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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Adachi N, Ito M. Epilepsy in patients with schizophrenia: Pathophysiology and basic treatments. Epilepsy Behav 2022; 127:108520. [PMID: 34999502 DOI: 10.1016/j.yebeh.2021.108520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
Abstract
Schizophrenia is a chronic psychiatric disorder that may lead to epilepsy. However, there are limited findings on the issues. This narrative review aimed to provide a practical perspective on epilepsy in patients with schizophrenia using the current treatment systems for epilepsy. While there has been a debate on the relationship between epilepsy and schizophrenia, i.e., antagonism, affinity, and coincidence, recent large cohort studies have revealed a high frequency of epilepsy in patients with schizophrenia (4-5 times higher than that of general population). The high incidence observed is likely to be due to the bidirectionality between epilepsy and schizophrenia and additional schizophrenia-related conditions, e.g., antipsychotic drugs (APD), substance abuse, and head injury. As for symptomatology of epilepsy, only one small-size study showed that seizures of patients with schizophrenia are equivalent to those of patients without schizophrenia. Patients with schizophrenia exhibit the first seizure in their twenties or later, which are mostly focal seizures. Most of seizures in patients with schizophrenia can be controlled with conventional antiepileptic drugs. Few patients with schizophrenia develop treatment-resistant epilepsy. However, since drug interactions can be more complicated due to multiple conditions, such as pre-existing polypharmacy, heavy smoking, irregular eating, and comorbid metabolic disorders, cautious monitoring for clinical symptoms is required. To improve seizure control and adherence, non-pharmacological approaches are also recommended. Thus far, for seizure treatments in patients with schizophrenia, we have to use many empirical findings or substitute certain findings from population without schizophrenia because evidence is insufficient. The accumulation of clinical findings may contribute to the development of efficient treatment systems.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; Jozen Clinic, Sapporo, Japan.
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Miron G, Strauss I, Fried I, Fahoum F. Anterior thalamic deep brain stimulation in epilepsy patients refractory to vagus nerve stimulation: A single center observational study. Epilepsy Behav Rep 2022; 20:100563. [PMID: 36119948 PMCID: PMC9471437 DOI: 10.1016/j.ebr.2022.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022] Open
Abstract
Patients with drug resistant epilepsy refractory to treatment with vagal nerve stimulation benefited from anterior thalamic deep brain stimulation. We report a combined neuromodulation approach of simultaneous vagal nerve and deep brain stimulation. Additional studies are needed to assess safety and efficacy of simultaneous VNS and DBS treatment.
Anterior thalamic deep brain stimulation (DBS) is a palliative treatment that may be considered in patients with drug resistant epilepsy (DRE) that fail treatment with vagus nerve stimulation (VNS). Combining VNS and DBS treatment is a therapeutic approach rarely reported. This single center observational study aims to describe response to DBS treatment in 11 epilepsy patients resistant to medications and VNS. Patients either had inactivated VNS (DBS only) or were treated with simultaneous DBS and VNS (DBS-VNS). Focal impaired awareness (FIA) and most disabling seizure rates were examined pre-DBS implantation, 3 months following implantation, and last follow up. Overall, a decrease in FIA (47.0 ± 30.7 %, p = 0.02) and most disabling seizure rate (54.8 ± 34.2 %, p = 0.03) was seen at last follow-up (average follow-up 28.5 ± 13.5 months). Eight of 11 patients were DBS responders (most disabling seizure rate reduction above 50%). No difference in seizure control was found between seven DBS only and four DBS-VNS patients. Our results argue that patients who have failed antiseizure medication and VNS therapies, could benefit from better seizure control if treated with adjunctive DBS. Larger prospective studies are needed to assess the efficacy and safety of combined neurostimulation treatments in DRE.
