Could vagus nerve stimulation influence bone remodeling? (original) (raw)
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Marmara Medical Journal, 2021
Objectives: To investigate the effects of low bone mineral density (BMD) on pain, quality of life (QoL), and fatigue in epileptic patients who use anticonvulsants. Patients and Methods: Epileptic patients aged 18 years or older who use anticonvulsant drugs were recruited into the study. Demographic and clinical features were recorded, including the duration of epilepsy, number of anticonvulsants used, previous fracture history and BMD scores. The functional parameters included back pain measured with the visual analogue scale (VAS) and brief pain inventory (BPI) scale, QoL assessed with the Qualeffo-41 questionnaire, and fatigue assessed with the fatigue severity scale (FSS). Results: Of the 100 patients screened for inclusion in the study, 63 epileptic patients met the inclusion criteria. The mean age and mean disease duration of all participants was 39.5 (±11.2) and 19.3 (±11.6) years, respectively. The median scores for VAS back pain, VAS low back pain, Qualeffo-41, FSS, pain severity, and pain interference (BPI) were significantly higher in patients with secondary osteoporosis compared to patients with normal BMD. There were significant correlations between lumbar spinal BMD and VAS back pain (rho =-0.58, p < 0.0005), BPI pain severity (rho =-0.56, p < 0.0005), BPI pain interference (rho =-0.52, p < 0.0005), Qualeffo-41 (rho =-0.56, p < 0.0005), and FSS (rho =-0.41, p = 0.001). Conclusion: Epileptic patients suffering from low BMD showed increased pain, fatigue and impaired QoL. Therefore, BMD measurement should be recommended for the evaluation and management of epileptic patients.
International Journal of Epilepsy
Epilepsy is one of the most common neurological disorder usually requiring life long treatment. Long term treatment with antiepileptic drugs (AED’s) is associated with chronic side effects which includes effect on bone healthThere is a growing volume of literature suggesting that chronic use of AED in patients with epilepsy significantly reduces bone mineral density (BMD) with an increased fracture risk. The causes of these associations are likely to be multifactorial. Unlike other chronic side effects, symptoms of bone loss are insidious and asymptomatic; hence they are usually not recognized, and thus untreated. Hence one needs to determine the presence of osteoporosis before the overt signs are evident to reduce fracture risk. Evaluation of bone health is mandatory for a comprehensive treatment and to provide calcium and 25-OH vitamin-D 3 supplementation if needed. The goals of epilepsy treatment are to achieve seizure freedom while minimizing adverse effects of treatment. Manage...
Seizure, 2018
The paper presents a long-term follow-up study of VNS patients, analyzing seizure outcome, medication changes, and surgical problems. 74 adults with VNS for 10 to 17 years were evaluated yearly as: non-responder - NR (seizure frequency reduction <50%), responder - R (reduction ≥ 50% and <90%), and 90% responder - 90R (reduction ≥ 90%). Delayed R or 90R (≥ 4 years after surgery), patients with antiepileptic medication changes and battery or complete system replacement were identified. Statistical analysis of potential outcome predictors (age, seizure duration, MRI, seizure type) was performed. The rates of R and 90R related to the patients with outcome data available for the study years 1, 2, 10, and 17 were for R 38.4%, 51.4%, 63.6%, and 77.8%, and for 90R 1.4%, 5.6%, 15.1%, and 11.1%. The absolute numbers of R and 90R increased until years 2 and 6. Antiepileptic therapy was changed in 62 patients (87.9%). There were 11 delayed R and four delayed 90R, with medication changes i...
Acta Neurochirurgica, 2012
Background The results of vagus nerve stimulation (VNS) for the treatment of drug-resistant epilepsies are highly variable due to the lack of defined patient's selection criteria and a follow-up of published studies being generally too short. Here we report the outcome of VNS in a series with long-term follow-up and try to identify subgroups of patients who could be better candidates for this procedure. Method We studied 53 patients (33 male, 20 female) with a prospectively recorded follow-up (mean, 55.96± 43.53 months). The monthly average seizure frequency for each patient at baseline, 3, 6, 12 months, and each year until the latest follow-up after implant was measured and the percentage of "responders" and response time (RT) were calculated. We investigated the following potential prognostic role of these factors: age of onset of epilepsy, pre-implant epilepsy duration, etiology, and age at implant. Results Globally, 40 % of patients responded to VNS (mean RT, 14.85±16.85 months). Lesional etiology (p00.0179, logrank test), particularly ischemia (p00.011, Fisher exact test) and tuberous sclerosis (p00.0229, Fisher exact test), and age at implant <18 years (p00.0242, logrank test) were associated to better response to VNS. In the lesional subgroup the best results were observed in patients with a pre-implant epilepsy duration <15 years (p00.0204, logrank test) and an age at implant <18 years (p00.0187 logrank test). Conclusions The best candidate to VNS seems to be a patient with lesional etiology epilepsy (particularly postischemic and tuberous sclerosis) and a short duration of epilepsy who undergo VNS younger than 18 years.
