Abstract
Background
Vagal nerve stimulation (VNS) is an effective palliative therapy in drug-resistant epileptic patients and is also approved as a therapy for treatment-resistant depression. Depression is a frequent comorbidity in epilepsy and it affects the quality of life of patients more than the seizure frequency itself. The aim of this systematic review is to analyze the available literature about the VNS effect on depressive symptoms in epileptic patients.
Material and methods
A comprehensive search of PubMed, Medline, Scopus, and Google Scholar was performed, and results were included up to January 2020. All studies concerning depressive symptom assessment in epileptic patients treated with VNS were included.
Results
Nine studies were included because they fulfilled inclusion criteria. Six out of nine papers reported a positive effect of VNS on depressive symptoms. Eight out of nine studies did not find any correlation between seizure reduction and depressive symptom amelioration, as induced by VNS. Clinical scales for depression, drug regimens, and age of patients were broadly different among the examined studies.
Conclusions
Reviewed studies strongly suggest that VNS ameliorates depressive symptoms in drug-resistant epileptic patients and that the VNS effect on depression is uncorrelated to seizure response. However, more rigorous studies addressing this issue are encouraged.
References
- 1.Chen Z, Brodie MJ, Liew D, Kwan P (2018) Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs a 30-year longitudinal cohort study. JAMA Neurol 75:279–286. https://doi.org/10.1001/jamaneurol.2017.3949Article PubMed Google Scholar
- 2.Spencer S, Huh L (2008) Outcomes of epilepsy surgery in adults and children. Lancet Neurol 7:525–537Article Google Scholar
- 3.De Tisi J, Bell GS, Peacock JL et al (2011) The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet 378:1388–1395. https://doi.org/10.1016/S0140-6736(11)60890-8Article PubMed Google Scholar
- 4.Rathore C, Radhakrishnan K (2015) Concept of epilepsy surgery and presurgical evaluation. In: Epileptic disorders
- 5.Benbadis SR, Geller E, Ryvlin P, Schachter S, Wheless J, Doyle W, Vale FL (2018) Putting it all together: options for intractable epilepsy. Epilepsy Behav 88:33–38. https://doi.org/10.1016/j.yebeh.2018.05.030Article Google Scholar
- 6.Ben-Menachem E, Mañon-Espaillat R, Ristanovic R et al (1994) Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. Epilepsia 35:616–626. https://doi.org/10.1111/j.1528-1157.1994.tb02482.xCAS Article PubMed Google Scholar
- 7.George R, Salinsky M, Kuzniecky R et al (1994) Vagus nerve stimulation for treatment of partial seizures: 3. Long-term follow-up on first 67 patients exiting a controlled study. Epilepsia. https://doi.org/10.1111/j.1528-1157.1994.tb02484.x
- 8.Elliott RE, Morsi A, Kalhorn SP, Marcus J, Sellin J, Kang M, Silverberg A, Rivera E, Geller E, Carlson C, Devinsky O, Doyle WK (2011) Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy Behav 20:57–63. https://doi.org/10.1016/j.yebeh.2010.10.017Article PubMed Google Scholar
- 9.Orosz I, McCormick D, Zamponi N, Varadkar S, Feucht M, Parain D, Griens R, Vallée L, Boon P, Rittey C, Jayewardene AK, Bunker M, Arzimanoglou A, Lagae L (2014) Vagus nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children. Epilepsia 55:1576–1584. https://doi.org/10.1111/epi.12762Article PubMed Google Scholar