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Doddamani RS, Agrawal M, Samala R, Ramanujam B, Chandra PS, Tripathi M. Vagal Nerve Stimulation in the Management of Epilepsy - Recent Concepts. Neurol India 2021; 68:S259-S267. [PMID: 33318360 DOI: 10.4103/0028-3886.302475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Epilepsy surgery currently offers the best treatment for patients with drug-refractory epilepsy (DRE). Resective surgery, in the presence of a well-localized epileptogenic focus, remains the best modality towards achieving seizure freedom. However, localization of the focus may not be possible in all the cases of DRE, despite comprehensive epilepsy workup. Neuromodulation techniques such as vagal nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS) may be a good alternative in these cases. This article intends to provide an overview of VNS in the management of DRE, including indications, comprehensive preoperative workup, exemplified by case illustrations and outcomes by reviewing the evidence available in the literature.
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Affiliation(s)
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujam
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ivanović J, Alfstad KÅ, Marthinsen PB, Olsen KB, Larsson PG, Pripp AH, Stanišić M. Seizure Outcome After Ipsitemporal Reoperation in Pharmacoresistant Temporal Lobe Epilepsy Patients With Hippocampal Sclerosis and Nonspecific Pathology. Neurosurg open 2021. [DOI: 10.1093/neuopn/okab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Alemany M, Real E, Custal N, Sala-Padró J, Rodríguez-Bel L, Plans G, Mora J, Santurino M, Vancamp T, Falip M. Vagus nerve stimulation as a potential modulator of periictal psychotic episodes: A report of four cases. Epilepsy Behav Rep 2021; 15:100434. [PMID: 33665601 DOI: 10.1016/j.ebr.2021.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
PPE are treatable and we report a case series of patients successfully treated with VNS. Both antiseizure and antipsychotic VNS effects are not immediate. Antipsychotic effect of VNS may be observed even in patients who do not become seizure free.
Drug resistant epilepsy (DRE) has been associated with a high incidence of psychotic disorders. Patients can develop psychosis after starting a new antiseizure medication, after undergoing resective surgery, or after implantation of a vagus nerve stimulation (VNS) system. The aim of this study was to investigate the modulation effect of VNS on psychotic episodes in DRE patients with a pre-existing history of periictal psychotic episodes (PPE). We retrospectively report the outcome of four patients from a single tertiary center with PPE prior to implantation. None of the implanted patients developed de novo PPE after VNS therapy. Regarding seizure outcome, all patients demonstrated a response to VNS with two who experienced who status epilepticus and three patients wtih a change in semiology with after VNS implantation. PPE disappeared in all the study patients, two of them at 6 months post-implantation and in the others after 2 and 3 years, respectively. 18F-FDG-PET results showed hypermetabolism in both anterior insular and medial frontal lobes which disappeared in the 18F -FDG-PET 4 years post-implantation. Based on the results of this series of cases we suggest that VNS therapy may be useful to modulatet PPE in patients with DRE, though effectiveness may be time-dependent.
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Abstract
Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%-40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.
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Affiliation(s)
| | | | - Sean Higgins
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Abstract
Supplemental Digital Content is Available in the Text. BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response. OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS. METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies. RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom. CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients. ABBREVIATIONS: AED, antiepileptic drug VNS, vagus nerve stimulation
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Affiliation(s)
- Dario J Englot
- *UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California; ‡Department of Neurological Surgery, University of California, San Francisco, California; §Cyberonics, Inc., Houston, Texas
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Wang K, Chai Q, Qiao H, Zhang J, Liu T, Meng F. Vagus nerve stimulation balanced disrupted default-mode network and salience network in a postsurgical epileptic patient. Neuropsychiatr Dis Treat 2016; 12:2561-2571. [PMID: 27785033 PMCID: PMC5067064 DOI: 10.2147/ndt.s116906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In recent years, treatment of intractable epilepsy has become more challenging, due to an increase in resistance to antiepileptic drugs, as well as diminished success following resection surgery. Here, we present the case of a 19-year old epileptic patient who received vagus nerve stimulation (VNS) following unsuccessful left parietal-occipital lesion-resection surgery, with results indicating an approximate 50% reduction in seizure frequency and a much longer seizure-free interictal phase. MATERIALS AND METHODS Using resting-state functional magnetic resonance imaging, we measured the changes in resting-state brain networks between pre-VNS treatment and 6 months post-VNS, from the perspective of regional and global variations, using regional homogeneity and large-scale functional connectives (seeding posterior cingulate cortex and anterior cingulate cortex), respectively. RESULTS After 6 months of VNS therapy, the resting-state brain networks were slightly reorganized in regional homogeneity, mainly in large-scale functional connectivity, where excessive activation of the salience network was suppressed, while at the same time the suppressed default-mode network was activated. CONCLUSION With regard to resting-state brain networks, we propose a hypothesis based on this single case study that VNS acts on intractable epilepsy by modulating the balance between salience and default-mode networks through the integral hub of the anterior cingulate cortex.
