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Wessel C, Candan FU, Panah PY, Karia S, Sah J, Mutchnick I, Karakas C. Efficacy of vagus nerve stimulation in managing drug-resistant absence epilepsy syndromes. Seizure 2024; 117:60-66. [PMID: 38330751 DOI: 10.1016/j.seizure.2024.01.019] [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: 11/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Around 11% of patients with absence epilepsy develop drug-resistant absence epilepsy (DRAE), and are at increased risk for developing psychiatric and neurologic comorbidities. Current therapeutic options for DRAE are limited. The purpose of this study was to assess the efficacy of vagus nerve stimulation (VNS) in treating DRAE. METHODS Our institution maintains a database of patients who received VNS between 2010 and 2022. We identified DRAE patients who were <18 years of age at seizure onset, were electro-clinically diagnosed with an absence epilepsy syndrome (childhood absence, juvenile absence, or Jeavons Syndrome) by an epileptologist, and had normal brain imaging. The primary outcome measure was post-VNS absence seizure frequency. RESULTS Twenty-six patients (M/F:14/12) were identified. Median age at seizure onset was 7 years (IQR 4-10) and patients experienced seizures for 6 years (IQR 4.3-7.6) before VNS. After VNS, the median absence seizure frequency reduced to 1.5 days (IQR 0.1-3.5) per week from 7 days (IQR 7-7), a 66% reduction seizure frequency. VNS responder rate was 80%, and seven patients achieved seizure freedom. There was no significant effect on VNS efficacy between the time from DRAE diagnosis to VNS placement (p = 0.067) nor the time from first seizure onset to VNS implant (p = 0.80). The median follow-up duration was 4.1 years (IQR 2.4-6.7), without any significant association between follow-up duration and VNS efficacy (r2=0.023) CONCLUSIONS: VNS is effective in managing DRAE. The responder rate was 80%; seizure improvement was independent of age at both seizure onset and latency to VNS after meeting DRAE criteria.
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Affiliation(s)
- Caitlin Wessel
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Feride Un Candan
- Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States
| | - Paya Yazdan Panah
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Samir Karia
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Jeetendra Sah
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Ian Mutchnick
- University of Louisville School of Medicine, Louisville KY 40202, United States; University of Louisville Department of Neurosurgery, Louisville KY 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Cemal Karakas
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States.
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Yeap TB, Koo TH, Ang SY, Ab Mukmin L. Perianaesthetic management on a child with Lennox-Gastaut Syndrome for vagus nerve stimulation (VNS) placement. BMJ Case Rep 2023; 16:e255897. [PMID: 38011949 PMCID: PMC10685940 DOI: 10.1136/bcr-2023-255897] [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] [Indexed: 11/29/2023] Open
Abstract
Vagus nerve stimulation (VNS) is a neurostimulatory modality in treating patients with medically resistant epilepsy (MRE). It was introduced in 1997 and has been proven to reduce patients' dependency on antiepileptic drugs and seizure frequency. However, the usage of VNS in children with MRE has been limited, especially those with Lennox Gastaut Syndrome (LGS). Our teenage boy with this syndrome developed MRE and successfully underwent VNS placement. We discuss the perianaesthetic challenges, a brief description of VNS and the reported successes in patients with LGS.
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Affiliation(s)
- Tat Boon Yeap
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Thai Hau Koo
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Laila Ab Mukmin
- Department of Anaesthesia and Intensive Care Unit, Hospital Universiti Sains Malaysia, Kota Bahru, Kelantan, Malaysia
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Ghosh S, Sinha JK, Ghosh S, Sharma H, Bhaskar R, Narayanan KB. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci 2023; 13:1305. [PMID: 37759906 PMCID: PMC10527076 DOI: 10.3390/brainsci13091305] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy is a complex neurological disorder affecting millions worldwide, with a substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone of epilepsy treatment, but their limitations necessitate alternative approaches. The review delves into cutting-edge therapies such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), highlighting their mechanisms of action and promising clinical outcomes. Additionally, the potential of gene therapies and optogenetics in epilepsy research is discussed, revealing groundbreaking findings that shed light on seizure mechanisms. Insights into cannabidiol (CBD) and the ketogenic diet as adjunctive therapies further broaden the spectrum of epilepsy management. Challenges in achieving seizure control with traditional therapies, including treatment resistance and individual variability, are addressed. The importance of staying updated with emerging trends in epilepsy management is emphasized, along with the hope for improved therapeutic options. Future research directions, such as combining therapies, AI applications, and non-invasive optogenetics, hold promise for personalized and effective epilepsy treatment. As the field advances, collaboration among researchers of natural and synthetic biochemistry, clinicians from different streams and various forms of medicine, and patients will drive progress toward better seizure control and a higher quality of life for individuals living with epilepsy.
