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Lee YS, Kim WJ, Shim M, Hong KH, Choi H, Song JJ, Hwang HJ. Investigating neuromodulatory effect of transauricular vagus nerve stimulation on resting-state electroencephalography. Biomed Eng Lett 2024; 14:677-687. [PMID: 38946812 PMCID: PMC11208373 DOI: 10.1007/s13534-024-00361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/19/2024] [Accepted: 02/04/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose: The purpose of this study was to investigate the neuromodulatory effects of transauricular vagus nerve stimulation (taVNS) and determine optimal taVNS duration to induce the meaningful neuromodulatroty effects using resting-state electroencephalography (EEG). Method: Fifteen participants participated in this study and taVNS was applied to the cymba conchae for a duration of 40 min. Resting-state EEG was measured before and during taVNS application. EEG power spectral density (PSD) and brain network indices (clustering coefficient and path length) were calculated across five frequency bands (delta, theta, alpha, beta and gamma), respectively, to assess the neuromodulatory effect of taVNS. Moreover, we divided the whole brain region into the five regions of interest (frontal, central, left temporal, right temporal, and occipital) to confirm the neuromodulation effect on each specific brain region. Result: Our results demonstrated a significant increase in EEG frequency powers across all five frequency bands during taVNS. Furthermore, significant changes in network indices were observed in the theta and gamma bands compared to the pre-taVNS measurements. These effects were particularly pronounced after approximately 10 min of stimulation, with a more dominant impact observed after approximately 20-30 min of taVNS application. Conclusion: The findings of this study indicate that taVNS can effectively modulate the brain activity, thereby exerting significant effects on brain characteristics. Moreover, taVNS duration of approximately 20-30 min was considered appropriate for inducing a stable and efficient neuromodulatory effects. Consequently, these findings have the potential to contribute to research aimed at enhancing cognitive and motor functions through the modulation of EEG using taVNS. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-024-00361-8.
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Affiliation(s)
- Yun-Sung Lee
- Department of Electronics and Information, Korea University, Sejong, 30019 Republic of Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, Republic of Korea
| | - Woo-Jin Kim
- Department of Electronics and Information, Korea University, Sejong, 30019 Republic of Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, Republic of Korea
| | - Miseon Shim
- Department of Artificial Intelligence, Tech University of Korea, Siheung, Republic of Korea
| | - Ki Hwan Hong
- Neurive Co., Ltd, Gimhae, 50969 Republic of Korea
| | - Hyuk Choi
- Neurive Co., Ltd, Gimhae, 50969 Republic of Korea
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, 028411 Republic of Korea
| | - Jae-Jun Song
- Neurive Co., Ltd, Gimhae, 50969 Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Seoul, 08308 Republic of Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information, Korea University, Sejong, 30019 Republic of Korea
- Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, Republic of Korea
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Su L, Chang M, Li Y, Ding H, Zhao X, Li B, Li J. Analysis of factors influencing the efficacy of vagus nerve stimulation for the treatment of drug-resistant epilepsy in children and prediction model for efficacy evaluation. Front Neurol 2024; 15:1321245. [PMID: 38419715 PMCID: PMC10899677 DOI: 10.3389/fneur.2024.1321245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Vagus nerve stimulation (VNS) has been widely used in the treatment of drug-resistant epilepsy (DRE) in children. We aimed to explore the efficacy and safety of VNS, focusing on factors that can influence the efficacy of VNS, and construct a prediction model for the efficacy of VNS in the treatment of DRE children. Methods Retrospectively analyzed 45 DRE children who underwent VNS at Qilu Hospital of Shandong University from June 2016 to November 2022. A ≥50% reduction in seizure frequency was defined as responder, logistic regression analyses were performed to analyze factors affecting the efficacy of VNS, and a predictive model was constructed. The predictive model was evaluated by receiver operating characteristic curve (ROC), calibration curves, and decision curve analyses (DCA). Results A total of 45 DRE children were included in this study, and the frequency of seizures was significantly reduced after VNS treatment, with 25 responders (55.6%), of whom 6 (13.3%) achieved seizure freedom. There was a significant improvement in the Quality of Life in Childhood Epilepsy Questionnaire (15.5%) and Seizure Severity Score (46.2%). 16 potential factors affecting the efficacy of VNS were included, and three statistically significant positive predictors were ultimately screened: shorter seizure duration, focal seizure, and absence of intellectual disability. We developed a nomogram for predicting the efficacy of VNS in the treatment of DRE children. The ROC curve confirmed that the predictive model has good diagnostic performance (AUC = 0.864, P < 0.05), and the nomogram can be further validated by bootstrapping for 1,000 repetitions, with a C-index of 0.837. Besides, this model showed good fitting and calibration and positive net benefits in decision curve analysis. Conclusion VNS is a safe and effective treatment for DRE children. We developed a predictive nomogram for the efficacy of VNS, which provides a basis for more accurate selection of VNS patients.