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Affiliation(s)
- Kailiang Wang
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
| | - Qi Chai
- Beijing Neurosurgical Institute, Capital Medical University
| | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University
| | - Jianguo Zhang
- Beijing Key Laboratory of Neurostimulation; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tinghong Liu
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
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Ghani S, Vilensky J, Turner B, Tubbs RS, Loukas M. Meta-analysis of vagus nerve stimulation treatment for epilepsy: correlation between device setting parameters and acute response. Childs Nerv Syst 2015; 31:2291-304. [PMID: 26493055 DOI: 10.1007/s00381-015-2921-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is an adjunctive neurophysiological treatment for those patients who have pharmacoresistant or surgically resistant partial onset epilepsy. OBJECTIVE The aim of this study is to determine the effects of high and low stimulation paradigms on a responder rate of ≥50 and ≥75% reduction in seizure frequency and associated adverse effects in adults and children. METHOD A literature search was performed using Medline, PubMed, EMBASE, and Cochrane library for studies using vagus nerve stimulation published from January 1980 until July 2014 for medically or surgically resistant partial onset seizures, in children and adults. No restrictions on languages were imposed. DATA COLLECTION AND ANALYSIS Four authors reviewed and selected studies for inclusion and exclusion. The search identified five randomized control trials that fit with our inclusion criteria. The following outcomes were evaluated: 50% or greater reduction in total seizure frequency, 75% or greater reduction in total seizure frequency, and adverse effects. RESULTS Four randomized controlled trials were analyzed in this meta-analysis. Results indicate high stimulation is more effective in adult patients who experienced ≥50 and ≥75% reduction in seizure frequency with a significant difference within both high and low stimulation groups. In children, there was no significant difference between the two groups and patients with ≥50 % reduction in seizures. Adverse effects such as hoarseness and dyspnea were more common in the high stimulation group where the remaining side effects were not statistically different among both groups. CONCLUSION High stimulation is more effective than low stimulation in producing a greater reduction in seizure frequency in patients with medically and surgically resistant epilepsy.
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Affiliation(s)
- S Ghani
- Department of Psychiatry, School of Medicine, University of Arizona, Tucson, AZ, USA.,Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA
| | - J Vilensky
- Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Fort Wayne, IN, USA
| | - B Turner
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA
| | - R S Tubbs
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA.,Pediatric Neurosurgery, Children's Hospital, Birmingham, AL, USA
| | - M Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, WI, USA.
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Ryzí M, Brázdil M, Novák Z, Hemza J, Chrastina J, Ošlejšková H, Rektor I, Kuba R. Long-term outcomes in patients after epilepsy surgery failure. Epilepsy Res 2014; 110:71-7. [PMID: 25616458 DOI: 10.1016/j.eplepsyres.2014.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. METHODS Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. RESULTS At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. CONCLUSION Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed.
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Affiliation(s)
- Michal Ryzí
- Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic.
| | - Milan Brázdil
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic.
| | - Zdeněk Novák
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic.
| | - Jan Hemza
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic.
| | - Jan Chrastina
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic.
| | - Hana Ošlejšková
- Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic.
| | - Ivan Rektor
- Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic.
| | - Robert Kuba
- Brno Epilepsy Center, Department of Child Neurology, Brno University Hospital and Faculty of Medicine, Masaryk University, Černopolní 9, Brno 625 00, Czech Republic; Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 53, Brno 656 91, Czech Republic; Central European Institute of Technology (CEITEC), Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic.