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Affiliation(s)
- Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
- ICMR—National Institute of Nutrition, Tarnaka, Hyderabad 500007, India
| | | | - Soumya Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | | | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kannan Badri Narayanan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
- Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
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González-González MA, Alemansour H, Maroufi M, Coskun MB, Lloyd D, Reza Moheimani SO, Romero-Ortega MI. Biomechanics Characterization of Autonomic and Somatic Nerves by High Dynamic Closed-Loop MEMS force sensing. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.13.536752. [PMID: 37090537 PMCID: PMC10120675 DOI: 10.1101/2023.04.13.536752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The biomechanics of peripheral nerves are determined by the blood-nerve barrier (BNB), together with the epineural barrier, extracellular matrix, and axonal composition, which maintain structural and functional stability. These elements are often ignored in the fabrication of penetrating devices, and the implant process is traumatic due to the mechanical distress, compromising the function of neuroprosthesis for sensory-motor restoration in amputees. Miniaturization of penetrating interfaces offers the unique opportunity of decoding individual nerve fibers associated to specific functions, however, a main issue for their implant is the lack of high-precision standardization of insertion forces. Current automatized electromechanical force sensors are available; however, their sensitivity and range amplitude are limited (i.e. mN), and have been tested only in-vitro. We previously developed a high-precision bi-directional micro-electromechanical force sensor, with a closed-loop mechanism (MEMS-CLFS), that while measuring with high-precision (-211.7μN to 211.5μN with a resolution of 4.74nN), can be used in alive animal. Our technology has an on-chip electrothermal displacement sensor with a shuttle beam displacement amplification mechanism, for large range and high-frequency resolution (dynamic range of 92.9 dB), which eliminates the adverse effect of flexural nonlinearity measurements, observed with other systems, and reduces the mechanical impact on delicate biological tissue. In this work, we use the MEMS-CLFS for in-vivo bidirectional measurement of biomechanics in somatic and autonomic nerves. Furthermore we define the mechanical implications of irrigation and collagen VI in the BNB, which is different for both autonomic and somatic nerves (~ 8.5-8.6 fold density of collagen VI and vasculature CD31+ in the VN vs ScN). This study allowed us to create a mathematical approach to predict insertion forces. Our data highlights the necessity of nerve-customization forces to prevent injury when implanting interfaces, and describes a high precision MEMS technology and mathematical model for their measurements.
