Role of vagus nerve stimulation in epilepsy
DOI:
https://doi.org/10.12775/QS.2024.18.53950Keywords
epilepsy, vagus nerve, VNS, seizuresAbstract
Introduction and purpose:
Epilepsy affects 1% globally, with 2.6 to 6 million cases in Europe. 30-40% of the 50 million epilepsy patients globally don't respond to drugs. For those ineligible for surgery, Vagus Nerve Stimulation (VNS) therapy offers an alternative for drug-resistant epilepsy and major depression.
A brief description of the state of knowledge:
Vagus Nerve Stimulation (VNS) is a modern therapy using implanted or non-invasive devices to regulate nerve activity with controlled electrical impulses. Vagus Nerve Stimulation (VNS) is effective for focal seizures, including simple partial seizures and auras. It also shows promise in reducing seizures in generalized tonic-clonic seizures and benefits patients with epileptic encephalopathies like Lennox-Gastaut syndrome. VNS effectively decreases both the frequency and duration of seizures in individuals contending with intractable epilepsy. The use of vagus nerve stimulation is generally a safe and well-tolerated form of treatment. VNS therapy improves psychomotor functions in patients with severe drug-resistant epilepsy, showing positive effects on cognitive aspects. The precise mechanism through which VNS affects the body is not fully understood, but it has demonstrated effectiveness, especially in cases of drug-resistant epilepsy.
Conclusions:
Extensive research backs Vagus Nerve Stimulation (VNS) as an effective palliative for intractable epilepsy, reducing seizures. Yet, identifying specific patients who would benefit most from VNS treatment lacks clear criteria. Neuromodulation remains crucial for healthcare professionals handling drug-resistant epilepsy.
References
Behr C., Goltzene M.A., Kosmalski G., et. al.: Epidemiology of epilepsy. Rev Neurol (PaBehr C, Goltzene MA, Kosmalski G, Hirsch E, Ryvlin P. Epidemiology of epilepsy. Rev Neurol (Paris). 2016;172(1):27-36. doi:10.1016/j.neurol.2015.11.003.
Gustavsson A, Svensson M, Jacobi F, et al. Cost of disorders of the brain in Europe 2010 [published correction appears in Eur Neuropsychopharmacol. 2012 Mar;22(3):237-8. den Bergh, Peter Van [corrected to Van den Bergh, Peter]]. Eur Neuropsychopharmacol. 2011;21(10):718-779. doi:10.1016/j.euroneuro.2011.08.008
Engel J Jr. What can we do for people with drug-resistant epilepsy? The 2016 Wartenberg Lecture. Neurology. 2016;87(23):2483-2489. doi:10.1212/WNL.0000000000003407
Wiebe S, Jette N. Pharmacoresistance and the role of surgery in difficult to treat epilepsy. Nat Rev Neurol. 2012;8(12):669-677. doi:10.1038/nrneurol.2012.181
Lulic D, Ahmadian A, Baaj AA, Benbadis SR, Vale FL. Vagus nerve stimulation. Neurosurg Focus. 2009;27(3):E5. doi:10.3171/2009.6.FOCUS09126
Liporace J, Hucko D, Morrow R, et al. Vagal nerve stimulation: adjustments to reduce painful side effects. Neurology. 2001;57(5):885-886. doi:10.1212/wnl.57.5.885
Kaur S, Selden NR, Aballay A. Anti-inflammatory effects of vagus nerve stimulation in pediatric patients with epilepsy. Front Immunol. 2023;14:1093574. Published 2023 Feb 10. doi:10.3389/fimmu.2023.1093574
