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Epilepsy vns

Hanne Schevernels, Marlies E van Bochove, Leen De Taeye, Klaas Bombeke, Kristl Vonck, Dirk Van Roost, Veerle De Herdt, Patrick Santens, Robrecht Raedt, C Nico Boehler
In the current study, we explored whether vagus nerve stimulation (VNS) in patients with epilepsy, which is believed to increase norepinephrine (NE) levels via activation of the locus coeruleus, would positively affect response inhibition. Moreover, we tried to identify the dynamics of the underlying neural processes by investigating event-related potentials (ERPs) and pupil size. Patients performed a stop-signal task once when stimulation was switched on and once when it was switched off. We found a correlational pattern suggesting that patients who clinically benefit more from VNS treatment also show a larger behavioral advantage, in terms of faster response inhibition, when the vagus nerve is being stimulated...
October 12, 2016: Epilepsy & Behavior: E&B
Alberto M Saibene, Elena Zambrelli, Carlotta Pipolo, Alberto Maccari, Giovanni Felisati, Elena Felisati, Francesca Furia, Aglaia Vignoli, Maria Paola Canevini, Enrico Alfonsi
Vagus nerve stimulation (VNS) is a useful tool for drug-resistant epilepsy, but it induces known laryngeal side effects, with a significant role on patients' quality of life. VNS patients may show persistent left vocal fold (LVF) palsy at rest and/or recurrent LVF adduction during stimulation. This study aims at electromyographically evaluating laryngeal muscles abnormalities in VNS patients. We compared endoscopic laryngeal evaluation data in six VNS patients with laryngeal muscle electromyography (LMEMG) carried out on the thyroarytenoid, cricothyroid, posterior cricoarytenoid, and cricopharyngeal muscles...
October 13, 2016: European Archives of Oto-rhino-laryngology
Barış Akdemir, David G Benditt
The vagus nerve is a major component of the autonomic nervous system and plays a critical role in many body functions including for example, speech, swallowing, heart rate and respiratory control, gastric secretion, and intestinal motility. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, with electrical stimulation being the most important. Implantable devices for VNS are approved therapy for refractory epilepsy and for treatment-resistant depression. In the case of heart disease applications, implantable VNS has been shown to be beneficial for treating heart failure in both preclinical and clinical studies...
October 2016: Anatolian Journal of Cardiology
Min-Jee Kim, Mi-Sun Yum, Eun-Hee Kim, Yun-Jeong Lee, Junkyo Lee, Seokho Hong, Su Jeong You, Yong Soon Hwang, Tae-Sung Ko
PURPOSE: This study aimed to evaluate the long-term efficacy of vagus nerve stimulation (VNS) in children and adolescents with intractable epilepsy and identify predictive factors for responsiveness to VNS. METHODS: Medical records of pediatric patients who underwent VNS implantation at two Korean tertiary centers were reviewed. At 0.5, 1, 3, and 5 years post-VNS implantation, the frequency of the most disabling seizures in each patient was assessed. Responders were defined as showing an overall 50 % reduction from baseline seizure frequency during follow-up...
October 6, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Simon Wostyn, Willeke Staljanssens, Leen De Taeye, Gregor Strobbe, Stefanie Gadeyne, Dirk Van Roost, Robrecht Raedt, Kristl Vonck, Pieter van Mierlo
The mechanism of action of vagus nerve stimulation (VNS) is yet to be elucidated. To that end, the effects of VNS on the brain of epileptic patients were studied. Both when VNS was switched "On" and "Off", the brain activity of responders (R, seizure frequency reduction of over 50%) was compared to the brain activity of nonresponders (NR, seizure frequency reduction of less than 50%). Using EEG recordings, a significant increase in P300 amplitude for R and a significant decrease in P300 amplitude for NR were found...
July 11, 2016: International Journal of Neural Systems
Poul Jennum, Anne Sabers, Jakob Christensen, Rikke Ibsen, Jakob Kjellberg
PURPOSE: We aimed to determine the health costs and social outcomes in terms of education, employment and income level after insertion of a vagus nerve stimulator (VNS) in patients with epilepsy. METHODS: This is a case-control study using Danish health care and socioeconomic register data. The analysis of the effect involved a comparison of the health care costs, occupation and income status of VNS-treated epilepsy patients with those of a control group of epilepsy patients who had a VNS implanted during the 12 months before the index date (pre-period) and during the two years after the index date (post-period)...