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Affiliation(s)
| | - Hammed Alemansour
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX. 75080
| | - Mohammad Maroufi
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX. 75080
| | - Mustafa Bulut Coskun
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX. 75080
| | - David Lloyd
- Biomedical Engineering and Biomedical Sciences. University of Houston, Houston TX. 77204-6064
| | - S. O. Reza Moheimani
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX. 75080
| | - Mario I. Romero-Ortega
- Biomedical Engineering and Biomedical Sciences. University of Houston, Houston TX. 77204-6064
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Sunkonkit K, Go C, Alzaid M, Massicotte C, Narang I, Amin R. An Unusual Cause of Worsening Obstructive Sleep Apnea. Clin Pediatr (Phila) 2023; 62:188-190. [PMID: 36016488 DOI: 10.1177/00099228221118957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kanokkarn Sunkonkit
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cristina Go
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mohammed Alzaid
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Colin Massicotte
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Coskun Y, Yildirim C. A 3-year-old child with multi-drug resistant epilepsy responding to pharmacological and nonpharmacological treatments. Int J Neurosci 2023; 133:322-326. [PMID: 33843424 DOI: 10.1080/00207454.2021.1916488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Despite the development of new antiseizure drugs (ASDs), around one third of epilepsy patients become refractory to treatment or experience adverse events due to ASDs. Therefore, discovery of new ASDs and new therapy options are crucial to improve the quality of life. Herein, we report a 3-year-old child with multi-drug resistant epilepsy caused by perinatal asphyxia whose seizures were reduced by 90% after the introduction of ketogenic diet, vagal nerve stimulation (VNS) AspireSR (SR-seizure response) and oral cannabidiol.Case presentation: A 9-month-old female infant had a history of multidrug resistant epilepsy due to perinatal asphyxia. At admission, she was experiencing up to 20-25 seizures per day lasting for 2-3 minutes. In addition to antiseizure drugs (ASDs), she was put on ketogenic diet (KD), vagal nerve stimulation (VNS) aspire seizure response (AspireSR) was inserted and oral cannabidiol (CBD) was started sequentially. Using pharmacological and nonph armacological therapies, her seizures have been reduced by 90%.Conclusion: The concurrent use of pharmacological and nonpharmacological therapies may be beneficial to improve seizures in infants with multi- Furthermore, our patient is the youngest child inserted VNS AspireSR in Turkey.
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Affiliation(s)
- Yesim Coskun
- Department of Pediatrics, Koc University Hospital, Istanbul, Turkey
| | - Canan Yildirim
- Department of Pediatrics, Division of Pediatric Neurology, Okan University School of Medicine, Istanbul, Turkey
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LoPresti MA, Katlowitz KA, Sharma H, McGinnis JP, Weiner HL. Pediatric Vagus Nerve Stimulation: Case Series Outcomes and Future Directions. Neurosurgery 2023; 92:1043-1051. [PMID: 36700739 DOI: 10.1227/neu.0000000000002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a neuromodulatory procedure most extensively studied as an adjunct to medically refractory epilepsy. Despite widespread adoption and decades of clinical experience, clinical predictors of response to VNS remain unclear. OBJECTIVE To evaluate a retrospective cohort of pediatric patients undergoing VNS at our institution to better understand who may benefit from VNS and identify factors which may predict response to VNS. METHODS We conducted a retrospective cohort study examining pediatric patients undergoing VNS over nearly a 20-year span at a single institution. Presurgical evaluation, including demographics, clinical history, and diagnostic electroencephalogram, and imaging findings were examined. Primary outcomes included VNS response. RESULTS Two hundred ninety-seven subjects were studied. The mean age at surgery was 10.1 (SD = 4.9, range = 0.8-25.3) years; length of follow-up was a mean of 4.6 years (SD = 3.5, median = 3.9 years, range 1 day-16.1 years). There was no association between demographic factors, epilepsy etiology, or genetic basis and VNS outcomes. There was an association between reduction in main seizure type with positive MRI finding. Of all MRI findings analyzed, brain atrophy was significantly associated with worse VNS outcomes, whereas dysplastic hippocampus and chronic periventricular leukomalacia findings were found to be associated with improved outcomes. Increased seizure semiology variability and seizure type were also associated with improved seizure outcomes. CONCLUSION Predicting response to VNS remains difficult, leading to incompletely realized benefits and suboptimal resource utilization. Specific MRI findings and increased seizure semiology variability and type can help guide clinical decision making and patient counseling.