- 10.Helmers SL, Wheless JW, Frost M, Gates J, Levisohn P, Tardo C, Conry JA, Yalnizoglu D, Madsen JR (2001) Vagus nerve stimulation therapy in pediatric patients with refractory epilepsy: retrospective study. J Child Neurol 16:843–848. https://doi.org/10.1177/08830738010160111101CAS Article PubMed Google Scholar
- 11.Boylan LS, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O (2004) Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy. Neurology 62:258–261. https://doi.org/10.1212/01.WNL.0000103282.62353.85CAS Article PubMed Google Scholar
- 12.Kim M, Kim Y-S, Kim D-H, Yang TW, Kwon OY (2018) Major depressive disorder in epilepsy clinics: a meta-analysis. Epilepsy Behav 84:56–69. https://doi.org/10.1016/j.yebeh.2018.04.015Article PubMed Google Scholar
- 13.Ajinkya S, Fox J, Lekoubou A (2020) Trends in prevalence and treatment of depressive symptoms in adult patients with epilepsy in the United States. Epilepsy Behav 105:106973. https://doi.org/10.1016/j.yebeh.2020.106973Article PubMed Google Scholar
- 14.Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Ulivi M, di Lazzaro V (2020) Depressive symptoms and difficulties in emotion regulation in adult patients with epilepsy: association with quality of life and stigma. Epilepsy Behav 107:107073Article Google Scholar
- 15.Yuan T-F, Li A, Sun X, Arias-Carrión O, Machado S (2016) Vagus nerve stimulation in treating depression: a tale of two stories. Curr Mol Med 16:33–39. https://doi.org/10.2174/1566524016666151222143609CAS Article PubMed Google Scholar
- 16.Harden CL, Pulver MC, Ravdin LD, Nikolov B, Halper JP, Labar DR (2000) A pilot study of mood in epilepsy patients treated with vagus nerve stimulation. Epilepsy Behav 1:93–99. https://doi.org/10.1006/ebeh.2000.0046Article PubMed Google Scholar
- 17.Elger G, Hoppe C, Falkai P, Rush AJ, Elger CE (2000) Vagus nerve stimulation is associated with mood improvements in epilepsy patients. Epilepsy Res 42:203–210. https://doi.org/10.1016/S0920-1211(00)00181-9CAS Article PubMed Google Scholar
- 18.Rush AJ, Marangell LB, Sackeim HA, George MS, Brannan SK, Davis SM, Howland R, Kling MA, Rittberg BR, Burke WJ, Rapaport MH, Zajecka J, Nierenberg AA, Husain MM, Ginsberg D, Cooke RG (2005) Vagus nerve stimulation for treatment-resistant depression: a randomized, controlled acute phase trial. Biol Psychiatry 58:347–354. https://doi.org/10.1016/j.biopsych.2005.05.025Article PubMed Google Scholar
- 19.Rush AJ, George MS, Sackeim HA, Marangell LB, Husain MM, Giller C, Nahas Z, Haines S, Simpson RK Jr, Goodman R (2000) Vagus nerve stimulation (VNS) for treatment-resistant depressions: a multicenter study∗∗See accompanying Editorial, in this issue. Biol Psychiatry 47:276–286. https://doi.org/10.1016/S0006-3223(99)00304-2CAS Article PubMed Google Scholar
- 20.Rush AJ, Sackeim HA, Marangell LB, George MS, Brannan SK, Davis SM, Lavori P, Howland R, Kling MA, Rittberg B, Carpenter L, Ninan P, Moreno F, Schwartz T, Conway C, Burke M, Barry JJ (2005) Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry 58:355–363. https://doi.org/10.1016/j.biopsych.2005.05.024Article PubMed Google Scholar
- 21.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34. https://doi.org/10.1016/j.jclinepi.2009.06.006Article PubMed Google Scholar