Vagus Nerve Stimulation for Epilepsy: The Notre-Dame Hospital Experience
The Canadian Journal of Neurological Sciences, 2011
Purpose:Retrospective study assessing the efficacy and tolerability of vagus nerve stimulation (VNS) for the treatment of refractory epilepsy at Notre-Dame Hospital.Methodology:Chart review of all adult epileptic patients treated by VNS with ≥ 1 year follow-up. Responders were defined as patients with ≥ 50% reduction of baseline seizure frequency.Results:Thirty-four patients (14M; mean age = 29.9 yrs) received a VNS. Sub-pectoralis implantation (n = 25) was more frequent than subcutaneous (n = 9). Most patients suffered from intractable partial epilepsy. After 6 months, 12 months, 24 months, and 36 months, 14/34 patients (41%), 16/34 patients (47%), 17/30 patients (57%) and 12/20 patients (60%) respectively were responders. Two patients (6%) became seizure-free. Complications related to implantation were minor: eight cases of limited cervical hypoesthesia, two minor scar infections and one Horner syndrome. Adverse events (voice hoarseness, throat paresthesia, coughing) related to st...
Vagus Nerve Stimulation in Patients With Refractory Epilepsy: a case series
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Approximately 33% of patients with epilepsy do not respond to treatment with a single antiepileptic drug. Many of these patients can benefit from neurosurgical treatment. However, not all patients are candidates for surgery, and in these cases vagus nerve stimulation (VNS) presents as a good therapeutic option. Objectives: Evaluation of efficiency, tolerability and safety in the control of seizures after VNS implantation in patients from a reference hospital. Methods: cross-sectional study examined 20 patients who underwent implantation of the VNS in our facilities between 2007 and 2014. Proportions and chi-square test were applied (statistical significance level set to p ≤ 0.05). Results: Mean follow-up was 31.3 months. Seizure frequency decreased in 55% of the patients. Among them, 11 patients believed that VNS had improved their quality of life. The mean reduction reported by other patients was 78.3%. More than 30% reported no adverse effects. About 70% of patients no longer requ...
Clinical Cases and Reviews in Epilepsy, 2017
Vagus Nerve Stimulation (VNS) is a palliative therapy for patients with drug-resistant epilepsy. Nonetheless, no predictive factors for efficacy have been identified. Recently, a non-invasive transcutaneous VNS (t-VNS) has been developed. It stimulates an auricular branch of the vagus nerve directed to the same nuclei of VNS. Here we report the case of a young female patient with drug-resistant epilepsy, caused by a right frontal cortical dysplasia. She had the onset of seizures at the age of 4 months, and she presented with a West syndrome in the first year of life; in the following years, she had various types of focal seizures, with rare secondary generalization and frequent falls. She had uncountable seizures every day and a severe psychomotor delay. At the age of eight, she underwent surgery, however without benefit. At 13 years, she tested t-VNS with significant seizure reduction. Stable VNS was then implanted. Quality of life, alertness and performances of the patient improved. Even if it needs demonstration in larger case series, t-VNS could be used to predict the effectiveness of VNS, in order to select the best candidates for a stable implant.
Seizure, 2020
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Vagus Nerve Stimulation Therapy for Drug-resistant Epilepsy
2003
Context: Vagus nerve stimulation is a relatively new treatment for epilepsy. Objective: To confirm the safety and efficacy of vagus nerve stimulation in postmarketing clinical practice. Design: Prospective case series. Setting: Comprehensive Epilepsy Program of the Southern California Permanente Medical Group. Patients: Thirty four patients with drug-resistant epilepsy. Intervention: We implanted a device for vagus nerve stimulation (the NeuroCybernetic Prosthesis (NCP) system) in all 34 patients and monitored their condition for six months. Main outcome measures: Frequency and type of postoperative seizures. Results: During the six-month study period, 22 patients had partial seizures or and without generalized seizures; 12 patients had multiple types of generalized seizures. Of the 34 patients, 21 (61.8%) had ＞50% reduction in seizure frequency after NCP implantation; ten of those 21 patients had ＞90% reduction in seizure frequency. Thirteen (38.2%) of the original 34 patients show...