Posts Tagged Vagus Nerve Stimulation

[WEB SITE] Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy – NEUROSURGERY Report

Abstract

BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.

OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS.

METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.

RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.

CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

Source: Open Access: Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy | NEUROSURGERY Report

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[ARTICLE] Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy – Full Text

Abstract

BACKGROUND: Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.

OBJECTIVE: To elucidate rates and predictors of seizure freedom with VNS.

METHODS: We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.

RESULTS: Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.

CONCLUSION: Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

 

Approximately 1% of the population has epilepsy, and seizures are refractory to antiepileptic drugs (AEDs) in approximately 30% of these individuals.1 Many patients with drug-resistant temporal or extratemporal lobe epilepsy can become seizure-free with surgical resection or ablation, but other patients with epilepsy are not candidates for resection given the presence of primary generalized seizures, nonlocalizable or multifocal seizure onset, or seizure onset from an eloquent brain region.2-5 Treatments based on neuromodulation, such as vagus nerve stimulation (VNS), have, therefore, become an increasingly important part of multimodal epilepsy treatment. VNS therapy was approved by the US Food and Drug Administration in 1997 as an adjunctive therapy for reducing seizures in patients with medically refractory epilepsy, and more than 80 000 patients have received treatment with VNS.6-8 The efficacy of VNS therapy has been evaluated by randomized controlled trials,9,10 retrospective case series,11,12 meta-analysis,13 and registry-based studies.14 These studies show that about 50% to 60% of patients achieve ≥50% reduction in seizure frequency after 2 years of treatment, and response rates increase over time, likely related to neuromodulatory effects with ongoing stimulation.13 Complete seizure freedom, however, is less common with VNS therapy and other neuromodulation treatment modalities.

Given that a minority of patients achieve seizure freedom with VNS, rates and predictors of seizure freedom have not been well studied and remain poorly understood. The vast majority of studies that evaluate VNS therapy focus on rate of response over time (defined as ≥50% reduction in seizures) and predictors of response; there has never been a large-scale evaluation of seizure freedom as a primary end point in patients treated with VNS. However, seizure freedom is the single best predictor of quality of life in patients with epilepsy,15,16 and therefore a better understanding of seizure freedom rates and predictors in patients treated with VNS therapy is critically needed. Importantly, this information may lead to improved patient selection and counseling in the treatment of drug-resistant epilepsy.

Here, we provide the first large-scale study of VNS therapy with a primary goal of defining seizure freedom rates and predictors, and comparing predictors of seizure freedom with those of overall response to treatment. Our study includes univariate and multivariate analyses of registry data including 5554 patients treated with VNS, and also includes a systematic review of the literature including 2869 patients across 78 studies, to help confirm registry-based results.

Continue —> Rates and Predictors of Seizure Freedom With Vagus Nerve Sti… : Neurosurgery

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[ARTICLE] Vagus nerve stimulation delivered with motor training enhances recovery of function after traumatic brain injury

ABSTRACT

Traumatic Brain Injury (TBI) is one of the largest health problems in the United States, and affects nearly two million people every year. The effects of TBI, including weakness and loss of coordination, can be debilitating and last years after the initial injury. Recovery of motor function is often incomplete. We have developed a method using electrical stimulation of the vagus nerve paired with forelimb use by which we have demonstrated enhanced recovery from ischemic and hemorrhagic stroke. Here we have tested the hypothesis that vagus nerve stimulation (VNS) paired with physical rehabilitation could enhance functional recovery after TBI. We trained rats to pull on a handle to receive a food reward. Following training, they received a controlled-cortical impact (CCI) in the forelimb area of motor cortex opposite the trained forelimb, and were then randomized into two treatment groups. One group of animals received vagus nerve stimulation (VNS) paired with rehabilitative therapy, while another group received rehabilitative therapy without VNS. Following CCI, volitional forelimb strength and task success rate in all animals were significantly reduced. VNS paired with rehabilitative therapy over a period of five weeks significantly increased recovery of both forelimb strength and hit rate on the isometric pull task compared to rehabilitative training without VNS. No significant improvement was observed in the Rehab group. Our findings indicate that VNS paired with rehabilitative therapy enhances functional motor recovery after TBI.

via Vagus nerve stimulation delivered with motor training enhances recovery of function after traumatic brain injury | Abstract.