- 22.Klinkenberg S, van den Bosch CNCJ, Majoie HJM, Aalbers MW, Leenen L, Hendriksen J, Cornips EMJ, Rijkers K, Vles JSH, Aldenkamp AP (2013) Behavioural and cognitive effects during vagus nerve stimulation in children with intractable epilepsy–a randomized controlled trial. Eur J Paediatr Neurol 17:82–90. https://doi.org/10.1016/j.ejpn.2012.07.003Article PubMed Google Scholar
- 23.Ryvlin P, Gilliam FG, Nguyen DK, Colicchio G, Iudice A, Tinuper P, Zamponi N, Aguglia U, Wagner L, Minotti L, Stefan H, Boon P, Sadler M, Benna P, Raman P, Perucca E (2014) The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: the PuLsE (Open Prospective Randomized Long-term Effectiveness) trial. Epilepsia 55:893–900. https://doi.org/10.1111/epi.12611CAS Article PubMed Google Scholar
- 24.Radloff LS (1977) The CES-D Scale. Appl Psychol Meas 1:385–401. https://doi.org/10.1177/014662167700100306Article Google Scholar
- 25.Gilliam FG, Barry JJ, Hermann BP, Meador KJ, Vahle V, Kanner AM (2006) Rapid detection of major depression in epilepsy: a multicentre study. Lancet Neurol 5:399–405. https://doi.org/10.1016/S1474-4422(06)70415-XArticle PubMed Google Scholar
- 26.Klinkenberg S, Majoie HJM, Van Der Heijden MMAA et al (2012) Vagus nerve stimulation has a positive effect on mood in patients with refractory epilepsy. Clin Neurol Neurosurg 114:336–340. https://doi.org/10.1016/j.clineuro.2011.11.016CAS Article PubMed Google Scholar
- 27.Chavel SM, Westerveld M, Spencer S (2003) Long-term outcome of vagus nerve stimulation for refractory partial epilepsy. Epilepsy Behav 4:302–309. https://doi.org/10.1016/S1525-5050(03)00109-4Article PubMed Google Scholar
- 28.Hoppe C, Helmstaedter C, Scherrmann J, Elger CE (2001) Self-reported mood changes following 6 months of vagus nerve stimulation in epilepsy patients. Epilepsy Behav 2:335–342. https://doi.org/10.1006/ebeh.2001.0194CAS Article PubMed Google Scholar
- 29.Hallböök T, Lundgren J, Stjernqvist K, Blennow G, Strömblad LG, Rosén I (2005) Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood. Seizure 14:504–513. https://doi.org/10.1016/j.seizure.2005.08.007Article PubMed Google Scholar
- 30.Spindler P, Bohlmann K, Straub H-B, Vajkoczy P, Schneider UC (2019) Effects of vagus nerve stimulation on symptoms of depression in patients with difficult-to-treat epilepsy. Seizure 69:77–79. https://doi.org/10.1016/j.seizure.2019.04.001Article PubMed Google Scholar
- 31.Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR, Lenn NJ, Novak GP, Hermann BP (1998) Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 39:595–599. https://doi.org/10.1111/j.1528-1157.1998.tb01427.xCAS Article PubMed Google Scholar
- 32.Kerr MP, Mensah S, Besag F, de Toffol B, Ettinger A, Kanemoto K, Kanner A, Kemp S, Krishnamoorthy E, LaFrance WC Jr, Mula M, Schmitz B, van Elst L, Trollor J, Wilson SJ, International League of Epilepsy (ILAE) Commission on the Neuropsychiatric Aspects of Epilepsy (2011) International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy. Epilepsia 52:2133–2138. https://doi.org/10.1111/j.1528-1167.2011.03276.xArticle PubMed Google Scholar
- 33.Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, de Mojà R, Ulivi M, di Lazzaro V (2019) Epilepsy-associated stigma from the perspective of people with epilepsy and the community in Italy. Epilepsy Behav 98:66–72. https://doi.org/10.1016/j.yebeh.2019.06.026Article PubMed Google Scholar