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Affiliation(s)
- Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
| | - Kalman A Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
| | - John P McGinnis
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
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Abstract
BACKGROUND This is an updated version of the Cochrane Review published in 2015. Epilepsy is a chronic neurological disorder, characterised by recurring, unprovoked seizures. Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with drug-resistant epilepsy. VNS consists of chronic, intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator. OBJECTIVES To evaluate the efficacy and tolerability of VNS when used as add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS For this update, we searched the Cochrane Register of Studies (CRS), and MEDLINE Ovid on 3 March 2022. We imposed no language restrictions. CRS Web includes randomised or quasi-randomised controlled trials from the Specialised Registers of Cochrane Review Groups, including Epilepsy, CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We considered parallel or cross-over, randomised, double-blind, controlled trials of VNS as add-on treatment, which compared high- and low-level stimulation (including three different stimulation paradigms: rapid, mild, and slow duty-cycle), and VNS stimulation versus no stimulation, or a different intervention. We considered adults or children with drug-resistant focal seizures who were either not eligible for surgery, or who had failed surgery. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods, assessing the following outcomes: 1. 50% or greater reduction in seizure frequency 2. Treatment withdrawal (any reason) 3. Adverse effects 4. Quality of life (QoL) 5. Cognition 6. Mood MAIN RESULTS We did not identify any new studies for this update, therefore, the conclusions are unchanged. We included the five randomised controlled trials (RCT) from the last update, with a total of 439 participants. The baseline phase ranged from 4 to 12 weeks, and double-blind treatment phases from 12 to 20 weeks. We rated two studies at an overall low risk of bias, and three at an overall unclear risk of bias, due to lack of reported information about study design. Effective blinding of studies of VNS is difficult, due to the frequency of stimulation-related side effects, such as voice alteration. The risk ratio (RR) for 50% or greater reduction in seizure frequency was 1.73 (95% confidence interval (CI) 1.13 to 2.64; 4 RCTs, 373 participants; moderate-certainty evidence), showing that high frequency VNS was over one and a half times more effective than low frequency VNS. The RR for treatment withdrawal was 2.56 (95% CI 0.51 to 12.71; 4 RCTs, 375 participants; low-certainty evidence). Results for the top five reported adverse events were: hoarseness RR 2.17 (99% CI 1.49 to 3.17; 3 RCTs, 330 participants; moderate-certainty evidence); cough RR 1.09 (99% CI 0.74 to 1.62; 3 RCTs, 334 participants; moderate-certainty evidence); dyspnoea RR 2.45 (99% CI 1.07 to 5.60; 3 RCTs, 312 participants; low-certainty evidence); pain RR 1.01 (99% CI 0.60 to 1.68; 2 RCTs; 312 participants; moderate-certainty evidence); paraesthesia 0.78 (99% CI 0.39 to 1.53; 2 RCTs, 312 participants; moderate-certainty evidence). Results from two studies (312 participants) showed that a small number of favourable QOL effects were associated with VNS stimulation, but results were inconclusive between high- and low-level stimulation groups. One study (198 participants) found inconclusive results between high- and low-level stimulation for cognition on all measures used. One study (114 participants) found the majority of participants showed an improvement in mood on the Montgomery-Åsberg Depression Rating Scale compared to baseline, but results between high- and low-level stimulation were inconclusive. We found no important heterogeneity between studies for any of the outcomes. AUTHORS' CONCLUSIONS VNS for focal seizures appears to be an effective and well-tolerated treatment. Results of the overall efficacy analysis show that high-level stimulation reduced the frequency of seizures better than low-level stimulation. There were very few withdrawals, which suggests that VNS is well tolerated. Adverse effects associated with implantation and stimulation were primarily hoarseness, cough, dyspnoea, pain, paraesthesia, nausea, and headache, with hoarseness and dyspnoea more likely to occur with high-level stimulation than low-level stimulation. However, the evidence for these outcomes is limited, and of moderate to low certainty. Further high-quality research is needed to fully evaluate the efficacy and tolerability of VNS for drug-resistant focal seizures.
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Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alexandra Rigby
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Jankauskaite L, Malinauskas M, Mickeviciute GC. HMGB1: A Potential Target of Nervus Vagus Stimulation in Pediatric SARS-CoV-2-Induced ALI/ARDS. Front Pediatr 2022; 10:884539. [PMID: 35633962 PMCID: PMC9132499 DOI: 10.3389/fped.2022.884539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/11/2022] [Indexed: 12/19/2022] Open
Abstract
From the start of pandemics, children were described as the ones who were less affected by SARS-Cov-2 or COVID-19, which was mild in most of the cases. However, with the growing vaccination rate of the adult population, children became more exposed to the virus and more cases of severe SARS-CoV-2-induced ARDS are being diagnosed with the disabling consequences or lethal outcomes associated with the cytokine storm. Thus, we do hypothesize that some of the children could benefit from nervus vagus stimulation during COVID-19 ARDS through the inhibition of HMGB1 release and interaction with the receptor, resulting in decreased neutrophil accumulation, oxidative stress, and coagulopathy as well as lung vascular permeability. Moreover, stimulation through alpha-7 nicotinic acetylcholine receptors could boost macrophage phagocytosis and increase the clearance of DAMPs and PAMPs. Further rise of FGF10 could contribute to lung stem cell proliferation and potential regeneration of the injured lung. However, this stimulation should be very specific, timely, and of proper duration, as it could lead to such adverse effects as increased viral spread and systemic infection, especially in small children or infants due to specific pediatric immunity state and anatomical features of the respiratory system.
