Vagus nerve stimulation in refractory and super-refractory status epilepticus - A systematic review
Dibué-Adjei M, Brigo F, Yamamoto T, Vonck K, Trinka E.
Brain Stimul. Sep-Oct 2019;12(5):1101-1110.
http://doi.org/10.1016/j.brs.2019.05.011.
Refractory or super refractory status epilepticus (#RSE/SRSE) are acute life-threatening situations that, if not interrupted, may be fatal or result in severe neurological impairments. Acute insertion of a vagus nerve stimulator may be a possible treatment alternative for these patients.
A systematic literature #review by Dibué-Adjei et al. from 2019 investigated the effectiveness of vagus nerve stimulation (#VNS) Therapy on RSE/SRSE by identifying all publications (N=26) that included patients with status epilepticus (#SE) treated with VNS Therapy.
Highlights
• VNS Therapy successfully interrupted the RSE/SRSE episodes in 74% of the patients.
• Beneficial effects were reported in 82% of the patients.
• VNS insertion decreased the median duration of RSE/SRSE with 10 days.
In total, the literature review identified 38 patients suffering from RSE/SRSE that were acutely treated with VNS implantation. VNS insertion successfully terminated RSE/SRSE in 74% of the cases and had a beneficial effect in 82% of the patients. Beneficial effects were defined as successful interruption of RSE/SRSE and no documentation of death at a later stage, >50% #seizure reduction, or seizure freedom including no reoccurrence of SE. In addition, median duration of RSE/SRSE decreased from 18 days to 8 days following VNS insertion.
VNS parameter settings (#dosing) were available for 19 patients and the median output current was 1.5 mA (range: 1-3 mA) with a median duty cycle of 16% (range: 10-58%).
The current review suggests acute VNS insertion to be a valuable and effective treatment option for RSE/SRSE and similar results have been reported in a previous review article (Zeiler et al. 2015). Nevertheless, the analysis was solely based on studies with low evidence class (level IV evidence in accordance with the American Academy of Neurology’s classification system) and should therefore be interpreted with caution as the risk of bias is high.
