Vagus Nerve Stimulator Epilepsy Medline Results 11/95
The following file is the result of a 11/95 search on the MEDLINE database with the key words 'Vagus nerve stimulator epilepsy'. MEDLINE is the US National Institute of Health searchable database of medical publications from around the world. There are more than 7.5 million citations, from over 4000 medical journals. Over 50% of the citations include abstracts. No full text documents are available. A guide with information on accessing MEDLINE through various providers (it is not free) is available on the WWW at http://www.sils.umich.edu/~nscherer/Medline/MedlineGuide.html A biomedical subset of MEDLINE is provided for free by the National Center for Biotechnology Information located at http://www3.ncbi.nlm.nih.gov/Entrez/. There is little clinical information, but it provides a good demonstration of the database. Further infor regarding vagal nerve stimulation can be gotten from Cyberon Corporation, Mr. Shawn Lunney, 713-332-1375 x233 He indicated all US Studies are full, but 15-20 European countries do this implant. The Greatful Med search of the National Library of Medicine showed the following: 1 Murphy JV; Hornig G; Schallert G Left vagal nerve stimulation in children with refractory epilepsy. Preliminary observations. Section of Neurology, Children's Mercy Hospital, Kansas City, Mo., USA. Arch Neurol 1995 Sep;52(9):886-9 Unique Identifier: MEDLINE 95390831 Abstract: OBJECTIVE: To observe the tolerance and efficacy of periodic left vagal nerve stimulation in a group of children with medically intractable epilepsies. DESIGN: A vagal nerve stimulator (Cyberonics Inc, Webster, Tex) was implanted in 12 children with medically and surgically refractory epilepsies. These children were followed up for 2 to 14 months. OUTCOME MEASUREMENTS: (1) The number of seizures recorded during the final month of observation was compared with the number recorded during the month before the implantation of the vagal nerve stimulator. (2) Parents were asked to compare overall status of their child, relative to the period prior to using the vagal nerve stimulator, on a global rating scale. (3) The number of antiepileptic drugs at the last visit was compared with the number before the use of this device. (4) Adverse events were recorded. RESULTS: Five of the 12 patients had a greater than 90% reduction in the number of monthly seizures. Global evaluation scores indicated that there were no deteriorations from baseline and that there was a considerable number with improved status. Four patients were able to reduce the number of antiepileptic drugs used. No significant adversities were noted. CONCLUSIONS: The vagal nerve stimulator is well tolerated in children with intractable epilepsies, and it may have a role in their medical management. We were unable to determine specific epilepsies or seizures that were sensitive to this intervention. 2 Koeze TH Neuromodulation for pain and epilepsy. Academic Unit of Neurosurgery, London Hospital Medical College, UK. REVIEW ARTICLE: 75 REFS. Baillieres Clin Neurol 1995 Apr;4(1):167-83 Unique Identifier: MEDLINE 95360401 3 A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology 1995 Feb;45(2):224-30 Unique Identifier: MEDLINE 95157736 Abstract: Preliminary reports have suggested that chronic, intermittent stimulation of the vagus nerve (VNS) is an alternative treatment for patients with medically refractory seizures. We performed a multicenter, randomized, controlled trial to evaluate the efficacy and safety of adjunctive VNS in patients with poorly controlled partial seizures. An implanted, programmable pacemaker-like device was connected to two stimulating electrodes wrapped around the left vagus nerve. One hundred fourteen patients were randomized to receive 14 weeks of high-level stimulation (presumed therapeutic dose) or low-level stimulation (presumed subtherapeutic dose) using a blinded, parallel study design. Seizure frequency was compared with a 12-week baseline. Mean reduction in seizure frequency was 24.5% for the high stimulation group versus 6.1% for the low stimulation group (p = 0.01). Thirty-one percent of patients receiving high stimulation had a seizure frequency reduction of > or = 50%, versus 13% of patients in the low group (p = 0.02). Treatment emergent side effects were largely limited to a transient hoarseness occurring during the stimulation train. One patient with no previous history of cardiac disease experienced a myocardial infarction during the third month of vagal stimulation. VNS may be an effective alternative treatment for patients who have failed antiepileptic drug therapy and are not optimal candidates for epilepsy surgery. 