engleski

Vagus nerve stimulation in drug resistant-epilepsy - from late to early implantation

Epilepsy is a common neurological disease that affects 1% of the population and at least 30% of patients have drug-resistant epilepsy. In these patients, non pharmacological treatment options should be considered early rather than late because of change in the epileptogenic network, cognitive decline, injuries caused by seizures, and worse postoperative outcome as a consequence of late operation. Only resective surgery can be curative and when this is not an option, neurostimulation modalities can be considered. Vagus nerve stimulation (VNS) launched modern era of neurostimulation 30 years ago. Responsive neurostimulation (RNS) and deep brain stimulation (DBS) are relatively new and change the landscape and approaches to drug-resistant epilepsy. For both generalized and multifocal epilepsies, VNS is an option, RNS is not, and DBS has only limited evidence. Neurostimulation therapies, at least VNS and RNS, may reduce the risk of sudden unexplained death in epilepsy. VNS decreases seizure frequency by approximately 50% in 30-40% of implanted patients. Adverse events can be stimulation or implantation associated. VNS has FDA approval for depression and has positive effects on mood and cognition. However, it can also be used in children with drug- resistant epilepsy, and the rationale behind this is a reduction of strong epileptic activity interfering with their cognitive processes and sensorimotor functions, with support of a remarkable amount of plasticity at a very young age. The authors presented experience of the Referral Centre for Epilepsy of the Ministry of Health of the Republic of Croatia in treating patients with drug- resistant epilepsy with VNS.

neuromodulation ; vagus nerve stimulation ; drug-resistant epilepsy

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