Clinical Benefit of Vagus Nerve Stimulation for Epilepsy: Assessment of Randomized Controlled Trials and Prospective Non-Randomized Studies.

Autor:	Cramer SW; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA., McGovern RA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.; Department of Neurology, University of Minnesota, Minneapolis, MN, USA., Chen CC; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA., Park MC; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.; Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
Jazyk:	angličtina
Zdroj:	Journal of central nervous system disease [J Cent Nerv Syst Dis] 2023 Jan 11; Vol. 15, pp. 11795735231151830. Date of Electronic Publication: 2023 Jan 11 (Print Publication: 2023).
DOI:	10.1177/11795735231151830
Abstrakt:	We examined the efficacy of vagal nerve stimulation (VNS) for patients suffering from medically intractable epilepsy. Four randomized controlled trials (RCTs - 3 adult RCTs and 1 pediatric RCT) were identified in our comprehensive literature search. Across the 4 studies, high frequency VNS stimulation (frequency >20 Hz) consistently achieved a greater seizure frequency reduction (23.4-33.1%) relative to low frequency VNS stimulation (1 Hz, .6-15.2%). We identified 2 RCTs examining whether the parameters of stimulation influenced seizure control. These studies reported that VNS achieved seizure control comparable to those reported by the first 4 RCTs (22-43% seizure frequency reduction), irrespective of the parameters utilized for VNS stimulation. In terms of VNS associated morbidity, these morbidities were consistently higher in adults who underwent high frequency VNS stimulation (eg dysphonia 37-66%, dyspnea 6-25.3%). However, no such differences were observed in the pediatric population. Moreover, <2% of patients withdrew from the RCTs/prospective studies due to intolerable symptoms. To provide an assessment of how the risks and benefits of VNS impact the patient experience, 1 study assessed the well-being of enrolled patients (as a secondary end point) and found VNS was associated with an overall improvement in well-being. Consistent with this observation, we identified a prospective, non-randomized study that demonstrated improved quality of life for epilepsy patients managed with VNS and best medical practice relative to best medical practice alone. In aggregate, these RCT studies support the efficacy and benefit of VNS as a neuro-modulatory platform in the management of a subset of medically refractory epilepsy patients. (© The Author(s) 2023.)
Databáze:	MEDLINE
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