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Fraschini M, Demuru M, Puligheddu M, Floridia S, Polizzi L, Maleci A, Bortolato M, Hillebrand A, Marrosu F. The re-organization of functional brain networks in pharmaco-resistant epileptic patients who respond to VNS. Neurosci Lett 2014; 580:153-7. [PMID: 25123446 DOI: 10.1016/j.neulet.2014.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/10/2014] [Accepted: 08/03/2014] [Indexed: 12/11/2022]
Abstract
Vagal nerve stimulation (VNS) is a therapeutic add-on treatment for patients with pharmaco-resistant epilepsy. The mechanism of action is still largely unknown. Previous studies have shown that brain network topology during the inter-ictal period in epileptic patients deviates from normal configuration. In the present paper, we investigate the relationship between clinical improvement induced by VNS and alterations in brain network topology. We hypothesize that, as a consequence of the VNS add-on treatment, functional brain network architecture shifts back toward a more efficient configuration in patients responding to VNS. Electroencephalographic (EEG) recordings from ten patients affected by pharmaco-resistant epilepsy were analyzed in the classical EEG frequency bands. The phase lag index (PLI) was used to estimate functional connectivity between EEG channels and the minimum spanning tree (MST) was computed in order to characterize VNS-induced alterations in network topology in a bias-free way. Our results revealed a clear network re-organization, in terms of MST modification, toward a more integrated architecture in patients responding to the VNS. In particular, the results show a significant interaction effect between benefit from VNS (responders/non-responders) and condition (pre/post VNS implantation) in the theta band. This finding suggests that the positive effect induced by VNS add-on treatment in epileptic patients is related to a clear network re-organization and that this network modification can reveal the long debated mechanism of action of VNS. Therefore, MST analysis could be useful in evaluating and monitoring the efficacy of VNS add-on treatment potentially in both epilepsy and psychiatric diseases.
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Affiliation(s)
- Matteo Fraschini
- Dipartimento di Ingegneria Elettrica ed Elettronica, Università di Cagliari, Cagliari, Italy.
| | - Matteo Demuru
- Dipartimento di Ingegneria Elettrica ed Elettronica, Università di Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy
| | - Simona Floridia
- Dipartimento di Ingegneria Elettrica ed Elettronica, Università di Cagliari, Cagliari, Italy
| | - Lorenzo Polizzi
- Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Alberto Maleci
- Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, Lawrence, KS, USA
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Francesco Marrosu
- Dipartimento di Sanità Pubblica, Medicina Clinica e Molecolare, Università di Cagliari, Cagliari, Italy; Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
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Waseem H, Raffa SJ, Benbadis SR, Vale FL. Lead revision surgery for vagus nerve stimulation in epilepsy: outcomes and efficacy. Epilepsy Behav 2014; 31:110-3. [PMID: 24389021 DOI: 10.1016/j.yebeh.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
We present, to our knowledge, the first published analysis of vagus nerve stimulation (VNS) lead revisions to incorporate quality of life, clinical response, and antiepileptic drug (AED) burden in postrevision clinical outcomes. Ten patients were followed and had no postoperative complications. Seven patients had improvement in quality of life, and three experienced no change. Eight patients noted a restoration of clinical response comparable with initial VNS implantation. Seven patients reported 30-60% improvement in seizure reduction, two experienced >60%, and one noted <30%. Six patients had no change in AED burden. Vagus nerve stimulation lead revision should be considered a safe option for patients with VNS lead failure and medically intractable epilepsy.
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Affiliation(s)
- Hena Waseem
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| | - Scott J Raffa
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
| | - Selim R Benbadis
- Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA.
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA.
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16
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Abstract
Stimulation of the brain for the treatment of epilepsy, indirectly via the vagus nerve and directly through intracranial targets, is feasible and has increased in use and complexity over the past 10 years. Vagus nerve stimulation is widely applied and the present indications and outcomes together with possible ways in which the treatment could be refined are reviewed. The application of stimulation to deep-brain targets is also reviewed along with present practice and results. Possible developments in the use of direct intracranial stimulation are also considered.
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Affiliation(s)
- Charles E Polkey
- King's College, London Academic Neurosciences Centre, Institute of Psychiatry, De Crespigney Park, Denmark Hill, London, SE5 8AF, UK.