- 34.Dussaule C, Bouilleret V (2018) Psychiatric effects of antiepileptic drugs in adults. Gériatrie Psychol Neuropsychiatr du Viellissement 16:181–188. https://doi.org/10.1684/pnv.2018.0733Article Google Scholar
- 35.Pisani LR, Nikanorova M, Landmark CJ, Johannessen SI, Pisani F (2018) Specific patient features affect antiepileptic drug therapy decisions: focus on gender, age, and psychiatric comorbidities. Curr Pharm Des 23:5639–5648. https://doi.org/10.2174/1381612823666170926103631CAS Article Google Scholar
- 36.Assenza G, Lanzone J, Dubbioso R et al (2020) Thalamic and cortical hyperexcitability in juvenile myoclonic epilepsy. Clin Neurophysiol
- 37.Pellegrino G, Mecarelli O, Pulitano P, Tombini M, Ricci L, Lanzone J, Brienza M, Davassi C, di Lazzaro V, Assenza G (2018) Eslicarbazepine acetate modulates EEG activity and connectivity in focal epilepsy. Front Neurol 9. https://doi.org/10.3389/fneur.2018.01054
- 38.Rolle CE, Fonzo GA, Wu W, Toll R, Jha MK, Cooper C, Chin-Fatt C, Pizzagalli DA, Trombello JM, Deckersbach T, Fava M, Weissman MM, Trivedi MH, Etkin A (2020) Cortical connectivity moderators of antidepressant vs placebo treatment response in major depressive disorder. JAMA Psychiatry 94305:397. https://doi.org/10.1001/jamapsychiatry.2019.3867Article Google Scholar
- 39.Vecchio F, Miraglia F, Curcio G, Della Marca G, Vollono C, Mazzucchi E, Bramanti P, Rossini PM (2015) Cortical connectivity in fronto-temporal focal epilepsy from EEG analysis: a study via graph theory. Clin Neurophysiol 126:1108–1116. https://doi.org/10.1016/j.clinph.2014.09.019Article PubMed Google Scholar
- 40.Vecchio F, Miraglia F, Curcio G, Altavilla R, Scrascia F, Giambattistelli F, Quattrocchi CC, Bramanti P, Vernieri F, Rossini PM (2015) Cortical brain connectivity evaluated by graph theory in dementia: a correlation study between functional and structural data. J Alzheimers Dis 45:745–756. https://doi.org/10.3233/JAD-142484Article PubMed Google Scholar
- 41.Parker CS, Clayden JD, Cardoso MJ, Rodionov R, Duncan JS, Scott C, Diehl B, Ourselin S (2018) Structural and effective connectivity in focal epilepsy. NeuroImage Clin 17:943–952. https://doi.org/10.1016/j.nicl.2017.12.020Article PubMed Google Scholar
- 42.Saletu B, Anderer P, Saletu-Zyhlarz GM (2010) EEG topography and tomography (LORETA) in diagnosis and pharmacotherapy of depression. Clin EEG Neurosci 41:203–210CAS Article Google Scholar
- 43.Zhdanov A, Atluri S, Wong W, Vaghei Y, Daskalakis ZJ, Blumberger DM, Frey BN, Giacobbe P, Lam RW, Milev R, Mueller DJ, Turecki G, Parikh SV, Rotzinger S, Soares CN, Brenner CA, Vila-Rodriguez F, McAndrews MP, Kleffner K, Alonso-Prieto E, Arnott SR, Foster JA, Strother SC, Uher R, Kennedy SH, Farzan F (2020) Use of machine learning for predicting escitalopram treatment outcome from electroencephalography recordings in adult patients with depression. JAMA Netw Open 3:e1918377–e1918377Article Google Scholar
- 44.Romero-Osorio Ó, Gil-Tamayo S, Nariño D, Rosselli D (2018) Changes in sleep patterns after vagus nerve stimulation, deep brain stimulation or epilepsy surgery: systematic review of the literature. Seizure 56:4–8. https://doi.org/10.1016/j.seizure.2018.01.022Article PubMed Google Scholar
- 45.Murray BJ, Matheson JK, Scammell TE (2001) Effects of vagus nerve stimulation on respiration during sleep. Neurology 57:1523–1524CAS Article Google Scholar