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Affiliation(s)
- Lina Jankauskaite
- Lithuanian University of Health Sciences, Medical Academy, Pediatric Department, Kaunas, Lithuania
- Lithuanian University of Health Sciences, Medical Academy, Institute of Physiology and Pharmacology, Kaunas, Lithuania
| | - Mantas Malinauskas
- Lithuanian University of Health Sciences, Medical Academy, Institute of Physiology and Pharmacology, Kaunas, Lithuania
| | - Goda-Camille Mickeviciute
- Lithuanian University of Health Sciences, Medical Academy, Pediatric Department, Kaunas, Lithuania
- Lithuanian University of Health Sciences, Medical Academy, Institute of Physiology and Pharmacology, Kaunas, Lithuania
- Rehabilitation Center “Palangos Linas”, Palanga, Lithuania
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Costea RM, Maniu I, Dobrota L, Pérez-Elvira R, Agudo M, Oltra-Cucarella J, Dragomir A, Bacilă C, Banciu A, Banciu DD, Cipăian CR, Crișan R, Neamtu B. Exploring Inflammatory Status in Febrile Seizures Associated with Urinary Tract Infections: A Two-Step Cluster Approach. Brain Sci 2021; 11:1168. [PMID: 34573189 PMCID: PMC8465625 DOI: 10.3390/brainsci11091168] [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: 07/31/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are considered common facilitating factors, along with other infections, in triggering febrile seizures (FS). The main purpose of our study was to identify specific inflammatory patterns of UTI cases from other infections in a specific cluster, using a combination of inflammatory biomarkers to differentiate UTIs from other bacterial diseases triggering FS. METHOD This prospective study included a number of 136 patients with 197 distinct FS events, from patients hospitalized in the Pediatric Clinical Hospital Sibiu, among which 10.2% were diagnosed with UTIs. RESULTS In one-third of the patients with UTIs (20 cases), the symptoms were limited to fever and FS. Using two-step cluster analysis, a distinct UTI inflammatory pattern has emerged: highest platelet values (PLT), median value 331 × 103/mm3 and intermediate C-reactive protein (CRP), median value 15 mg/dL, platelet distribution width (PDW), median value 9.65%, platelet-large cell ratio (P-LCR), median value 14.45%, mean platelet volume (MPV), median value 8.60 fL and neutrophil-to-lymphocyte values (NLR), median value 3.64. Furthermore, higher PDW (median value 12.25%), P-LCR (median value 28.55%), MPV (median value 10.40 fL), CRP (median value 74.00 mg/dL) and NLR values (median value 4.11) were associated mainly (85.7%) with bacterial lower respiratory infections. UTIs were highly unlikely in these patients with significantly increased CRP values and normal values of platelet indices. CONCLUSIONS Considering the nonspecific clinical picture of UTIs at an early age, to optimize the management of FS, a fast diagnosis of UTI is mandatory. The analysis of the inflammatory biomarker clusters (rather than individual parameters) correlated with urine leukocyte and nitrite stick evaluation for specific age groups could help in identifying even oligosymptomatic UTIs patients. The study limitation (20 UTI cases) recommends future multicentric trials on larger datasets to validate the model.