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Affiliation(s)
- Li Su
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mengmeng Chang
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yumei Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hao Ding
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyu Zhao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jun Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Shan M, Mao H, Xie H, Gan Y, Wu D, Song J, Bai Y, Zhang J. Vagus Nerve Stimulation for Drug Resistant Epilepsy: Clinical Outcome, Adverse Events, and Potential Prognostic Factors in a Single Center Experience. J Clin Med 2022; 11:jcm11247536. [PMID: 36556153 PMCID: PMC9783695 DOI: 10.3390/jcm11247536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Vagus nerve stimulation (VNS) has been used for adjunctive treatment in drug resistant epilepsy (DRE) for decades. Nevertheless, information is lacking on possible potential prognostic factors. Our study presents the efficacy and safety of VNS with a focus on prognostic factors in 45 patients with DRE. METHODS We retrospectively evaluated the clinical outcome of 45 consecutive patients with DRE undergoing VNS implantation in The First Affiliated Hospital of Anhui Medical University between November 2016 and August 2021. Medical records were aggregated across all patient visits. Cox proportional hazards regression was used to estimate the prognostic factors. RESULTS Significant decrease in seizure frequency was observed after intermittent stimulation of the vagus nerve. According to the modified McHugh classification, 11 patients (24.4%) were Class I, 11 patients (24.4%) were Class II, four patients (8.9%) were Class III, 10 patients (22.2%) were Class IV, and nine patients (20.0%) were Class V. Notably, 22 patients (48.9%) were responders and four patients (8.9%) were seizure-free at the final follow-up. No significant prognostic factors were found in this cohort. Furthermore, 37 patients reported improved quality of life. Of the patients, 22 (48.9%) experienced adverse events after surgery; hoarseness, discomfort at the surgical site, and coughing were the most common. CONCLUSION The results confirmed the efficacy and safety of VNS. No prognostic factors were identified.
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Affiliation(s)
- Ming Shan
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
- First Clinical Medical College, Anhui Medical University, Meishan Road 81, Hefei 230032, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Delong Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
| | - Jian Song
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- Correspondence: (Y.B.); (J.Z.)
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
- Correspondence: (Y.B.); (J.Z.)
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Martorell-Llobregat C, González-López P, Luna E, Asensio-Asensio M, Jadraque-Rodríguez R, García-March G, Moreno-López P. The role of vagus nerve stimulation in the treatment of refractory epilepsy: Clinical outcomes and impact on quality of life. Neurologia 2022; 37:450-458. [PMID: 31345600 DOI: 10.1016/j.nrl.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/14/2019] [Accepted: 04/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life. MATERIAL AND METHODS We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life. RESULTS According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A≥50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life. CONCLUSIONS VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life.
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Affiliation(s)
- C Martorell-Llobregat
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España
| | - P González-López
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España.
| | - E Luna
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España
| | - M Asensio-Asensio
- Servicio de Neurología, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España
| | - R Jadraque-Rodríguez
- Servicio de Pediatría, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España
| | - G García-March
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia, Valencia, España
| | - P Moreno-López
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, España
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Steinke KV, Möbius H, Christen HJ, Welkoborsky HJ. [Results of vagus nerve stimulator implantation in children and adolescents with treatment-refractory epilepsy]. HNO 2022; 70:389-395. [PMID: 35412064 DOI: 10.1007/s00106-022-01164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
Abstract
Vagus nerve stimulation (VNS) is a therapeutic procedure that can be applied in a palliative setting in patients with treatment-refractory epilepsy who are not suitable for epilepsy surgery. The mechanism of action of VNS is currently not completely understood but appears to depend on a modification of neurotransmitter metabolism. Data of 25 patients with treatment-refractory epilepsy who underwent implantation of a vagus nerve stimulator were retrospectively analyzed in a monocentric study. A reduction in epileptic seizure rate of 28% was observed 3 months after initial activation and of 32.9% after 6-12 months. The responder rate (reduction in seizure rate of more than 50% compared to before implantation) was 40% 6-12 months after initial activation. In one third of patients, a reduction in epileptic seizure rate of at least 75% occurred. Adverse effects of surgery or the stimulation were rare.