- 46.Benca RM, Obermeyer WH, Thisted RA, Gillin JC (1992) Sleep and psychiatric disorders: a meta-analysis. Arch Gen Psychiatry 49:651–668CAS Article Google Scholar
- 47.Wu JC, Bunney WE (1990) The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. Am J Psychiatry
- 48.Tononi G, Cirelli C (2012) Time to be SHY? Some comments on sleep and synaptic homeostasis. Neural Plast 2012:1–12. https://doi.org/10.1155/2012/415250Article Google Scholar
- 49.Assenza G, Pellegrino G, Tombini M, di Pino G, di Lazzaro V (2013) Delta waves increase after cortical plasticity induction during wakefulness. Clin Neurophysiol 124:e71–e72. https://doi.org/10.1016/j.clinph.2014.09.029Article Google Scholar
- 50.Assenza G, Di Lazzaro V (2015) A useful electroencephalography (EEG) marker of brain plasticity: delta waves. Neural Regen Res 10:1216–1217. https://doi.org/10.4103/1673-5374.162698Article PubMed Google Scholar
- 51.Wolf E, Kuhn M, Normann C, Mainberger F, Maier JG, Maywald S, Bredl A, Klöppel S, Biber K, van Calker D, Riemann D, Sterr A, Nissen C (2016) Synaptic plasticity model of therapeutic sleep deprivation in major depression. Sleep Med Rev 30:53–62Article Google Scholar
- 52.Sanacora G, Zarate CA, Krystal JH, Manji HK (2008) Targeting the glutamatergic system to develop novel, improved therapeutics for mood disorders. Nat Rev Drug Discov 7:426–437CAS Article Google Scholar
- 53.Di Pino G, Pellegrino G, Capone F et al (2016) Val66Met BDNF polymorphism implies a different way to recover from stroke rather than a worse overall recoverability. Neurorehabil Neural Repair 30:3–8. https://doi.org/10.1177/1545968315583721Article PubMed Google Scholar
- 54.Sen S, Duman R, Sanacora G (2008) Serum brain-derived neurotrophic factor, depression, and antidepressant medications: meta-analyses and implications. Biol Psychiatry 64:527–532CAS Article Google Scholar
- 55.Goldschmied JR, Gehrman P (2019) An integrated model of slow-wave activity and neuroplasticity impairments in major depressive disorder. Curr Psychiatry Rep 21:30Article Google Scholar
- 56.O’Leary OF, Ogbonnaya ES, Felice D et al (2018) The vagus nerve modulates BDNF expression and neurogenesis in the hippocampus. Eur Neuropsychopharmacol 28:307–316. https://doi.org/10.1016/j.euroneuro.2017.12.004CAS Article PubMed Google Scholar
- 57.Lang UE, Bajbouj M, Gallinat J, Hellweg R (2006) Brain-derived neurotrophic factor serum concentrations in depressive patients during vagus nerve stimulation and repetitive transcranial magnetic stimulation. Psychopharmacology 187:56–59. https://doi.org/10.1007/s00213-006-0399-yCAS Article PubMed Google Scholar
- 58.Hays SA, Rennaker RL, Kilgard MP (2013) Targeting plasticity with vagus nerve stimulation to treat neurological disease. Progress in brain research. Elsevier, In, pp 275–299Google Scholar
- 59.Capone F, Assenza G, Di Pino G et al (2015) The effect of transcutaneous vagus nerve stimulation on cortical excitability. J Neural Transm 122:679–685. https://doi.org/10.1007/s00702-014-1299-7Article PubMed Google Scholar
- 60.Kimberley TJ, Prudente CN, Engineer ND, Pierce D, Tarver B, Cramer SC, Dickie DA, Dawson J (2019) Study protocol for a pivotal randomised study assessing vagus nerve stimulation during rehabilitation for improved upper limb motor function after stroke. Eur Stroke J 4:363–377Article Google Scholar
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