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Affiliation(s)
- Raluca Maria Costea
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Pediatric Neurology Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Ionela Maniu
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Research Center in Informatics and Information Technology, Mathematics and Informatics Department, Faculty of Sciences, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
| | - Luminita Dobrota
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Rubén Pérez-Elvira
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain; (R.P.-E.); (M.A.)
| | - Maria Agudo
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 37003 Salamanca, Spain; (R.P.-E.); (M.A.)
| | - Javier Oltra-Cucarella
- Department of Health Psychology, Universidad Miguel Hernández de Elche, 03202 Elche, Spain;
| | - Andrei Dragomir
- N.1 Institute for Health, National University of Singapore, Singapore 117575, Singapore;
| | - Ciprian Bacilă
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Adela Banciu
- Department of Bioengineering and Biotechnology, Faculty of Medical Engineering, Politechnic University of Bucharest, 011061 Bucharest, Romania; (A.B.); (D.D.B.)
| | - Daniel Dumitru Banciu
- Department of Bioengineering and Biotechnology, Faculty of Medical Engineering, Politechnic University of Bucharest, 011061 Bucharest, Romania; (A.B.); (D.D.B.)
| | - Călin Remus Cipăian
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Roxana Crișan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
| | - Bogdan Neamtu
- Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (L.D.); (C.B.); (C.R.C.); (R.C.)
- Computer and Electrical Engineering Department, Faculty of Engineering, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania
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Subgroup analysis of seizure and cognitive outcome after vagal nerve stimulator implantation in children. Childs Nerv Syst 2021; 37:243-252. [PMID: 32361930 DOI: 10.1007/s00381-020-04628-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Vagal nerve stimulator (VNS) implantation at an early age seems to lead to improved quality of life and cognitive outcome. The aim of this analysis is to evaluate whether specific patient or seizure characteristics might lead to better seizure control, cognitive outcome, and higher quality of life in children undergoing VNS implantation. METHODS Primary outcome measure was reduction in seizure frequency. Secondary outcome measures were epilepsy outcome assessed by McHugh and Engel classifications, reduction in antiepileptic drugs (AED), developmental and cognitive outcome, as well as quality of life assessed through the pediatric quality of life (PEDSQL™) questionnaire and care giver impression (CGI) scale. Forty-five consecutive children undergoing VNS implantation were analyzed for the following subgroups: age (categorized to 1-2 years old, 3-5 years old, 6-12 years old, and 13-18 years old), sex, underlying cause (categorized to idiopathic, encephalitis, stroke, syndromic), duration of preoperative seizures (dichotomized to under or above 89 months, corresponding to the median of the whole cohort), and preoperative seizure frequency (dichotomized to under and above 360 seizures per month). RESULTS Encephalitis as the underlying cause for seizures was the only variable significantly associated with higher reduction rate of seizure frequency. Patients with VNS implantation at the age of ≤ 2 years showed a strong association with better developmental and cognitive outcome, as well as quality of life. Shorter duration of preoperative seizures and higher preoperative seizure frequency showed a strong association with better developmental outcome, as well as quality of life. Engel outcome scores were significantly better in patients with epilepsy due to encephalitis (100% Engel I-III). However, patients with epilepsy due to encephalitis showed significantly higher complication rates (71.4%, p = 0.045). CONCLUSIONS Children suffering from epilepsy due to encephalitis show higher seizure reduction rates after VNS implantation when compared with children suffering from epilepsy due to other causes. Developmental and cognitive outcomes as well as quality of life of children undergoing VNS implantation is strongly associated with shorter duration of preoperative seizures and implantation at a young age.
