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Hamza M, Carron R, Dibué M, Moiraghi A, Barrit S, Filipescu C, Landré E, Gavaret M, Domenech P, Pallud J, Zanello M. Right-sided vagus nerve stimulation for drug-resistant epilepsy: A systematic review of the literature and perspectives. Seizure 2024; 117:298-304. [PMID: 38615369 DOI: 10.1016/j.seizure.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Right-sided vagus nerve stimulation (RS-VNS) is indicated when the procedure was deemed not technically feasible or too risky on the indicated left side. OBJECTIVE The present study aims to systematically review the literature on RS-VNS, assessing its effectiveness and safety. METHODS A systematic review following PRISMA guidelines was conducted: Pubmed/MEDLINE, The Cochrane Library, Scopus, Embase and Web of science databases were searched from inception to August 13th,2023. Gray literature was searched in two libraries. Eligible studies included all studies reporting, at least, one single case of RS-VNS in patients for the treatment of drug-resistant epilepsy. RESULTS Out of 2333 initial results, 415 studies were screened by abstract. Only four were included in the final analysis comprising seven patients with RS-VNS for a drug-resistant epilepsy. One patient experienced nocturnal asymptomatic bradycardia whereas the other six patients did not display any cardiac symptom. RS-VNS was discontinued in one case due to exercise-induced airway disease exacerbation. Decrease of epileptic seizure frequency after RS-VNS ranged from 25 % to 100 % in six cases. In the remaining case, VNS effectiveness was unclear. In one case, RS-VNS was more efficient than left-sided VNS (69 % vs 50 %, respectively) whereas in another case, RS-VNS was less efficient (50 % vs 95 %, respectively). CONCLUSION Literature on the present topic is limited. In six out of seven patients, RS-VNS for drug-resistant epilepsy displayed reasonable effectiveness with a low complication rate. Further research, including prospective studies, is necessary to assess safety and effectiveness of RS-VNS for drug-resistant epilepsy patients.
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Affiliation(s)
- Meissa Hamza
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Romain Carron
- Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France; Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
| | - Maxine Dibué
- Department of Neurosurgery, Friedrich-Schiller University, Jena, Germany; Medical Affairs Neuromodulation International, LivaNova PLC, London United Kingdom
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France
| | - Sami Barrit
- Department of Neurosurgery, Erasmus Hospital, Free University of Brussels, Belgium
| | - Cristina Filipescu
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Elisabeth Landré
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France; Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Philippe Domenech
- Neuromodulation Institute, GHU Paris, Psychiatrie et neurosciences, Hôpital Saint-Anne, Université Paris Cité, Paris, France; Cognitive Neuroimaging Unit, INSERM, CEA, CNRS, Université Paris-Saclay, NeuroSpin Center, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Université Paris Cité, INSERM UMR1266, IPNP, Paris, France.
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Kaoutzani L, Goldman LV, Piper K, Kumar M, Vale FL. Revision and removal of vagus nerve stimulation systems: twenty-five years' experience. Acta Neurochir (Wien) 2023; 165:3913-3920. [PMID: 37957310 DOI: 10.1007/s00701-023-05875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Epilepsy, a disease characterized by recurrent seizures, is a common chronic neurologic condition. Antiepileptic drugs (AED) are the mainstay of treatment for epilepsy. Vagus nerve stimulation (VNS) surgery is an adjuvant therapy for the treatment of drug refractory epilepsy (DRE). VNS revision and implant removal surgeries remain common. METHODS Using a single neurosurgeon data registry for epilepsy surgery, we retrospectively analyzed a total of 824 VNS surgeries. Patients were referred to two Level IV Comprehensive Epilepsy centers (from 08/1997 to 08/2022) for evaluation. Patients were divided into four groups: new device placement, revision surgery, removal surgery, and battery replacement for end-of-life of the generator. The primary endpoint was to analyze the reasons that led patients to undergo revision and removal surgeries. The time period from the index surgery to the removal surgery was also calculated. RESULTS The median age of patients undergoing any type of surgery was 34 years. The primary reason for revision surgeries was device malfunction, followed by patients' cosmetic dissatisfaction. There was no statistical sex-difference in revision surgeries. The median age and body mass index (BMI) of patients who underwent revision surgery were 38 years and 26, respectively. On the other hand, the primary reason for removal was lack of efficacy, followed again by cosmetic dissatisfaction. The survival analysis showed that 43% of VNS device remained in place for 5 years and 50% of the VNS devices were kept for 1533 days or 4.2 years. CONCLUSIONS VNS therapy is safe and well-tolerated. VNS revision and removal surgeries occur in less than 5% of cases. More importantly, attention to detail and good surgical technique at the time of the index surgery can increase patient satisfaction, minimize the need for further surgeries, and improve acceptance of the VNS technology.