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17
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Hoppe C, Wagner L, Hoffmann JM, von Lehe M, Elger CE. Comprehensive long-term outcome of best drug treatment with or without add-on vagus nerve stimulation for epilepsy: A retrospective matched pairs case–control study. Seizure 2013. [DOI: 10.1016/j.seizure.2012.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Affiliation(s)
- Kristl Vonck
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
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19
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Elliott RE, Morsi A, Geller EB, Carlson CC, Devinsky O, Doyle WK. Impact of Failed Intracranial Epilepsy Surgery on the Effectiveness of Subsequent Vagus Nerve Stimulation. Neurosurgery 2011; 69:1210-7. [DOI: 10.1227/neu.0b013e3182230ae3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Using the Cyberonics registry, Amar and colleagues reported poorer efficacy of vagus nerve stimulation (VNS) in patients who failed intracranial epilepsy surgery (IES).
OBJECTIVE
To study the impact of failed IES and other surrogate marker of severe epilepsy on VNS effectiveness in a large cohort with treatment-resistant epilepsy (TRE).
METHODS
We retrospectively reviewed 376 patients (188 female patients; 265 adults; mean age, 29.4 years at implantation) with TRE who underwent VNS implantation between 1997 and 2008 and had at least 1 year of follow-up. One hundred ten patients (29.3%) had failed ≥1 prior craniotomies for TRE, and 266 (70.7%) had no history of IES.
RESULTS
The mean duration of VNS therapy was 5.1 years. Patients with prior IES were more commonly male and adult, had a greater number of seizure types, and more commonly had focal or multifocal vs generalized seizures (P > .05). There was no significant difference in the mean percentage seizure reduction between patients with and without a history of IES (59.1% vs 56.5%; P = .42). There was no correlation between type of failed IES (callosotomy vs resection) and seizure reduction with VNS therapy.
CONCLUSION
Failed IES did not affect the response to VNS therapy. Unlike prior reports, patients with callosotomy did not respond better than those who had resective surgery. Nearly 50% of patients experienced at least 50% reduction in seizure frequency. For patients with TRE, including patients who failed cranial epilepsy surgeries, VNS should be considered a palliative treatment option.
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Affiliation(s)
- Robert E. Elliott
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Amr Morsi
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Eric B. Geller
- Department of Neurology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Chad C. Carlson
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Orrin Devinsky
- Department of Neurology, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
| | - Werner K. Doyle
- Department of Neurosurgery, Neurosurgery and Psychiatry, New York University Langone Medical Center, New York, New York
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20
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Vale FL, Ahmadian A, Youssef AS, Tatum WO, Benbadis SR. Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery. Seizure 2010; 20:244-8. [PMID: 21196125 DOI: 10.1016/j.seizure.2010.12.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/27/2010] [Accepted: 12/03/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Adequate control of intractable epilepsy continues to be a challenge. Little is known about the role of VNS therapy in intractable epilepsy in patients who failed to respond to surgical management. The objective of the present study is to determine the efficacy of vagus nerve stimulation therapy in patients with intractable epilepsy who have failed surgical and medical therapy. METHODS All the patients who had persistent seizures after cranial surgery who subsequently underwent vagus nerve stimulator (VNS) placement at our institution from 1998 to 2008 were included in the study. Thirty-seven consecutive patients were enrolled and followed for the outcome measures of seizure burden, anti-epileptic drug (AED) burden and quality of life (QoL). Minimum follow-up was 18 months. RESULTS Overall, 24 (64.9%), 9 (24.3%), 4 (10.8%) patients reported less than 30%, between 30% and 60% and greater than 60% reduction in seizure frequency after VNS placement, respectively at a mean of 5 years follow-up period. Post-VNS anti-epileptic requirement exhibited a decreasing trend. 17 patients (45.9%) report an improvement in QoL (better or much better). CONCLUSION VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects.
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Affiliation(s)
- Fernando L Vale
- University of South Florida, Department of Neurosurgery, Tampa, FL 33606, United States.