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Zhu J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. Epilepsy duration as an independent predictor of response to vagus nerve stimulation. Epilepsy Res 2020; 167:106432. [DOI: 10.1016/j.eplepsyres.2020.106432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022]
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Muthiah N, Zhang J, Remick M, Welch W, Sogawa Y, Jeong JH, Abel TJ. Efficacy of vagus nerve stimulation for drug-resistant epilepsy in children age six and younger. Epilepsy Behav 2020; 112:107373. [PMID: 32942207 DOI: 10.1016/j.yebeh.2020.107373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The objective of the study were to examine the safety and efficacy of vagus nerve stimulation (VNS) for reducing seizure frequency and antiepileptic drugs (AEDs) in children younger than six years and to examine long-term VNS efficacy for children who receive the device at ages 1-3 and at ages 4-6. METHODS We conducted a 10-year retrospective analysis of VNS implantations at UPMC Children's Hospital of Pittsburgh. Relevant data were collected within 12 months of VNS implantation and at six months, one, two, and four years after VNS implantation. RESULTS This analysis included 99 patients ages 0-3 (n = 40) and 4-6 (n = 59) at first VNS implantation. Eighty-six patients followed up for ≥4 years. There were no significant differences between age at VNS implant (0-3 vs. 4-6) and seizure etiology or most seizure semiologies. Patients took an average of 3.01 ± 1.29 AEDs prior to VNS and 3.84 ± 1.68 AEDs at their latest follow-up. The overall response to VNS therapy (≥50% seizure reduction) at one year, two years, and four years after VNS implantation was 55%, 60%, and 52%, respectively. At two years, 59% of 0- to 3-year-old patients responded to VNS and 52% of 4- to 6-year-old patients responded to VNS. The overall major complication rate was 5.6%, consistent with VNS use for older age groups. SIGNIFICANCE This study demonstrates the safety and efficacy of VNS for children with drug-resistant epilepsy (DRE) younger than six. One, two, and four years after VNS implantation, 55%, 60%, and 52% of these patients, respectively, achieved ≥50% reduction in seizure frequency. The safety of VNS is also comparable with older, better studied, age groups. Based on these data, VNS therapy should be considered for children younger than six.
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Affiliation(s)
| | - Jun Zhang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Madison Remick
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - William Welch
- Division of Pediatric Neurology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yoshimi Sogawa
- Division of Pediatric Neurology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jong-Hyeon Jeong
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA, USA
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Davis P, Gaitanis J. Neuromodulation for the Treatment of Epilepsy: A Review of Current Approaches and Future Directions. Clin Ther 2020; 42:1140-1154. [DOI: 10.1016/j.clinthera.2020.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 02/08/2023]
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Zhang M, Gazimbi MM, Chen Z, Zhang B, Chen Y, Yu Y, Tang J. Association between birth weight and neurodevelopment at age 1-6 months: results from the Wuhan Healthy Baby Cohort. BMJ Open 2020; 10:e031916. [PMID: 31900268 PMCID: PMC6955482 DOI: 10.1136/bmjopen-2019-031916] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The association between birth weight and infants' neurodevelopment is not well understood. We aimed to examine the impact of birth weight on neurodevelopment of infants at age 1-6 months using data from the Wuhan Healthy Baby Cohort (WHBC) study. SETTING AND PARTICIPANTS This is a prospective cohort study of 4026 infants from the WHBC study who were born at the Women and Children's Hospital of Wuhan, China between October 2012 and September 2013 and who had complete healthcare records within 6 months after birth. Participants were categorised into three groups according to their birth weight: low birth weight (LBW; birth weight <2500 g), normal birth weight (2500 g ≤ birth weight <4000 g) and macrosomia (birth weight ≥4000 g). MAIN OUTCOME MEASURES The main outcomes were development quotient (DQ) and clinical diagnosis of neurodevelopmental delay. Both adjusted regression coefficients and ORs were estimated for LBW and macrosomia. RESULTS Of the 4026 infants, 166 (4.12%) were of LBW and 237 (5.89%) were with macrosomia. Adjusted regression coefficients of LBW and macrosomia for gross motor DQ were -11.18 (95% CI -11.36 to 10.99) and 0.49 (95% CI 0.36 to 0.63), fine motor DQ -6.57 (95% CI -6.76 to -6.39) and -2.73 (95% CI -2.87 to -2.59), adaptability DQ -4.87 (95% CI -5.05 to -4.68) and -1.19 (95% CI -1.33 to -1.05), language DQ -6.23 (95% CI -6.42 to -6.05) and 0.43 (95% CI 0.29 to 0.57), and social behaviour DQ -6.82 (95% CI -7.01 to -6.64) and 1.10 (95% CI 0.96 to 1.24). Adjusted OR of LBW for clinical diagnosis of 'neurodevelopmental delay' in gross motor was 2.43 (95% CI 1.65 to 3.60), fine motor 1.49 (95% CI 1.01 to 2.19) and adaptability 1.56 (95% CI 1.06 to 2.31). LBW has no significant effects on 'neurodevelopmental delay' in language and social behaviour, and macrosomia has no significant effects on clinical diagnosis of 'neurodevelopmental delay' in all domains. CONCLUSION Both LBW and macrosomia are associated with infants' DQ, and LBW increases the risk of being diagnosed with 'neurodevelopmental delay' in gross motor, fine motor and adaptability among infants aged 1-6 months.
