Transcutaneous vagal nerve stimulatio (t-VNS): An adjunctive treatment option for refractory epilepsy. (August 2018)

• Record Type: Journal Article
• Authors: Barbella, Giuseppina; Cocco, Isabella; Freri, Elena; Marotta, Guia; Visani, Elisa; Franceschetti, Silvana; Casazza, Marina
• Is Part Of: Seizure. Volume 60(2018)
• Page Start: 115
• Page End: 119
• Publication Date: 2018-08
• Subjects: t-VNS transcutaneousvagal nerve stimulation -- EEG electroencephalography -- AEDs antiepilepticdrugs -- DBS deepbrain stimulation -- RCS responsivecortical stimulation -- VNS vagalnerve stimulation -- NTS solitarytract nucleus -- ABVN auricularbranch of the vagus nerve -- QoLIE-31-P Qualityof Life in Epilepsy-31-P questionnaire; Transcutaneous vagal stimulation (t-VNS) -- Medically refractory epilepsy -- Palliative treatment -- Seizure severity; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2018.06.016
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: One third of focal seizures are drug resistant, 30% are not eligible for surgery. VNS is a modulation treatment with side effects and no sure selection criteria. t-VNS is a new not invasive method with an antiepileptic effect similar to VNS. In our study it reduces seizures, above all seizures with fall in 30% of patients. Further studies are needed to assess t-VNS predictive value of VNS efficacy. Abstract: Purpose: The aim of this trial was to investigate the efficacy and safety of transcutaneous vagal nerve stimulation (t-VNS) in the palliative treatment of drug resistant epileptic patients ineligible for surgery. Methods: Twenty adult patients received four hours of t-VNS per day for six months (T1), followed by a two-month washout period (T2). The frequency and type of seizures recorded at T1 and T2 were compared with those occurring in the three months preceding study entry (T0). Responders (> 30% reduction in the total number of seizures) subsequently received two hours of t-VNS per day for further six months (T3). All patients underwent electroencephalography (EEG) and completed the Quality of Life in Epilepsy questionnaire at baseline and T1. Results: At T1 six patients were considered responders. In these patients, at T3 the average reduction in seizure frequency was 60% compared to T0 (p = 0.043), and 51% compared to T2 (p = 0.043). Responders had more often seizures with falls (5 of 6; 83.3%) compared with non-responders (3 of 14; 21.4%) (p = 0, 010) and t-VNS reduced their frequency by a percentage ranging from 47.5 to 100%. There was no change in responders' EEG findings after stimulation. At the end of the trial, three responders continued t-VNS, one implanted VNS. Conclusions: t-VNS had no or minimal side effects and significantly reduced seizures in about one third of the enrolled patients. Further studies should be planned to assess whether t-VNS is a suitable tool to predict the efficacy of implanted VNS.