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Affiliation(s)
- Kim Vanessa Steinke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Tumorzentrum, Klinikum Region Hannover GmbH, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland. .,Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland.
| | - Hartmut Möbius
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Tumorzentrum, Klinikum Region Hannover GmbH, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland.,Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Hans-Jürgen Christen
- Abteilung für Neuropädiatrie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
| | - Hans-Jürgen Welkoborsky
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Tumorzentrum, Klinikum Region Hannover GmbH, KRH Klinikum Nordstadt, Haltenhoffstraße 41, 30167, Hannover, Deutschland.,Abteilung für HNO-Heilkunde, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
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Mao H, Chen Y, Ge Q, Ye L, Cheng H. Short- and Long-Term Response of Vagus Nerve Stimulation Therapy in Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 25:327-342. [PMID: 35396068 DOI: 10.1111/ner.13509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the short- and long-term efficacies as well as tolerability of vagus nerve stimulation (VNS) for the patients with drug-resistant epilepsy (DRE) in comparison with status at baseline. MATERIALS AND METHODS We conducted a specific and systematic search in online data bases for relevant literature published prior to December 2020. The literature retrieved, including randomized clinical trials (RCTs) and observational studies, were then reviewed, and analyzed. A fixed-effect model was used to evaluate the pooled odds ratio (OR) of responder rates and complications associated with RCTs. A random-effect model was used to generate overall responder rates and overall incidences of complication. RESULTS A total of 61 studies, featuring 5223 patients, were included in our study. The pooled ORs of responder rates, hoarseness/voice change, throat pain, coughing, dyspnea, paresthesia, muscle pain, and headache during the short-term phase were 2.195 (p = 0.001), 5.527 (p = 0.0001), 0.935 (p = 0.883), 1.119 (p = 0.655), 2.901 (p = 0.005), 1.775 (p = 0.061), 3.606 (p = 0.123), and 0.928 (p = 0.806), respectively. The overall responder rates in 3, 6, 12, 24, 36, 48, and 60 months postoperatively were 0.421, 0.455, 0.401, 0.451, 0.482, 0.502, and 0.508, respectively. The overall incidences of complication were 0.274 for hoarseness/voice change, 0.099 for throat pain, 0.133 for coughing, 0.099 for dyspnea, 0.102 for paresthesia, 0.062 for muscle pain, 0.101 for headache, 0.015 for dysphagia, 0.013 for neck pain, 0.040 for infection, 0.030 for lead fracture, 0.019 for vocal cord palsy, and 0.020 for device malfunction, respectively. CONCLUSIONS The estimating of efficacy and tolerability, using data from the existing literature, indicated VNS therapy is a safe and effective treatment option for patients with DRE.
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Affiliation(s)
- Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yonghao Chen
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Qintao Ge
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Lei Ye
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Factors Affecting Vagus Nerve Stimulation Outcomes in Epilepsy. Neurol Res Int 2021; 2021:9927311. [PMID: 34394987 PMCID: PMC8357517 DOI: 10.1155/2021/9927311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/06/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Epilepsy as a common neurological disease is mostly managed effectively with antiepileptic medications. One-third of patients do not respond to medical treatments requiring alternative therapies. Vagus nerve stimulation (VNS) has been used in the last decades for the treatment of medically resistant epilepsy. Despite the extensive use of VNS in these patients, factors associated with clinical outcomes of VNS remain to be elucidated. In this study, we evaluated factors affecting VNS outcomes in epileptic patients to have a better understanding of patients who are better candidates for VNS therapy. Several databases including PubMed, Scopus, and Google Scholar were searched through June 2020 for relevant articles. The following factors were assessed in this review: previous surgical history, age at implantation and gender, types of epilepsy, duration of epilepsy, age at epilepsy onset, frequency of attacks, antiepileptic drugs, VNS parameters, EEG findings, MRI findings, and biomarkers. Literature data show that nonresponder rates range between 25% and 65%. Given the complexity and diversity of factors associated with response to VNS, more clinical studies are needed to establish better paradigm for selection of patients for VNS therapy.
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Martorell-Llobregat C, González-López P, Luna E, Asensio-Asensio M, Jadraque-Rodríguez R, García-March G, Moreno-López P. The role of vagus nerve stimulation in the treatment of refractory epilepsy: clinical outcomes and impact on quality of life. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:450-458. [PMID: 34088638 DOI: 10.1016/j.nrleng.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life. MATERIAL AND METHODS We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life. RESULTS According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A ≥ 50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life. CONCLUSIONS VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life.