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[WEB SITE] Bioengineering Professor Recognized for Stroke Recovery Research

March 25, 2015

UT Dallas’ Dr. Seth Hays was honored by the American Heart Association with the Robert G. Siekert New Investigator in Stroke Award recently at the 2015 International Stroke Conference in Nashville, Tenn.

The award, which is presented each year to one outstanding young scientist, encourages new investigators to undertake or continue stroke-related research.

“It is an honor to be recognized by the American Heart Association, an organization with a long tradition of supporting excellent research,” said Hays, an assistant professor of bioengineering in the Erik Jonsson School of Engineering and Computer Science.

Hays’ recent research focuses on developing vagus nerve stimulation (VNS) to improve recovery of motor function after stroke, traumatic brain injury and spinal cord injury, and explaining in detail the mechanisms engaged by VNS to support functional recovery.

VNS is an FDA-approved method for treating various illnesses, such as depression and epilepsy. It involves sending a mild electric pulse through the vagus nerve, which relays information about the state of the body to the brain. Researchers at UT Dallas are studying a novel implementation of VNS to treat neurological disorders.

The association recognized Hays for his paper “Vagus Nerve Stimulation Enhances Neuroplasticity and Forelimb Recovery after Stroke in Aged Rats.” The study, which Hays presented at the conference on Feb. 12, concludes that VNS paired with rehabilitation enhances neuroplasticity — the ability of the brain to change — and functional recovery in post-stroke, aged rats.

“This research project provides additional evidence supporting the ability of VNS to improve recovery after stroke,” he said. “We are now exploring this in greater detail in order to develop this powerful potential therapy.”

Last year, Hays published papers in Stroke, Neuroreport,  Neurorehabilitation & Neural Repair and Brain Research.

Hays received his undergraduate degree in biomedical engineering from The University of Texas at Austin in 2007. In 2012, he completed his PhD in neuroscience at the University of Texas Southwestern Medical Center.

The first postdoctoral research fellow at the UT Dallas Texas Biomedical Device Center, Hays worked under the direction of Dr. Michael Kilgard and Dr. Robert Rennaker.

Rennaker, director of the center and department head of bioengineering, said Hays excelled as a researcher and a colleague during his two years as a fellow, playing a primary role in writing a successful National Institutes of Health research project grant to fund stroke research.

“Dr. Hays is a great example of how UT Dallas will become a top-tier university and develop a pre-eminent bioengineering program,” Rennaker said.

via Bioengineering Professor Recognized for Stroke Recovery Research – News Center – The University of Texas at Dallas.

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[WEB SITE] New treatment for stroke recovery shows early success

Researchers at The University of Texas at Dallas have taken a step toward developing a new treatment to aid the recovery of limb function after strokes.

In a study published online in the journal Neurobiology of Disease, researchers report the full recovery of forelimb strength in animals receiving vagus nerve stimulation…

via New treatment for stroke recovery shows early success – Medical News Today.

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WEB SITE: Vagus Nerve Stimulation (VNS) | Epilepsy Foundation

Vagus nerve stimulation (VNS Therapy®) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. These pulses are supplied by a device something like a pacemaker…

Vagus Nerve Stimulation (VNS) | Epilepsy Foundation.

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More Fetal Risks Linked to Epilepsy Drugs

…Fetal exposure to anti-epileptic drugs (AEDs) appears to carry risks beyond those congenital defects currently listed on the products’ labels, a researcher said here…

μέσω More Fetal Risks Linked to Epilepsy Drugs.

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[ARTICLE] Post-traumatic epilepsy: current and emerging treatment options – Full Text PDF or HTML

…Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence…

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μέσω Post-traumatic epilepsy: current and emerging treatment options | NDT.

