepsy. Neurotherapeutics. 2009 Apr; 6 (2): 228-37.

50. Malow B. A., Edwards J., Marzec M., Sagher O., Fromes G. Effects of vagus nerve stimulation on respiration during sleep: a pilot study. Neurology. 2000; 55: 1450-4.

51. Papacostas S. S., Myrianthopoulou P., Dietis A., Papathanasiou E. S. Induction of central-type sleep apnea by vagus nerve stimulation. Electromyogr Clin Neurophysiol. 2007; 47: 61-3.

52. Couch J. D., Gilman A. M., Doyle W. K. Long-term expectations of vagusnerve stimulation: a look at battery replacement and revision surgery. Neurosurgery. 2016; 78: 42-46.

53. Revesz D., Rydenhag B., Ben-Menachem E. Complications and safetyof vagus nerve stimulation: 25 years of experience at a single center. JNeurosurg Pediatr. 2016; 18: 97-104.

54. Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet neurol. 2002; 1: 477-482.


For citation:


Areshkina I.G., Dmitrenko D.V., Shnayder N.A., Narodova E.A. Efficacy and safety of vagal nerve stimulation in patients with pharmacoresistant epilepsy. Epilepsy and paroxysmal conditions. 2019;11(1):27-36. (In Russ.) https://doi.org/10.17749/2077-8333.2019.11.1.27-36

Views: 70


ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)