Wang W, Huang XR, Li AG, et al. Signaling mechanism of TGF-beta1 in prevention of renal inflammation: role of Smad7. J Am Soc Nephrol. 2005;16(5):1371-1383. doi:10.1681/ASN.2004121070
González HFJ, Yengo-Kahn A, Englot DJ. Vagus Nerve Stimulation for the Treatment of Epilepsy. Neurosurg Clin N Am. 2019;30(2):219-230. doi:10.1016/j.nec.2018.12.005
Baltuch GH, Villemure JG. Operative Techniques in Epilepsy Surgery. AJNR Am J Neuroradiol. 2009;30(9):E133. doi:10.3174/ajnr.A1689
Boluk C, Ozkara C, Isler C, Uzan M. Vagus Nerve Stimulation in Intractable Epilepsy. Turk Neurosurg. 2022;32(1):97-102. doi:10.5137/1019-5149.JTN.33775-21.2
Suller Marti A, Mirsattari SM, MacDougall K, et al. Vagus nerve stimulation in patients with therapy-resistant generalized epilepsy. Epilepsy Behav. 2020;111:107253. doi:10.1016/j.yebeh.2020.107253
Wheless JW, Gienapp AJ, Ryvlin P. Vagus nerve stimulation (VNS) therapy update. Epilepsy Behav. 2018;88S:2-10. doi:10.1016/j.yebeh.2018.06.032
Sourbron J, Klinkenberg S, Kessels A, Schelhaas HJ, Lagae L, Majoie M. Vagus Nerve Stimulation in children: A focus on intellectual disability. Eur J Paediatr Neurol. 2017;21(3):427-440. doi:10.1016/j.ejpn.2017.01.011
Wang W, Huang XR, Li AG, et al. Signaling mechanism of TGF-beta1 in prevention of renal inflammation: role of Smad7. J Am Soc Nephrol. 2005;16(5):1371-1383. doi:10.1681/ASN.2004121070
Peña-Ceballos J, Moloney PB, Valentin A, et al. Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study. Seizure. 2023;112:98-105. doi:10.1016/j.seizure.2023.09.019
Weissinger F, Losch F, Winter Y, Brecht S, Lendemans D, Kockelmann E. Effectiveness of eslicarbazepine acetate in dependency of baseline anticonvulsant therapy: Results from a German prospective multicenter clinical practice study. Epilepsy Behav. 2019;101(Pt A):106574. doi:10.1016/j.yebeh.2019.106574
Lulic D, Ahmadian A, Baaj AA, Benbadis SR, Vale FL. Vagus nerve stimulation. Neurosurg Focus. 2009;27(3):E5. doi:10.3171/2009.6.FOCUS09126
Zabara J. Peripheral control of hypersynchronous discharge in epilepsy. Electroencephalography. 1985;61:S162.
Xie H, Ma J, Ji T, Liu Q, Cai L, Wu Y. Efficacy of vagus nerve stimulation in 95 children of drug-resistant epilepsy with structural etiology. Epilepsy Behav. 2023;140:109107. doi:10.1016/j.yebeh.2023.109107
Englot DJ, Chang EF, Auguste KI. Efficacy of vagus nerve stimulation for epilepsy by patient age, epilepsy duration, and seizure type. Neurosurg Clin N Am. 2011;22(4):443-v. doi:10.1016/j.nec.2011.07.002
Lim MJR, Fong KY, Zheng Y, et al. Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis. Neurosurg Rev. 2022;45(3):2361-2373. doi:10.1007/s10143-022-01757-9
Cramer SW, McGovern RA, Chen CC, Park MC. Clinical Benefit of Vagus Nerve Stimulation for Epilepsy: Assessment of Randomized Controlled Trials and Prospective Non-Randomized Studies. J Cent Nerv Syst Dis. 2023;15:11795735231151830. Published 2023 Jan 11. doi:10.1177/11795735231151830
Dibué M, Greco T, Spoor JKH, Senft C, Kamp MA. Does response to vagus nerve stimulation for drug-resistant epilepsy differ in patients with and without Lennox-Gastaut syndrome?. Brain Behav. 2023;13(8):e3025. doi:10.1002/brb3.3025
Navas M, Navarrete EG, Pascual JM, et al. Treatment of refractory epilepsy in adult patients with right-sided vagus nerve stimulation. Epilepsy Res. 2010;90(1-2):1-7. doi:10.1016/j.eplepsyres.2010.04.007