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[WEB SITE] Seizures and Traumatic Brain Injury

Seizures and Traumatic Brain InjuryOne of the problems that can occur after a traumatic brain injury (TBI) is seizures. Although most people who have a brain injury will never have a seizure, it is good to understand what a seizure is and what to do if you have one. Most seizures happen in the first several days or weeks after a brain injury. Some may occur months or years after the injury. About 70-80% of people who have seizures are helped by medications and can return to most activities. Rarely, seizures can make you much worse or even cause death.

What are seizures?

Seizures happen in 1 of every 10 people who have a TBI that required hospitalization. The seizure usually happens where there is a scar in the brain as a consequence of the injury.

During a seizure there is a sudden abnormal electrical disturbance in the brain that results in one or more of the following symptoms:

  • Strange movement of your head, body, arms, legs, or eyes, such as stiffening or shaking.
  • Unresponsiveness and staring.
  • Chewing, lip smacking, or fumbling movements.
  • Strange smell, sound, feeling, taste, or visual images.
  • Sudden tiredness or dizziness.
  • Not being able to speak or understand others.

Symptoms of a seizure happen suddenly, and you are unable to control them. Seizures usually last only a few seconds or minutes, but sometimes continue for 5 to 10 minutes. You may have a bladder or bowel accident or bite your tongue or the inside of your mouth during a seizure. After the seizure, you may be drowsy, weak, confused or have a hard time talking to or understanding others. After a severe seizure, one that lasts longer than 2 minutes, it may be harder for you to stand, walk or take care of yourself for a few days or even longer.

Conditions that could increase the risk of having a seizure include:

  • High fever.
  • Loss of sleep and extreme fatigue.
  • Drug and alcohol use.
  • Chemical changes in the body such as low sodium or magnesium, or high calcium.

Seizures and TBI

  • Early post-traumatic seizures: A seizure in the first week after a brain injury is called an early post-traumatic seizure. About 25% of people who have an early post-traumatic seizure will have another seizure months or years later.
  • Late post-traumatic seizures: A seizure more than seven days after a brain injury is called a late post-traumatic seizure. About 80% of people who have a late post-traumatic seizure will have another seizure (epilepsy).
  • Epilepsy: Having more than one seizure is called epilepsy. More than half the people with epilepsy will have this problem for their whole lives.

The cause of your brain injury can help doctors figure out how likely you are to have seizures.

  • 65% of people with brain injuries caused by bullet wounds have seizures.
  • 20% of people with ‘closed head injuries’ that cause bleeding between the brain and the skull experience seizures. A ‘closed head injury’ means the skull and brain contents were not penetrated in the injury.
  • Over 35% of people who need 2 or more brain surgeries after a brain injury experience late post-traumatic seizures.

Medications to treat seizures

Medications that are used to control seizures are called antiepileptic drugs (AEDs). These drugs may be used for other problems, such as chronic pain, restlessness, or mood instability. You and your doctor will decide on which drug to use based on your type of seizures, your age, how healthy you are, and if you get any side effects from the medications. Side effects of AEDs usually improve after you’ve been taking the medication for 3-5 days.

Some common side effects of AEDs are:

  • Sleepiness or fatigue.
  • Worsening of balance.
  • Lightheadedness or dizziness.
  • Trembling.
  • Double vision.
  • Confusion.

Blood tests may be needed to make sure you are getting enough of the medication and to make sure the drug isn’t causing other problems. Although these drugs rarely cause birth defects in newborns, tell your doctor if you are pregnant or may become pregnant.

Sometimes your doctor will prescribe two or more of these medications to stop your seizures. Some common AEDs are:

  • Carbamazepine (also known as Tegretol).
  • Lamotrigine (also known as Lamictal).
  • Levitiracetam (also known as Keppra).
  • Gabapentin (also known as Neurontin).
  • Oxcarbazepine (also known as Trileptal).
  • Phenobarbital.
  • Phenytoin/ fosphenytoin (also known as Dilantin).
  • Pregabalain (also known as Lyrica).
  • Topiramate (also known as Topamax).
  • Valproic acid or valproate (also known as Depakene or Depakote).
  • Zonisamide (also known as Zonegran).

What if the medications do not work?