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21
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Abstract
Vagus nerve stimulation (VNS) is an established neurostimulation therapy used to treat refractory epilepsy. The effect of acute or chronic VNS on the postictal state as a separate entity is seldom reported in clinical or experimental studies. Apart from its antiseizure effects, VNS has several other beneficial effects. These effects may be of particular benefit for patients with postictal neuropsychiatric symptoms. The hypothesized mechanisms underlying the initiation and sustainment of the postictal phase, to some extent, overlap with mechanisms involved in the seizure-suppressing effects of VNS as well as other neurological and psychotropic effects of VNS. Both the clinical symptoms and the basic research hypotheses of the postictal state show similarities with clinical effects induced by VNS and its underlying mechanisms of action.
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Affiliation(s)
- Kristl Vonck
- Reference Center for Refractory Epilepsy and Laboratory for Clinical and Experimental Neurophysiology, Department of Neurology, Ghent University Hospital, Gent, Belgium.
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22
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Ramos E, Benbadis S, Vale FL. Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis: results and treatment options. J Neurosurg 2009; 110:1127-34. [PMID: 19249930 DOI: 10.3171/2009.1.jns08638] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control. METHODS This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24-84 months). Surgeries were all performed by the senior author (F.L.V.). RESULTS Following initial surgical intervention, 97 patients (92%) improved to Engel Class I or II (Group A), and 8 (8%) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5%) with contralateral temporal EEG findings. Five patients (62.5%) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5%) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I. CONCLUSIONS Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.
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Affiliation(s)
- Edwin Ramos
- Department of Neurological Surgery, University of South Florida College of Medicine, Tampa, Florida, USA
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23
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Abstract
The aim of epilepsy surgery in children is not only to control seizures but also to curtail future adverse neurological sequelae and improve quality of life. If presurgical evaluation demonstrates discordant or multifocal disease, intracranial surgery may be denied as a viable treatment option. When surgical therapy is offered not just as curative but also as palliative therapy, many children not considered optimal surgical candidates may benefit. From a consecutive series of 57 cases involving children who underwent intracranial epilepsy surgery at Rainbow Babies and Children's Hospital during 2001-2005, the authors present in detail 3 cases involving children who benefited significantly from such an aggressive approach. Marked improvement occurred not only in seizure control, but also in developmental and social functioning.
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Affiliation(s)
- Monisha Goyal
- Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA
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24
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Abstract
Neurostimulation is an emerging treatment for neurological diseases. Electrical stimulation of the tenth cranial nerve or vagus nerve stimulation (VNS) has become a valuable option in the therapeutic armamentarium for patients with refractory epilepsy. It is indicated in patients with refractory epilepsy who are unsuitable candidates for epilepsy surgery or who have had insufficient benefit from such a treatment. Vagus nerve stimulation reduces seizure frequency with > 50% in 1/3 of patients and has a mild side effects profile. Research to elucidate the mechanism of action of vagus nerve stimulation has shown that effective stimulation in humans is primarily mediated by afferent vagal A- and B-fibers. Crucial brainstem and intracranial structures include the locus coeruleus, the nucleus of the solitary tract, the thalamus and limbic structures. Neurotransmitters playing a role may involve the major inhibitory neurotransmitter GABA but also serotoninergic and adrenergic systems. This manuscript reviews the clinical studies investigating efficacy and side effects in patients and the experimental studies aiming to elucidate the mechanims of action.
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Affiliation(s)
- K Vonck
- Department of Neurology, Ghent University Hospital, Gent, Belgium
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25
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Abstract
Vagus nerve stimulation (VNS) for epilepsy has been available in the United States for 8 years. Pivotal randomized, blinded clinical trials leading to FDA approval in patients age 12 and older with refractory partial seizures have not been performed for other age groups or epilepsy syndromes. This practical review takes stock of the current information about VNS use and efficacy in various types of epilepsy. We review the evidence for commonly used stimulation parameters, end of battery life, predictors of response including duration of epilepsy, seizure type/epilepsy syndrome, bihemispheric seizures, age at implant, and prior cranial surgery. We review adverse events and VNS effects on respiratory patterns, cardiac function, and mood and behavior. With the recent U.S. approval of VNS for treatment-resistant depression, we anticipate that lessons learned from treating patients with epilepsy will be useful to physicians using VNS to treat patients with depression and possibly other conditions.