4 Friedman M; Wernicke JF; Caldarelli DD Safety and tolerability of the implantable recurrent laryngeal nerve stimulator. Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612. Laryngoscope 1994 Oct;104(10):1240-4 Unique Identifier: MEDLINE 95020291 Abstract: The recurrent laryngeal nerve (RLN) stimulator has been implanted on a limited basis since 1988 for control of spasmodic dysphonia. A similar vagus nerve stimulator has been implanted in a larger series of patients to control epilepsy. The safety and tolerability of these two stimulators were evaluated. In 113 patients implanted with the vagus nerve stimulator, the complication rate was 0.9%. All patients were monitored for vital signs, electrocardiographic changes, and adverse effects. The absence of changes in vital signs and electrocardiograms during vagal stimulation establishes the safety of this treatment. Since placement of the electrode around the vagus nerve is an easier surgical technique than placement deep to the RLN, it seems reasonable to change the technique to implant the stimulator on the vagus in patients with spasmodic dysphonia. 5 Michael JE; Wegener K; Barnes DW Vagus nerve stimulation for intractable seizures: one year follow-up. Baylor College of Medicine, Department of Otolaryngology, Houston, Texas 77030. J Neurosci Nurs 1993 Dec;25(6):362-6 Unique Identifier: MEDLINE 94149389 Abstract: Even with the best health care available, many patients with epilepsy still suffer from poorly controlled seizures. Patients with intractable partial seizures are often inhibited from realizing their full potential and may experience a less than optimal quality of life. Vagus nerve stimulation (VNS) is being studied in a double-blind, controlled, randomized trial at 17 epilepsy centers throughout the U.S. and Europe as a potential therapy for patients with refractory seizures. During a 14-week controlled phase in three of the centers, the therapeutic group (N = 10) experienced a mean seizure frequency percent reduction (SFPR) of 33.1% as compared to baseline (p = 0.0084) while the subtherapeutic group (N = 12) experienced an SFPR of 0.6% as compared to baseline (p = 0.9183). After the controlled phase, all patients were switched into the therapeutic group in an open extension phase. Results after one year of therapeutic stimulation (N = 15) reveal a mean SFPR of 35.6% (p = 0.0088) with 6 of the 15 patients (40%) achieving at least a 50% seizure reduction. Adverse effects included hoarseness, coughing and nausea. There were no deaths or serious injuries related to the device. Based on these limited data, VNS appears to be a safe and efficacious new therapy for refractory partial seizures. 6 McLachlan RS Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada. Epilepsia 1993 Sep-Oct;34(5):918-23 Unique Identifier: MEDLINE 94008874 Abstract: The effects of electrical stimulation of the vagus nerve, a proposed treatment for patients with intractable epilepsy, on focal interictal spikes produced by penicillin and EEG secondarily generalized seizures induced by pentylenetetrazol were assessed in rats. Interictal spike frequency was reduced by 33% during 20 s of stimulation (p < 0.001) and remained low for < or = 3 min. Amplitude of residual spikes was also decreased. Cardiac and respiratory rates were suppressed. Cooling the nerve proximal to the point of stimulation abolished the EEG and respiratory effects. A similar reduction in spike frequency of 39% was obtained by heating the animals' tail (p < 0.01). Vagal stimulation at onset of seizures reduced mean seizure duration from 30.2 +/- 15.7 s without stimulation to 5.0 +/- 1.8 s (p < 0.01). Only the EEG equivalent of the clonic phase of the seizure was affected. These findings suggest that vagus nerve stimulation can be a potent but nonspecific method to reduce cortical epileptiform activity, probably through an indirect effect mediated by the reticular activating system. 