If your seizures continue even after trying medications, your doctor may refer you to a comprehensive Epilepsy Center for more tests and to be seen by special seizure doctors called epileptologists or neurologists specializing in epilepsy. At the comprehensive Epilepsy Center the doctors may do brain wave tests and take a video of you during one of your seizures to help figure out what is causing the problems. This may help your doctor decide what drug will work best, and to see if other types of treatment will help with the problems you are having.

The websites of the Epilepsy Foundation of America (www.efa.org)or the American Epilepsy Society (www.aesnet.org) can tell you about the nearest comprehensive Epilepsy Center.

Safety issues

In most states, if you have had a seizure you cannot drive and you must notify the department of motor vehicles (DMV). Usually you won’t be able to return to driving for a period of time, or until your seizures have been completely stopped. Laws vary from state to state regarding how long after a seizure you must not drive.

Other things you should do to stay safe if your seizures have not stopped:

  • Always have someone with you if you are in water (pool, lake, ocean, bath tub).
  • Don’t climb on ladders, trees, roofs or other tall objects.
  • Let people you eat with know what to do in case you have a seizure and start choking.

What your caregiver should do if you are having a seizure

Family members or caregivers should watch closely to see what happens during a seizure so they can explain it to medical professionals. They should make a diary describing the date, time of day, length of time, and description of each seizure. Your doctor will need this information about your seizures and the drugs you are taking to control them.

The majority of seizures are short and do not result in significant injuries. However, it is important for your caregivers to know what to do to keep you from hurting yourself.

What to do for someone having a seizure:

  • Loosen tight clothing, especially around the neck.
  • Make sure the person does not fall. Hold the person steady if he or she is in a chair, couch or bed. If the person is standing, get him or her to the ground safely.
  • Turn the person and his or her head to the side so that anything in the mouth, even spit, does not block the throat.
  • It can be dangerous to put anything in the mouth as you can get bitten.
  • If you know CPR, check the heart beat in the neck. Start CPR if there is no pulse. Call 911.
  • Listen for breathing at the mouth and extend the neck if breathing is difficult. If there is no breathing, start CPR by sealing your lips over the person’s mouth and breathing 2 quick breaths. Continue breathing every 5 seconds unless the person starts breathing without help. Call 911.
  • If this is the first seizure after TBI, call the person’s doctor for advice.
  • If the seizure does not stop after 3 minutes, call 911.
  • If the seizure stops within 3 minutes, call the person’s doctor.
  • If the person does not return to normal within 20 minutes after the seizure, call 911.

For More Information

The Epilepsy Foundation of America
Phone: 1-800-332-1000
Web: www.efa.org

Brain Injury Association of America
Phone: 1-800-444-6443
Web: www.biausa.org

References

  1. Diaz-Arrastia R, Agostini MA, Frol AB et al, Neurophysiologic and neuradiologic features of intractable epilepsy after traumatic brain injury in adults. Arch Neurol 2000; 57:1611-6.
  2. Englander J, Bushnik T, Duong TT et al, Analyzing risk factors for late posttraumtic seizures: a prospective, mulitcenter investigation. Arch Phys Med Rehabil 2003; 84: 365-373.
  3. Yablon SA, Dostrow VG. Post-traumatic seizures and epilepsy in Zasler ND, Katz DI, Zafonte RD, Brain Injury Medicine: Priciples and Practice. Demos, New York, 2007.
  4. Brain Trauma Foundation and American Association of Neurological Surgeons: Management and prognosis of severe traumatic brain injury 2000; pp 159-165.

 

Continue –> Seizures and Traumatic Brain Injury.

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[WEB SITE] UTHSC Researchers Find Link Between Incidence Of Epilepsy And Traumatic Brain Injury

…A new study by researchers at The University of Texas Health Science Center at San Antonio that reviewed the medical records of Afghanistan and Iraq war veterans who sustained traumatic brain injuries (TBIs), has revealed that subjects with mild TBIs (85 percent of veterans with such injuries) are approximately 28 percent more likely to develop epilepsy than individuals without TBIs…

μέσω UTHSC Researchers Find Link Between Incidence Of Epilepsy And Traumatic Brain Injury.

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