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Affiliation(s)
- Evelyn S Tecoma
- Department of Neurosciences, University of California, San Diego, Epilepsy Center, UCSD Thornton Hospital, La Jolla, CA 92037-7740, USA.
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26
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Chen Z, Hao H, Li L, Dong J. Wavelet transform for rabbit EEG with vagus nerve electric stimulation. Conf Proc IEEE Eng Med Biol Soc 2006; 2006:1715-1718. [PMID: 17946063 DOI: 10.1109/iembs.2006.260698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Vagus nerve electric stimulation is a new method for preventing and treating epilepsy, pain disorders and depression with a subcutaneous surgically implanted device. The mechanisms of action of implanted stimulation device are still unknown. And the vagus nerve electric stimulator has several operating and stimulation parameters with the programming wand or the magnet. We had finished designing a new vagus nerve electric stimulator for the epilepsy last year. In order to analysis and detect the effects on the brain characteristics with these operation and the electrical activation, the rabbits are implanted the device. Then the EEG is used for recording the brain functional activity of the rabbit with the stimulator. Moreover the wavelet transform is employed to classify and separate the EEG signals into different spectral components. The delta, theta, alpha and beta waves are obtained to better understand the stimulation effects on the brain. The results demonstrated that the new device is safe and has excellent potential role for the epilepsy treatment.
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Affiliation(s)
- Zhaoyang Chen
- Dept. of Eng. Mech., Tsinghua Univ., Beijing, PR China
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27
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Gaykema RPA, Goehler LE, Lyte M. Brain response to cecal infection with Campylobacter jejuni: analysis with Fos immunohistochemistry. Brain Behav Immun 2004; 18:238-45. [PMID: 15050651 DOI: 10.1016/j.bbi.2003.08.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Revised: 07/17/2003] [Accepted: 08/19/2003] [Indexed: 01/30/2023] Open
Abstract
Infections with bacterial pathogens can induce increased anxiety-like behaviors in rodents without otherwise noticeable behavioral or physiological symptoms of sickness, as shown with the food-borne pathogen Campylobacter jejuni. This observation implicates the ability of the brain to sense, and respond to, such an infection. We tested our hypothesis that intestinal infection with the gram-negative bacterium C. jejuni leads to activation of certain brain regions that process gastro-intestinal sensory information. The induction of c-Fos protein as a marker for neuronal activation was assessed in the brains of mice inoculated orally with live C. jejuni, as compared to saline-treated controls. Upon colonization of the intestines, C. jejuni activated visceral sensory nuclei in the brainstem (the nucleus of the solitary tract and the lateral parabrachial nucleus) both one and two days after the oral challenge. In addition, increased c-Fos expression occurred in the hypothalamic paraventricular nucleus on the second day. This neural response occurred in the absence of measurable systemic immune activation, as serum levels of tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 were undetectable and/or unchanged. These findings support the notion that information about infection with C. jejuni in the gut is indeed relayed to the visceral sensory structures in the brain. The brain responses observed could contribute to changes in behavior observed after infection.
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Affiliation(s)
- Ronald P A Gaykema
- Department of Psychology and Neuroscience Graduate Program, University of Virginia, Charlottesville, VA 22904, USA.
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28
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Abstract
A long-recognized association exists between epilepsy and affective disturbance, especially depression. People with complex partial seizures that result from temporal lobe seizure foci are highly vulnerable to psychiatric disorders. Accurate diagnosis of such disorders is an important key to treatment. Interictal depression or dysphoria is the most clinically significant problem of this type. Pharmacotherapeutic treatments that have positive effects in other types of depressive illness are also effective for depression associated with epilepsy. Electroconvulsive therapy is helpful to some patients with depression that is refractory to drug treatment or psychotherapy. Surgical resection of seizure foci may lead to psychiatric improvement for some individuals, but can also have psychiatric complications.
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Affiliation(s)
- Brian A Greenlee
- Department of Psychiatry, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
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