7 Uthman BM; Wilder BJ; Penry JK; Dean C; and others Treatment of epilepsy by stimulation of the vagus nerve. Neurology Service, Veterans Administration Medical Center, Gainesville, FL 32608-1197. Neurology 1993 Jul;43(7):1338-45 Unique Identifier: MEDLINE 93317190 Abstract: We treated 14 patients with medically refractory partial seizures by stimulation of the vagus nerve in two single-blind pilot studies. Patients received stimulation through an implantable, programmable NeuroCybernetic Prosthesis, consisting of a pulse generator and a lead-electrode assembly. The mean reduction in seizure frequency after 14 to 35 months of vagal stimulation was 46.6%. Of the 14 patients, five (35.7%) had a 50% or greater reduction in seizure frequency. Two patients, one of whom had had 10 to 100 seizures per day before stimulation, have been seizure-free for over 1 year. Adverse events were primarily limited to initial hoarseness and a tingling sensation at the electrode site in the neck when the device was activated. Most patients tolerated the device and stimulation well. There were no permanent adverse events. Some cases of medically refractory partial seizures are improved by vagal stimulation. 8 Tougas G; Hudoba P; Fitzpatrick D; Hunt RH; Upton AR Cerebral-evoked potential responses following direct vagal and esophageal electrical stimulation in humans. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Am J Physiol 1993 Mar;264(3 Pt 1):G486-91 Unique Identifier: MEDLINE 93212826 Abstract: Cerebral evoked responses following direct electrical stimulation of the vagus and esophagus were compared in 8 epileptic subjects and with those recorded after esophageal stimulation in 12 healthy nonepileptic controls. Direct vagal stimulation was performed using a left cervical vagal pacemaker, which is used in the treatment of epilepsy. Esophageal stimulation was obtained with the use of an esophageal assembly incorporating two electrodes positioned 5 and 20 cm orad to the lower esophageal sphincter. Evoked potential responses were recorded with the use of 20 scalp electrodes. The evoked potential responses consisted of three distinct negative peaks and were similar with the use of either vagal or esophageal stimulation. The measured conduction velocity of the afferent response was 7.5 m/s in epileptic subjects and 10 m/s in healthy controls, suggesting that afferent conduction is through A delta-fibers rather than slower C afferent fibers. We conclude that the cortical-evoked potential responses following esophageal electrical stimulation are comparable to direct electrical stimulation of the vagus nerve and involve mostly A delta-fibers. This approach provides a method for the assessment of vagal afferent gastrointestinal sensory pathways in health and disease. 9 McIntosh S; Da Costa D; Kenny RA Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic [see comments] Department of Geriatric Medicine, Royal Victoria Infirmary, Newcastle upon Tyne. Age Ageing 1993 Jan;22(1):53-8 Unique Identifier: MEDLINE 93175257 Comment in: Age Ageing 1993 Sep;22(5):391 Abstract: Sixty-five consecutive elderly patients (mean age 78 years) referred to a 'syncope' clinic over a six-month period were prospectively studied. Initial evaluation included ambulatory electrocardiography, carotid sinus massage before and after atropine and prolonged head-up tilt. Diagnostic criteria for causes of syncope were assigned at the beginning of the study. Overall, a diagnosis was attributed to symptoms in 92% of patients; overlap was present in a quarter. Diagnoses were cardioinhibitory carotid sinus syndrome (CSS; 5%), vasodepressor CSS (26%), mixed CSS (14%), orthostatic hypotension (32%), vasodepressor vasovagal syncope (11%), cardiac arrhythmia (21%), epilepsy (9%), cerebrovascular disease (6%) and others (12.5%). Sixty per cent of patients with vasodepressor CSS also had orthostatic hypotension or vasodepressor vasovagal syncope suggesting a common aetiology. Using an integrated approach incorporating head-up tilt and carotid sinus massage in a selected group of elderly patients referred to a 'syncope'