Giuseppina Barbella1, Isabella Cocco2, Elena Freri3, Guia Marotta3, Elisa Visani4, Silvana Franceschetti4, Marina Casazza5. 1. Neurology Unit, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy. 2. School of Medicine and Surgery in Child Neurology, ASST Spedali Civili Hospital of Brescia, University of Brescia, Italy. 3. Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 4. Department of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 5. Department of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. Electronic address: Marina.Casazza@istituto-besta.it.
Abstract
PURPOSE: The aim of this trial was to investigate the efficacy and safety of transcutaneous vagal nerve stimulation (t-VNS) in the palliative treatment of drug resistant epileptic patients ineligible for surgery. METHODS: Twenty adult patients received four hours of t-VNS per day for six months (T1), followed by a two-month washout period (T2). The frequency and type of seizures recorded at T1 and T2 were compared with those occurring in the three months preceding study entry (T0). Responders (>30% reduction in the total number of seizures) subsequently received two hours of t-VNS per day for further six months (T3). All patients underwent electroencephalography (EEG) and completed the Quality of Life in Epilepsy questionnaire at baseline and T1. RESULTS: At T1 six patients were considered responders. In these patients, at T3 the average reduction in seizure frequency was 60% compared to T0 (p = 0.043), and 51% compared to T2 (p = 0.043). Responders had more often seizures with falls (5 of 6; 83.3%) compared with non-responders (3 of 14; 21.4%) (p = 0,010) and t-VNS reduced their frequency by a percentage ranging from 47.5 to 100%. There was no change in responders' EEG findings after stimulation. At the end of the trial, three responders continued t-VNS, one implanted VNS. CONCLUSIONS: t-VNS had no or minimal side effects and significantly reduced seizures in about one third of the enrolled patients. Further studies should be planned to assess whether t-VNS is a suitable tool to predict the efficacy of implanted VNS.
PURPOSE: The aim of this trial was to investigate the efficacy and safety of transcutaneous vagal nerve stimulation (t-VNS) in the palliative treatment of drug resistant epilepticpatients ineligible for surgery. METHODS: Twenty adult patients received four hours of t-VNS per day for six months (T1), followed by a two-month washout period (T2). The frequency and type of seizures recorded at T1 and T2 were compared with those occurring in the three months preceding study entry (T0). Responders (>30% reduction in the total number of seizures) subsequently received two hours of t-VNS per day for further six months (T3). All patients underwent electroencephalography (EEG) and completed the Quality of Life in Epilepsy questionnaire at baseline and T1. RESULTS: At T1 six patients were considered responders. In these patients, at T3 the average reduction in seizure frequency was 60% compared to T0 (p = 0.043), and 51% compared to T2 (p = 0.043). Responders had more often seizures with falls (5 of 6; 83.3%) compared with non-responders (3 of 14; 21.4%) (p = 0,010) and t-VNS reduced their frequency by a percentage ranging from 47.5 to 100%. There was no change in responders' EEG findings after stimulation. At the end of the trial, three responders continued t-VNS, one implanted VNS. CONCLUSIONS: t-VNS had no or minimal side effects and significantly reduced seizures in about one third of the enrolled patients. Further studies should be planned to assess whether t-VNS is a suitable tool to predict the efficacy of implanted VNS.
Authors: Randi von Wrede; Thorsten Rings; Timo Bröhl; Jan Pukropski; Sophia Schach; Christoph Helmstaedter; Klaus Lehnertz Journal: Front Hum Neurosci Date: 2022-06-23 Impact factor: 3.473
Authors: Adam D Farmer; Adam Strzelczyk; Alessandra Finisguerra; Alexander V Gourine; Alireza Gharabaghi; Alkomiet Hasan; Andreas M Burger; Andrés M Jaramillo; Ann Mertens; Arshad Majid; Bart Verkuil; Bashar W Badran; Carlos Ventura-Bort; Charly Gaul; Christian Beste; Christopher M Warren; Daniel S Quintana; Dorothea Hämmerer; Elena Freri; Eleni Frangos; Eleonora Tobaldini; Eugenijus Kaniusas; Felix Rosenow; Fioravante Capone; Fivos Panetsos; Gareth L Ackland; Gaurav Kaithwas; Georgia H O'Leary; Hannah Genheimer; Heidi I L Jacobs; Ilse Van Diest; Jean Schoenen; Jessica Redgrave; Jiliang Fang; Jim Deuchars; Jozsef C Széles; Julian F Thayer; Kaushik More; Kristl Vonck; Laura Steenbergen; Lauro C Vianna; Lisa M McTeague; Mareike Ludwig; Maria G Veldhuizen; Marijke De Couck; Marina Casazza; Marius Keute; Marom Bikson; Marta Andreatta; Martina D'Agostini; Mathias Weymar; Matthew Betts; Matthias Prigge; Michael Kaess; Michael Roden; Michelle Thai; Nathaniel M Schuster; Nicola Montano; Niels Hansen; Nils B Kroemer; Peijing Rong; Rico Fischer; Robert H Howland; Roberta Sclocco; Roberta Sellaro; Ronald G Garcia; Sebastian Bauer; Sofiya Gancheva; Stavros Stavrakis; Stefan Kampusch; Susan A Deuchars; Sven Wehner; Sylvain Laborde; Taras Usichenko; Thomas Polak; Tino Zaehle; Uirassu Borges; Vanessa Teckentrup; Vera K Jandackova; Vitaly Napadow; Julian Koenig Journal: Front Hum Neurosci Date: 2021-03-23 Impact factor: 3.169