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Affiliation(s)
- Lydia Kaoutzani
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
| | - Liam V Goldman
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
| | - Keaton Piper
- Department of Neurosurgery, University of South Florida (USF), Tampa, USA
| | - Manish Kumar
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA.
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Harcourt‐Brown TR, Carter M. Long-term outcome of epileptic dogs treated with implantable vagus nerve stimulators. J Vet Intern Med 2023; 37:2102-2108. [PMID: 37864369 PMCID: PMC10658546 DOI: 10.1111/jvim.16908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The long-term effect of implantable vagus nerve stimulators (VNS) on seizures has not been evaluated in epileptic dogs. OBJECTIVES Report seizure frequency in medication-resistant epileptic dogs before and after VNS implantation. ANIMALS Twelve client-owned dogs with idiopathic epilepsy and >1 seizure day per 3 weeks despite 3 months of appropriate use of 2 antiseizure medications and seizure diaries maintained 6 months before and >12 months after VNS implantation. METHODS Uncontrolled, open-label, before and after study. Mean monthly seizures and inter-seizure periods obtained from contemporaneous seizure diaries in the 6 months before implantation were compared with 0 to 6 months, 7 to 12 months, and subsequent 12-month periods after implantation. The number of dogs with >50% decrease in seizure frequency, >3 times increase in inter-ictal period interval, and seizure freedom for >3 months at the time of death or last follow-up were recorded. RESULTS Five of 12 dogs were euthanized <12 months after implantation. All 7 remaining dogs showed >50% decrease in seizure frequency until last follow-up, starting at a median of 37 to 48 months after implantation (range, 0-6 to 61-72 months) and a >3-fold increase in mean inter-seizure interval starting a median of 25 to 36 months after implantation (range, 0-6 months to 49-60 months), 3/7 dogs were seizure-free at death or last follow-up. CONCLUSIONS AND CLINICAL IMPORTANCE Monthly seizure frequencies decreased and inter-seizure intervals increased in all dogs 2 to 3 years after VNS implantation, but a high proportion were euthanized before this time point. Prospective clinical trials are required to establish causality and the magnitude of this association.
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Affiliation(s)
| | - Michael Carter
- Bristol Royal Hospital for ChildrenUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
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Saba ES, Rivero A. Pediatric vagal nerve stimulator explantation: A comprehensive literature review and tertiary care experience. Int J Pediatr Otorhinolaryngol 2023; 170:111603. [PMID: 37267661 DOI: 10.1016/j.ijporl.2023.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Patients with medically-refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require device removal. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. This comprehensive literature review and case series studies safety outcomes among pediatric patients undergoing complete VNS explantation. STUDY DESIGN/SETTING Literature review and tertiary care case series. METHODS PubMed, Embase, Web of Science, and Google Scholar were searched to identify all articles involving VNS explantation prior to January 2023. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009 to 2023 at our tertiary center was also conducted. RESULTS After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary VF paresis or dysphonia (n = 14; 3.6%), permanent vocal fold (VF) paralysis/paresis (n = 6; 1.5%), internal jugular vein injury (n = 4; 1.0%), temporary dysphagia (n = 2; 0.50%), and cable-bowstring phenomenon (n = 1; 0.25%). Data from our tertiary care center revealed eight patients (6 M: 2 F) with a mean age of 11.4 ± 6.2 years. Devices were removed for clinical ineffectiveness (n = 2), infection (n = 2), lead failures (n = 2), and increased lead impedance (n = 2). Mean total length of implantation was 44.4 ± 40.3 months. Mean follow-up was 44.8 ± 35.2 months. No complications were identified. CONCLUSIONS Complete VNS device removal in pediatric patients is technically feasible with low reported complications. Working alongside neurosurgery, otolaryngologists offer unique expertise in dissection along the vagus nerve and may thus add value to the practice of VNS surgery.
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Affiliation(s)
- Elias S Saba
- Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Alexander Rivero
- Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
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Yasmin F, Sahito AM, Mir SL, Khatri G, Shaikh S, Gul A, Hassan SA, Koritala T, Surani S. Electrical neuromodulation therapy for inflammatory bowel disease. World J Gastrointest Pathophysiol 2022; 13:128-142. [PMID: 36187600 PMCID: PMC9516456 DOI: 10.4291/wjgp.v13.i5.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/19/2022] [Accepted: 07/18/2022] [Indexed: 02/08/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an inflammatory disease of the gastrointestinal (GI) tract. It has financial and quality of life impact on patients. Although there has been a significant advancement in treatments, a considerable number of patients do not respond to it or have severe side effects. Therapeutic approaches such as electrical neuromodulation are being investigated to provide alternate options. Although bioelectric neuromodulation technology has evolved significantly in the last decade, sacral nerve stimulation (SNS) for fecal incontinence remains the only neuromodulation protocol commonly utilized use for GI disease. For IBD treatment, several electrical neuromodulation techniques have been studied, such as vagus NS, SNS, and tibial NS. Several animal and clinical experiments were conducted to study the effectiveness, with encouraging results. The precise underlying mechanisms of action for electrical neuromodulation are unclear, but this modality appears to be promising. Randomized control trials are required to investigate the efficacy of intrinsic processes. In this review, we will discuss the electrical modulation therapy for the IBD and the data pertaining to it.