September 13, 2016: Seizure: the Journal of the British Epilepsy Association
Aria Fallah, Alexander G Weil, Shelly Wang, Evan Lewis, Christine B Baca, Gary W Mathern
BACKGROUND: The management of drug-resistant epilepsy in children with Tuberous Sclerosis Complex (TSC) is challenging because of the multitude of treatment options, wide range of associated costs, and uncertainty of seizure outcomes. The most cost-effective approach for children whose epilepsy has failed to improve with first-line medical therapy is uncertain. METHODS: A review of MEDLINE from 1990 to 2015 was conducted. A cost-utility analysis, from a third-party payer perspective, was performed for children with drug-resistant epilepsy that had failed to improve with 2 antiseizure drugs (ASDs) and that was amenable to resective epilepsy surgery, across a time-horizon of 5years...
October 2016: Epilepsy & Behavior: E&B
Inuka Kishara Gooneratne, Alexander L Green, Patricia Dugan, Arjune Sen, Angelo Franzini, Tipu Aziz, Binith Cheeran
For patients with pharmacoresistant focal epilepsy in whom surgical resection of the epileptogenic focus fails or was not feasible in the first place, there were few therapeutic options. Increasingly, neurostimulation provides an alternative treatment strategy for these patients. Vagal nerve stimulation (VNS) is well established. Deep brain stimulation (DBS) and cortical responsive stimulation (CRS) are newer neurostimulation therapies with recently published long-term efficacy and safety data. In this literature review, we introduce these therapies to a non-specialist audience...
November 2016: Journal of Neurology, Neurosurgery, and Psychiatry
Fabrice Bartolomei, Francesca Bonini, Elsa Vidal, Agnes Trébuchon, Stanislas Lagarde, Isabelle Lambert, Aileen McGonigal, Didier Scavarda, Romain Carron, Christian G Benar
An effect of vagal nerve stimulation (VNS) on cortical synchronization has been postulated but remains to be verified. In this study we investigated the impact of VNS on functional connectivity (Fc) using direct intracerebral recordings (stereotactic EEG, SEEG). Five patients with epilepsy who underwent SEEG recordings during ongoing VNS therapy were investigated. Interdependencies between twenty-six selected bipolar SEEG channels were estimated by nonlinear regression analysis during ON and OF periods of stimulation...
October 2016: Epilepsy Research
Jeffrey E Arle, Kristen W Carlson, Longzhi Mei
OBJECTIVE: While the efficacy of vagus nerve stimulation (VNS) to reduce seizures in pharmaco-resistant patients is clinically proven, its efficacy and side effects mechanisms are not fully understood. Our goals were 1) to use a finite element model (FEM) and axon models to examine different fiber activation and blocking thresholds and 2) examine fiber activation and blocking in three fiber groups likely to be responsible for efficacy and side effects. METHODS: Using FEM, we examined the field potential along axons within a vagus nerve model with fascicles...
October 2016: Epilepsy Research
Brian J Dlouhy, Brandon Miller, Anna Jeong, Mary E Bertrand, David D Limbrick, Matthew D Smyth
PURPOSE: Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is a rare genetic disorder that results in severe childhood-onset epilepsy. Children with DS initially present with seizures in the first year of life that are often associated with fevers. With age, multiple seizure types develop. There are few reports and no guidelines regarding palliative surgical treatment for DS. Therefore, we reviewed our surgical experience with DS. METHODS: We conducted a retrospective review of all patients with genetically confirmed DS who underwent either vagal nerve stimulator (VNS) implantation or corpus callosotomy (CC) from May 2001 to April 2014 at our institution...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Richard L Verrier, Bruce D Nearing, Bryan Olin, Paul Boon, Steven C Schachter
OBJECTIVE: Reports of cardiac arrhythmias and cardiac pathology at postmortem examination of patients with epilepsy suggest a possible cardiac component of risk for sudden unexpected death in epilepsy (SUDEP). T-wave alternans (TWA) is an established marker of cardiac electrical instability and risk for sudden death in patients with cardiovascular disease. We determined the TWA level before vagus nerve stimulation (VNS) system implantation and subsequently the effect of VNS on TWA in patients with drug-resistant epilepsy...
September 2016: Epilepsy & Behavior: E&B
Hossein Pakdaman, Ali Amini Harandi, Mehdi Abbasi, Mohammad Karimi, Mohammad Ali Arami, Seyed Ali Mosavi, Karim Haddadian, Omidvar Rezaei, Sohrab Sadeghi, Guive Sharifi, Koroush Gharagozli, Parviz Bahrami, Farzad Ashrafi, Hosein Delavar Kasmae, Amirhossein Ghassemi, Mehran Arabahmadi, Behdad Behnam
Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy...