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Affiliation(s)
- C Martorell-Llobregat
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain
| | - P González-López
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain.
| | - E Luna
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain
| | - M Asensio-Asensio
- Servicio de Neurología, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain
| | - R Jadraque-Rodríguez
- Servicio de Pediatría, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain
| | - G García-March
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - P Moreno-López
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain
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Ding D, Zhou D, Sander JW, Wang W, Li S, Hong Z. Epilepsy in China: major progress in the past two decades. Lancet Neurol 2021; 20:316-326. [PMID: 33743240 DOI: 10.1016/s1474-4422(21)00023-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.
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Affiliation(s)
- Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Shichuo Li
- China Association against Epilepsy, Beijing, China
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Fang T, Xie ZH, Liu TH, Deng J, Chen S, Chen F, Zheng LL. Preliminary analysis of the effect of vagus nerve stimulation in the treatment of children with intractable epilepsy. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5915] [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: 02/04/2023] Open
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Fang T, Xie ZH, Liu TH, Deng J, Chen S, Chen F, Zheng LL. Preliminary analysis of the effect of vagus nerve stimulation in the treatment of children with intractable epilepsy. World J Clin Cases 2020; 8:5918-5925. [PMID: 33344590 PMCID: PMC7723719 DOI: 10.12998/wjcc.v8.i23.5918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/29/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Implant vagus nerve stimulation is an adjunctive treatment for intractable epilepsy when patients are not suitable for resective surgery.
AIM To identify the safety and efficacy of vagus nerve stimulation in children with intractable epilepsy and analyze the effects on different epilepsy syndromes.
METHODS Eligible children with intractable epilepsy were admitted to the study. We collected data from preoperative assessments as the baseline. During the follow-up time, we recorded the process of seizures (frequency, duration, and seizure type), the changes of drugs or parameters, the complications, etc. The mean reduction rate of seizures, response rate, and McHugh scale were chosen as the outcomes.
RESULTS A total of 213 patients were implanted with Tsinghua Pins vagus nerve stimulators, and the average age was 6.6 years. In the follow-up time of postoperative 3 mo, 6 mo, 12 mo, 18 mo, and 24 mo, the average reduction rate was 30.2%, 49.5%, 56.3%, 59.4%, and 63.2%, while the response rate was 21.8%, 62.5%, 57.1%, 69.2%, and 70.7%. In addition, implanted vagus nerve stimulation had different effects on epilepsy syndromes. The reduction rate of West syndrome increased from 36.4% (postoperative 6 m) to 74.3% (postoperative 24 m). The reduction rate of Lennox-Gastaut syndrome improved from 25.4% to 73.1% in 24 mo. The chi-square test of the five efficacy grades showed P < 0.05. The comparison between the 3-mo follow-up and the 6-mo follow-up showed P < 0.05, and the comparison between the 6-mo follow-up and the 24-mo follow-up showed P > 0.05.
CONCLUSION Vagus nerve stimulation is safe and effective in children with intractable epilepsy, and the seizure reduction occurred in a time-dependent manner. Moreover, patients with West syndrome may get the most benefits.
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Affiliation(s)
- Tie Fang
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Zi-Hang Xie
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Ting-Hong Liu
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Jie Deng
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Shuai Chen
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Feng Chen
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
| | - Li-Li Zheng
- Department of Functional Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100056, China
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Xiong J, Cao Y, Yang W, Chen Z, Yu Q. Can we predict response to vagus nerve stimulation in intractable epilepsy. Int J Neurosci 2020; 130:1063-1070. [PMID: 31914344 DOI: 10.1080/00207454.2020.1713777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Since vagus nerve stimulation (VNS) was approved by the Food and Drug Administration (FDA). A number of studies show that VNS was effective to reduce seizure frequency. However, there was still some patients treated with VNS having poor or even no clinical effect. OBJECTIVES The purpose of the present review was to identify factors predicting the effect of VNS therapy and to select patients suitable for VNS treatment. METHOD PubMed and Medline was searched with this terms "epilepsy," "vagus nerve stimulation," "vagal nerve stimulation," "VNS," "intractable," and "refractory".We selected studies by predefining inclusion and exclusion criteria. RESULTS the effectiveness of VNA was confirmed by a number of studies. We find many studies exploring the predictive factors to VNS. However there was no any study finding factors correlating clearly with the outcome of VNS. Although, we find these factors, such as post-traumatic epilepsy, temporal lobe epilepsy and focal interictal epileptiform discharges (IEDs), were favorable for the treatment of VNS, while comprehensive IEDs and neuronal migration disorders were indicative of the poor effect. Also, temporal lobe epilepsy was generally effectively controlled by this therapy and yougers seemed to get more benefit from VNS. Additionally, other indexes, such as cytokine profile, slow cortical potential (SCP) shift, preoperative heart rate variability (HRV), EEG reactivity and connectomic profiling, maybe predict the results of VNS. CONCLUSION In summary, these conventional and other new factors should be analyzed further by more science and rigorous experimental design to identify the clear correlation with the outcome of VNS therapy.