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Affiliation(s)
- Man Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Zhong Chen
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Bin Zhang
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Yanru Chen
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yizhen Yu
- Child and Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
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Qin X, Lin S, Yuan Y, Wen J, Chen Q, Lu X, Sun Y, Wang F, Tian X, Jiang N, Liao J, Li L. Vagus nerve stimulation for pediatric patients with drug-resistant epilepsy caused by genetic mutations: Two cases. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Vagus nerve stimulation (VNS) is a neuromodulation therapy increasingly used for treating drug-resistant epilepsy. However, it remains to be determined which patients are best suited for the treatment, and it is difficult to predict the therapeutic effect before the implantation. Mutations in some genes could lead to epilepsy. Here we report two cases of pediatric patients with drug-resistant epilepsy treated by VNS therapy: Patient 1 with ARX mutation achieved good outcomes; Patient 2 with the CDKL5 mutation did not show improvement. Additionally, the therapeutic impact of VNS on brain networks was investigated, hoping to provide some empirical evidence for a better understanding of the mechanism of VNS treatment.
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Yang Z, Zhang C, Wang Z, Cheng T, Qin X, Deng J, Fang X, Hao H, Peng J, Yin F, Li L. Vagal nerve stimulation is effective in pre-school children with intractable epilepsy: A report of two cases. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There is lack of prospective evidence regarding vagal nerve stimulator (VNS) in younger children with intractable epilepsy. Here, we report the outcomes of using VNS in two pre-school patients for pediatric intractable epilepsy (VNS-PIE) study. Medical treatment was ineffective in both the patients, and they underwent VNS implantation. Seizure frequency, score on the Gesell scale, and heart rate variability (HRV) were assessed following VNS therapy. After 6 months VNS treatment, the seizure frequency in the two patients decreased by 50% from that at baseline, based on the records in their epileptic diary. Video electroencephalography (EEG) examinations showed that abnormal fast waves diminished in the background in Patient 1, and captured seizure frequency in Patient 2 remarkably decreased. The adaptability, language, and individual and social interaction on their Gesell scales increased slightly, suggesting that VNS had a positive effect on the development of these two children. Moreover, the changes in the different HRV indices indicated improved cardiac autonomic function. In conclusion, these two cases indicated that VNS may not only be a superior therapy for pre-school children with intractable epilepsy, but also may exert a positive effect on their mental development and cardiac autonomic function.
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Starnes K, Miller K, Wong-Kisiel L, Lundstrom BN. A Review of Neurostimulation for Epilepsy in Pediatrics. Brain Sci 2019; 9:brainsci9100283. [PMID: 31635298 PMCID: PMC6826633 DOI: 10.3390/brainsci9100283] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
Neurostimulation for epilepsy refers to the application of electricity to affect the central nervous system, with the goal of reducing seizure frequency and severity. We review the available evidence for the use of neurostimulation to treat pediatric epilepsy, including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), chronic subthreshold cortical stimulation (CSCS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We consider possible mechanisms of action and safety concerns, and we propose a methodology for selecting between available options. In general, we find neurostimulation is safe and effective, although any high quality evidence applying neurostimulation to pediatrics is lacking. Further research is needed to understand neuromodulatory systems, and to identify biomarkers of response in order to establish optimal stimulation paradigms.
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Affiliation(s)
- Keith Starnes
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kai Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Cluster headache: crosspoint between otologists and neurologists—treatment of the sphenopalatine ganglion and systematic review. Neurol Sci 2019; 40:137-146. [DOI: 10.1007/s10072-019-03796-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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