July 11, 2016: Neurological Sciences
Elena Jiltsova, Timo Möttönen, Markus Fahlström, Joonas Haapasalo, Timo Tähtinen, Jukka Peltola, Juha Öhman, Elna-Marie Larsson, Tommi Kiekara, Kai Lehtimäki
BACKGROUND: Deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) is an evolving treatment option in refractory focal epilepsy. Due to poor visualization of ANT in traditional MRI sequences used for movement disorder surgery, targeting of ANT is mainly based on stereotactic atlas information. Sophisticated 3T MRI methods enable visualization of ANT, but 1.5T MRI is still preferred or more readily available in a large number of centers performing DBS. OBJECTIVE: In the present study, we sought to determine whether ANT could be adequately visualized at 1...
July 11, 2016: Neuromodulation: Journal of the International Neuromodulation Society
David Guiraud, David Andreu, Stéphane Bonnet, Guy Carrault, Pascal Couderc, Albert Hagège, Christine Henry, Alfredo Hernandez, Nicole Karam, Virginie Le Rolle, Philippe Mabo, Paweł Maciejasz, Charles-Henri Malbert, Eloi Marijon, Sandrine Maubert, Chloé Picq, Olivier Rossel, Jean-Luc Bonnet
OBJECTIVE: Neural signals along the vagus nerve (VN) drive many somatic and autonomic functions. The clinical interest of VN stimulation (VNS) is thus potentially huge and has already been demonstrated in epilepsy. However, side effects are often elicited, in addition to the targeted neuromodulation. APPROACH: This review examines the state of the art of VNS applied to two emerging modulations of autonomic function: heart failure and obesity, especially morbid obesity...
August 2016: Journal of Neural Engineering
G C Hotan, A F Struck, M T Bianchi, E N Eskandar, A J Cole, M B Westover
PURPOSE: Up to one third of epilepsy patients develop pharmacoresistant seizures and many benefit from resective surgery. However, patients with non-lesional focal epilepsy often require intracranial monitoring to localize the seizure focus. Intracranial monitoring carries operative morbidity risk and does not always succeed in localizing the seizures, making the benefit of this approach less certain. We performed a decision analysis comparing three strategies for patients with non-lesional focal epilepsy: (1) intracranial monitoring, (2) vagal nerve stimulator (VNS) implantation and (3) medical management to determine which strategy maximizes the expected quality-adjusted life years (QALYs) for our base cases...
August 2016: Seizure: the Journal of the British Epilepsy Association
Markus Gschwind, Margitta Seeck
Complete seizure control is achieved in 40-50% of all epileptic patients with drug treatment, as reported in most epidemiological studies. Many effective antiepileptic drugs with a favourable profile are available in Switzerland, allowing treatment tailored to the patient's needs. Unfortunately, up to 40-50% of all patients will eventually relapse (pharmacoresistant epilepsy). These patients run a high risk of additional morbidity and mortality. Possible pharmacoresistant epilepsy should be considered early in the disease, when there is a lack of response to the first antiepileptic drug, since only 14% of those will respond to a second drug, and only 2% to a third drug if the second fails too...
2016: Swiss Medical Weekly
Riëm El Tahry, Martin Hirsch, Kenou Van Rijckevorsel, Susana Ferrao Santos, Marianne de Tourtchaninoff, Herbert Rooijakkers, Volker Coenen, Andreas Schulze-Bonhage
Many epilepsy patients treated with vagus nerve stimulation additionally use an "on-demand" function, triggering an extra stimulation to terminate a seizure or diminish its severity. Nevertheless, a substantial number of patients are not able to actively trigger stimulations by use of a magnet, due to the absence of an aura or inability for voluntary actions in the early phase of a seizure. To address this need, a novel implantable pulse generator, the AspireSR VNS system, was developed to provide automated ictal stimulation triggered by a seizure-detecting algorithm...
June 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
C Champeaux, C Marchal, L Valton
BACKGROUND: Vagus nerve stimulation is an adjunctive palliative therapy for refractory epilepsy. MATERIAL AND METHODS: We reviewed the clinical and surgical records of patients who had a VNS implantation for intractable epilepsy between the years 1999 and 2010 at two institutions, Bordeaux and Toulouse University Hospitals. RESULTS: A total of 101 patients were included of whom 57 were male. Median age at epilepsy onset was 7.5 years, inter quartile range (IQR) [2...
June 2016: Neuro-Chirurgie
Steven W Lee, Qinglu Li, Imad Libbus, Xueyi Xie, Bruce H KenKnight, Mary G Garry, Elena G Tolkacheva
Cardiovascular disease degrades the regulatory function of the autonomic nervous system. Cyclic vagus nerve stimulation (VNS) is an already FDA-approved therapy for drug-resistant epilepsy and depression, and has been shown to normalize autonomic function and improve objective measures of heart function and subjective measures of heart failure symptoms. However, it remains unclear whether VNS may induce negative effects in patients with potentially healthy hearts where VNS can be used for epileptic patients...
May 2016: Physiological Reports
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