The role of vagus nerve stimulation in refractory epilepsy

Oliveira, Tatiana Von Hertwig Fernandes de; Francisco, Alexandre Novicki; Demartini, Zeferino; Stebel, Sergio Leandro

doi:10.1590/0004-282X20170113

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Brasil

Arquivos de Neuro-Psiquiatria

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Brasil

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Sumário

VIEWS AND REVIEWS • Arq. Neuro-Psiquiatr. 75 (9) • Sept 2017 • https://doi.org/10.1590/0004-282X20170113 copy

The role of vagus nerve stimulation in refractory epilepsy

O papel da estimulação do nervo vago na epilepsia refratária

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.

vagus nerve stimulation; epilepsy

Variable	1	2	3	4	5	6	7	8
Output current (mA)	0.25	0.5	0.75	1	1.25	1.5	1.5	1.5
Frequency (Hz)	20/30	20/30	20/30	20/30	20/30	20/30	20/30	20/30
Pulse width (µs)	250/500	250/500	250/500	250/500	250/500	250/500	250/500	250/500
ON time (sec)	30	30	30	30	30	30	30	30
OFF time (min)	5	5	5	5	5	5	3	1.8
Magnet current (mA)	0.5	0.75	1	1.25	1.5	1.75	1.75	1.75
Magnet ON time (sec)	60	60	60	60	60	60	60	60

Duty cycle (% ON time)

OFF time (min)	ON time (sec)

	7	14	21	30	60
0.2	58*	69*	76*	81*	89*
0.3	44	56*	64*	71*	82*
0.5	30	41	49	57*	71*
0.8	20	29	36	44	59*
1.1	15	23	29	35	51*
1.8	10	15	19	25	38
3	6	9	12	16	27
5	4	6	8	10	18
10	2	3	4	5	10

Authors and year	Class of evidence	No. of patients	Follow-up (mos)	> 50% reduction (%)	Mean or median % reduction (%)
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Murphy et al., 2003⁵⁴54. Murphy JV, Torkelson R, Dowler I, Simon S, Hudson S.Vagal nerve stimulation in refractory epilepsy: the first 100 patients receiving vagal nerve stimulation at a pediatric epilepsy center. Arch Pediatr Adolesc Med. 2003;157(6):560-4. https://doi.org/10.1001/archpedi.157.6.560 https://doi.org/10.1001/archpedi.157.6.5...	III	96	32 (12–108)	45	NR
Uthman et al., 2004⁵⁵55. Uthman BM, Reichl AM, Dean JC, Eisenschenk S, Gilmore R, Reid S et al.Effectiveness of vagus nerve stimulation in epilepsy patients: a 12-year observation. Neurology. 2004;63(6):1124-6. https://doi.org/10.1212/01.WNL.0000138499.87068.C0 https://doi.org/10.1212/01.WNL.000013849...	III	25	6–144	60	52**
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[1] Correspondence: Tatiana Von Hertwig Fernandes de Oliveira; Av. Sete de Setembro, 3165; 80230-901 Curitiba PR, Brasil; E-mail: tatiana.hertwig@gmail.com