Sourbron J, Klinkenberg S, Kessels A, Schelhaas HJ, Lagae L, Majoie M. Vagus Nerve Stimulation in children: A focus on intellectual disability. Eur J Paediatr Neurol. 2017;21(3):427-440. doi:10.1016/j.ejpn.2017.01.011
Pires do Prado HJ, Pinto LF, Bezerra DF, et al. Predictive factors for successful vagus nerve stimulation in patients with refractory epilepsy: real-life insights from a multicenter study. Front Neurosci. 2023;17:1210221. Published 2023 Jul 27. doi:10.3389/fnins.2023.1210221
Zhang L, Hall M, Lam SK. Comparison of long-term survival with continued medical therapy, vagus nerve stimulation, and cranial epilepsy surgery in paediatric patients with drug-resistant epilepsy in the USA: an observational cohort study. Lancet Child Adolesc Health. 2023;7(7):455-462. doi:10.1016/S2352-4642(23)00082-2
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 Suppl 1:85-90. doi:10.1111/epi.13678
Liporace J, Hucko D, Morrow R, et al. Vagal nerve stimulation: adjustments to reduce painful side effects. Neurology. 2001;57(5):885-886. doi:10.1212/wnl.57.5.885
Klinkenberg S, van den Bosch CN, Majoie HJ, et al. Behavioural and cognitive effects during vagus nerve stimulation in children with intractable epilepsy - a randomized controlled trial. Eur J Paediatr Neurol. 2013;17(1):82-90. doi:10.1016/j.ejpn.2012.07.003
Kaur S, Selden NR, Aballay A. Anti-inflammatory effects of vagus nerve stimulation in pediatric patients with epilepsy. Front Immunol. 2023;14:1093574. Published 2023 Feb 10. doi:10.3389/fimmu.2023.1093574
Lyu J, Wang JB, Quan Y, et al. Effectiveness of vagus nerve stimulation for drug-resistant generalized epilepsy in children aged six and younger. Neurochirurgie. 2023;69(6):101500. doi:10.1016/j.neuchi.2023.101500
Fernando DA, Lord RS. The blood supply of vagus nerve in the human: its implication in carotid endarterectomy, thyroidectomy and carotid arch aneurectomy. Ann Anat. 1994;176(4):333-337. doi:10.1016/s0940-9602(11)80511-x
Zhu J, Xu C, Zhang X, et al. Epilepsy duration as an independent predictor of response to vagus nerve stimulation. Epilepsy Res. 2020;167:106432. doi:10.1016/j.eplepsyres.2020.106432
Wheless JW. Intractable epilepsy: A survey of patients and caregivers. Epilepsy Behav. 2006;8(4):756-764. doi:10.1016/j.yebeh.2006.03.010
Colzato LS, Ritter SM, Steenbergen L. Transcutaneous vagus nerve stimulation (tVNS) enhances divergent thinking. Neuropsychologia. 2018;111:72-76. doi:10.1016/j.neuropsychologia.2018.01.003
Martin CO, Denburg NL, Tranel D, Granner MA, Bechara A. The effects of vagus nerve stimulation on decision-making. Cortex. 2004;40(4-5):605-612. doi:10.1016/s0010-9452(08)70156-4
Mezjan I, Gourfinkel-An I, Degos V, et al. Outpatient vagus nerve stimulation surgery in patients with drug-resistant epilepsy with severe intellectual disability. Epilepsy Behav. 2021;118:107931. doi:10.1016/j.yebeh.2021.107931
Sun L, Peräkylä J, Holm K, et al. Vagus nerve stimulation improves working memory performance. J Clin Exp Neuropsychol. 2017;39(10):954-964. doi:10.1080/13803395.2017.1285869
Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg. 2011;115(6):1248-1255. doi:10.3171/2011.7.JNS11977
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