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Affiliation(s)
- Farah Yasmin
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Abdul Moiz Sahito
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Syeda Lamiya Mir
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Govinda Khatri
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Somina Shaikh
- Department of Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Ambresha Gul
- Department of Medicine, People’s University of Medical and Health Sciences, Nawabshah 67480, Pakistan
| | - Syed Adeel Hassan
- Department of Medicine, University of Louisville, Louiseville, KY 40292, United States
| | - Thoyaja Koritala
- Department of Medicine, Mayo Clinic, Rochester, NY 55902, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, TX 77843, United States
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55902, United States
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Al Omari AI, Nuseir A, Kanaan Y, Al-Ashqar R, Alzoubi F. The feasibility of vagal nerve stimulation revision surgery and surgical techniques: a retrospective review. Acta Otolaryngol 2021; 141:719-723. [PMID: 34003719 DOI: 10.1080/00016489.2021.1916588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND With the large number of VNS implants performed worldwide, the need for removal or replacement of the device in selected cases is emerging, this removal or replacement of VNS can be challenging. AIMS/OBJECTIVE To describe the feasibility and safety of revising vagal nerve stimulation surgery in terms of the indications, surgical techniques, and outcomes. MATERIALS AND METHODS A retrospective study, a series of eight cases with VNS implants that needed revision surgery have been reviewed, four devices were completely removed and four were only revised. The revision surgery was performed after a range of 7 months to 6 years, due to different reasons. Initial surgeries and revisions were performed at the otolaryngology department in a major tertiary center. CONCLUSIONS AND SIGNIFICANCE We concluded that the previously implanted vagal nerve stimulation electrodes can be completely removed without any significant sequelae on the nerve. It may also be re-implanted safely at the previously used segment of the vagus nerve with a similar outcome in seizure control as the initial implantation.
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Affiliation(s)
- Ahmad I. Al Omari
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amjad Nuseir
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yazan Kanaan
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ra’ed Al-Ashqar
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Alzoubi
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Spindler P, Vajkoczy P, Schneider UC. Surgical revision after Vagus Nerve Stimulation. A case series. Epilepsy Behav Rep 2021; 15:100437. [PMID: 33912822 PMCID: PMC8063733 DOI: 10.1016/j.ebr.2021.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
With increasing use of vagus nerve stimulation (VNS) as an adjunct treatment for drug-resistant epilepsy, revision surgery of VNS grows in importance. Indications for revision surgery are diverse and extend of surgery varies. We report a retrospective review on indications and complications of VNS revision surgery at our center. Of 90 VNS procedures 54.4% were revision surgeries. Among those the vast majority was due to depletion of the battery. The entire system was explanted in 15 patients, due to no beneficial effect detected (n = 4), due to irritating side effects (n = 4), and so further diagnostics could cbe carried out (n = 7). Interestingly in three of the patients who underwent further diagnostics, resective epilepsy surgery was performed. Surgical complications occurred in 8.2%. In our experience, revision surgery of VNS was a frequent and safe procedure. There is a need to carefully reviewthe initial indication for VNS implantation prior to revision surgery.
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8
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Fisher B, DesMarteau JA, Koontz EH, Wilks SJ, Melamed SE. Responsive Vagus Nerve Stimulation for Drug Resistant Epilepsy: A Review of New Features and Practical Guidance for Advanced Practice Providers. Front Neurol 2021; 11:610379. [PMID: 33584511 PMCID: PMC7874068 DOI: 10.3389/fneur.2020.610379] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023] Open
Abstract
Vagus nerve stimulation (VNS) is a safe and effective therapy that has been available for over 20 years for adults and children with drug resistant epilepsy (DRE). Since U.S. Food and Drug Administration approval in 1997, VNS has been implanted in over 100,000 patients including over 30,000 children as an adjunctive therapy in reducing the frequency of seizures in patients 4 years of age and older with focal seizures that are refractory to antiseizure medications. VNS Therapy® has evolved over time and currently offers closed-loop, responsive stimulation as well as advanced features that streamline dosing and patient management. Advanced Practice Providers (APPs) such as nurse practitioners, physician assistants and clinical nurse specialists are integral in a comprehensive healthcare team, and dedicated VNS clinics have formed at comprehensive epilepsy centers across the world that are often managed by APPs. This approach improves access, education, and continuity of care for those with VNS or those considering VNS. Here we provide a review for APPs on the VNS Therapy® system focused on new features, dosing, and troubleshooting strategies with the goal to provide guidance to those managing VNS patients.
