Closed-loop vagal nerve stimulation for intractable epilepsy: A single-center experience

AdultPediatric
Written By Rodrigo Silva

Graham M. Winston, Sergio Guadix, Miguel Tusa Lavieri, Rafael Uribe-Cardenas, Gary Kocharian, Nicholas Williams, Evan Sholle, Zachary Grinspan, Caitlin E. Hoffman

Seizure. 2021 May;88:95-101.
doi: 10.1016/j.seizure.2021.03.030.

Closed-loop vagus nerve stimulation (#VNS) uses the increased #ictal heart rate, often preceding an epileptic #seizure, as an indicator for auto stimulation. This retrospective study by Winston et al. (Apr. 2021) compared the seizure-related outcome of closed-loop VNS with open-loop VNS devices in patients with drug-resistant epilepsy (#DRE).  

At the 9-month follow-up, the patients with closed-loop VNS (31 patients) showed a significantly larger median decrease in seizure frequency (75%) compared to the open-loop VNS (70 patients, 50%, p = 0.04). Likewise, patients treated with closed-loop VNS had better seizure outcomes according to the #Engel classification scale than those with open-loop VNS (OR 0.26 [95% CI 0.09-0.69]). The direction of effect continued to favor closed-loop VNS at 24 months, but no significant differences were observed (Figure 1).


Rodrigo Silva
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Electrocorticography Analysis in Patients With Dual Neurostimulators Supports Desynchronization as a Mechanism of Action for Acute Vagal Nerve Stimulator Stimulation
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Long-term surveillance of SUDEP in drug-resistant epilepsypatients treated with VNS therapy