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Affiliation(s)
- Jinbiao Xiong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yiyao Cao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Weidong Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhijuan Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Yu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
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Fan J, Shan W, Wu J, Wang Q. Research progress of vagus nerve stimulation in the treatment of epilepsy. CNS Neurosci Ther 2019; 25:1222-1228. [PMID: 31429206 PMCID: PMC6834923 DOI: 10.1111/cns.13209] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022] Open
Abstract
The International League Against Epilepsy (ILAE) defined drug-resistant epilepsy (DRE) that epilepsy seizure symptoms cannot be controlled with two well-tolerated and appropriately chosen antiepileptic drugs, whether they are given as monotherapy or in combination. According to the WHO reports, there is about 30%-40% of epilepsy patients belong to DRE. These patients need some treatments other than drugs, such as epilepsy surgery, and neuromodulation treatment. Traditional surgical approaches may be limited by the patient's clinical status, pathological tissue location, or overall prognosis. Thus, neuromodulation is an alternative choice to control their symptoms. Vagus nerve stimulation (VNS) is one of the neuromodulation methods clinically, which have been approved by the Food and Drug Administration (FDA). In this review, we systematically describe the clinical application, clinical effects, possible antiepileptic mechanisms, and future research directions of VNS for epilepsy.
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Affiliation(s)
- Jing‐Jing Fan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Wei Shan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Jian‐Ping Wu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Qun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
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Watila MM, Xiao F, Keezer MR, Miserocchi A, Winkler AS, McEvoy AW, Sander JW. Epilepsy surgery in low- and middle-income countries: A scoping review. Epilepsy Behav 2019; 92:311-326. [PMID: 30738248 DOI: 10.1016/j.yebeh.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC and discuss some challenges and priority. METHODS We used an accepted six-stage methodological framework for scoping reviews as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature. RESULTS We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The postoperative seizure-free rates and quality of life (QOL) are comparable with those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resource-limited setting through collaboration with international partners and through the use of information and communications technology (ICT). The cost of surgery is a fraction of what is available in HIC. CONCLUSION This review has demonstrated the availability of epilepsy surgery in a few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.
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Affiliation(s)
- Musa M Watila
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Magnetic Resonance Imaging Unit, Epilepsy Society, Gerrards Cross, UK
| | - Mark R Keezer
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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Low Frequency Electrical Stimulation Either Prior to Or after Rapid Kindling Stimulation Inhibits the Kindling-Induced Epileptogenesis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8623743. [PMID: 28373988 PMCID: PMC5360964 DOI: 10.1155/2017/8623743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/21/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022]
Abstract
Objective. Studies are ongoing to find appropriate low frequency stimulation (LFS) protocol for treatment of epilepsy. The present study aimed at assessing the antiepileptogenesis effects of LFS with the same protocol applied either just before or immediately after kindling stimulations. Method. This experimental animal study was conducted on adult Wistar rats (200 ± 20 g) randomly divided into kindle (n = 7), LFS + Kindle (n = 6), and Kindle + LFS groups (n = 6). All animals underwent rapid kindling procedure and four packages of LFS (1 Hz) with 5 min interval were applied either immediately before (LFS-K) or after kindling stimulation (K-LFS). The after discharge duration (ADD), daily stages of kindling, and kindling seizure stage and number of stimulations required to reach each stage were compared between the three groups using two-way analysis of variance (ANOVA) followed by Tukey post hoc and one-way ANOVA, and Kruskal-Wallis test, respectively. Results. LFS in both protocols significantly decreased the ADD (p < 0.05) and daily seizure stages (p < 0.05) and increased the number of stimulations required to achieve stage 3 and stages 4 and 5 of kindling compared with the kindle group (stage 2: p > 0.05, stages 3 to 5: p < 0.05). Conclusion. Although LFS-K showed more inhibiting effect than K-LFS, the difference was not statistically significant.
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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: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [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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