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Affiliation(s)
- Breanne Fisher
- Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Julie A DesMarteau
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth H Koontz
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
| | - Seth J Wilks
- Neuromodulation Division, LivaNova, Houston, TX, United States
| | - Susan E Melamed
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Alhajaj G, Atkinson J, Keezer MR, Nikolic A, Myers KA. A proposed guideline for vagus nerve stimulator handling in palliative care and after death. Epilepsia 2020; 61:1336-1340. [PMID: 32463125 DOI: 10.1111/epi.16553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
Vagus nerve stimulation (VNS) is often used for patients with drug-resistant epilepsy. Although this intervention may improve seizure control and mood, a number of factors must be considered when patients with VNS near end of life. We reviewed relevant literature to create a proposed guideline for management of patients with VNS in palliative care and after death. VNS has multiple possible side effects, including cough and swallowing difficulties. For patients with neurologic disease in palliative care, such adverse effects can severely affect quality of life and increase the risk for complications such as aspiration pneumonia. Patients with VNS should be screened regularly for such side effects, and VNS parameters should be adjusted if they are identified. If a patient requires urgent cardiac resuscitation involving external defibrillation, the VNS should be interrogated immediately afterwards to evaluate its function. During defibrillation, paddles should be placed perpendicular to the VNS, and as far as possible away from it. The VNS can be acutely turned off by taping the magnet to the patient's chest, thereby preventing any possible interference with restoration of a normal heart rhythm. After death, any staff involved with handling the body should be notified that a VNS is in place. The device must be removed prior to cremation, as it can explode with high heat. If the cause of death is unclear, a full postmortem examination should be undertaken, per sudden unexpected death in epilepsy guidelines. If there is concern about device malfunction, the device should be returned to the manufacturer for evaluation.
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Affiliation(s)
- Ghadd Alhajaj
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Atkinson
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Mark R Keezer
- Department of Neurosciences, University of Montreal, Montreal, QC, Canada.,Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Ana Nikolic
- Clark Smith Brain Tumour Centre, Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kenneth A Myers
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.,Research Institute of the McGill University Medical Centre, Montreal, QC, Canada
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Gigliotti MJ, Mao G, Dupré DA, Wilberger J. Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy. World Neurosurg 2018; 120:e1047-e1053. [DOI: 10.1016/j.wneu.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
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Bonaz B. Is-there a place for vagus nerve stimulation in inflammatory bowel diseases? Bioelectron Med 2018; 4:4. [PMID: 32232080 PMCID: PMC7098256 DOI: 10.1186/s42234-018-0004-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/27/2018] [Indexed: 12/11/2022] Open
Abstract
The vagus nerve (VN), the longest nerve of the organism that innervates the gastrointestinal tract, is a mixed nerve composed of 80% of afferent and 20% of efferent fibers. The VN has anti-inflammatory properties, in particular an anti-TNFα effect through the cholinergic anti-inflammatory pathway. The VN is a key component of the autonomic nervous system, i.e. the parasympathetic nervous system. An imbalance of the autonomic nervous system, as represented by a low vagal tone, is described in many diseases and has a pro-inflammatory role. Inflammatory bowel diseases (IBD) are chronic disorders of the gastro-intestinal tract where TNFα is a key cytokine. VN stimulation (VNS), classically used for the treatment of drug resistant epilepsy and depression, would be of interest in the treatment of IBD. We have recently reported in a 6 month follow-up pilot study that VNS improves active Crohn’s disease. Preliminary data of another pilot study confirm this interest. Similarly, VNS has recently been reported to improve rheumatoid arthritis, another TNFα mediated disease. Bioelectronic Medicine, as represented by VNS, opens new therapeutic avenues in the treatment of such chronic inflammatory disorders. In the present manuscript, we will focus on the interest of VNS in IBD.
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Affiliation(s)
- Bruno Bonaz
- 1Division of Hepato-Gastroenterology, University Hospital, Alpes, F-38000 Grenoble, France.,University Grenoble Alpes, Grenoble Institute of Neurosciences, GIN, Inserm U1216, F-38000 Grenoble, France.,3Division of Hepato-Gastroenterology, CHU Grenoble Alpes, -10217, 38043 Grenoble Cedex 09, CS France
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