engleski

Should vagus nerve stimulation (VNS) be recommended early in the course of illness when seizures fail to respond to medication and cause falling or generalize?

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, nonpharmacologic treatment options should be considered early rather than late, but only resective epilepsy surgery can be curative. When this is not an option, neurostimulation modalities can be considered. Vagus nerve stimulation (VNS) launched the modern era of neurostimulation 30 years ago, and it continues to be the most commonly used form of neurostimulation. 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, do not have typical systemic side effects of AEDs, and may reduce the risk of sudden unexplained death in epilepsy. VNS has also FDA approval for depression and has positive effects on mood and cognition, which suggest that this neurostimulation modality, except the use primarily in patients whose seizures may cause injury, should be more broadly applied. Short and long-term VNS studies demonstrate a seizure-suppressing effect, with a more efficacy in long-term treatment. VNS decreases seizure frequency by approximately 50% in 30– 40% of implanted patients. VNS is safe and generally well tolerated ; adverse events are typically related to the surgical procedure or stimulation itself. However, it is important to point out that it might have an unfavourable impact on sleep breathing disorders. VNS can also be used in children (e.g. - FDA indication is down to 4 years). The rationale behind early implantation of VNS in children with drug-resistant epilepsy is that reduction of seizure frequencies and duration at an early age could potentially lead to a better recovery and further development of the cognitive and motor functions. This is likely due to a reduction of a strong epileptic activity and frequent and long-lasting seizures interfering with their cognitive processes and sensorimotor functions and with the support of a remarkable amount of plasticity at a very young age. Author will also present experience of the Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy in treating patients with drug-resistant epilepsy with VNS.

drug-resistant epilepsy, vagus nerve stimulation

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