Guest guest Posted November 17, 2005 Report Share Posted November 17, 2005 The Pubmed search vagus AND nerve AND stimulation AND (seizur* OR epileptiform) today generated 341 cites. The first 20 or so were surprisingly on target. Here they are. Many of the next 321 are probaby peachy keen too. *1: *Eur J Paediatr Neurol. <javascript:AL_get(this, 'jour', 'Eur J Paediatr Neurol.');> 2005 Oct 27; [Epub ahead of print] Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16257548> Links <javascript:PopUpMenu2_Set(Menu16257548);> *Beneficial effects on sleep of vagus nerve stimulation in children with therapy resistant epilepsy.* *Hallbook T* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Hall\ book+T%22%5BAuthor%5D>, *Lundgren J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Lund\ gren+J%22%5BAuthor%5D>, *Kohler S* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Kohl\ er+S%22%5BAuthor%5D>, *Blennow G* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Blen\ now+G%22%5BAuthor%5D>, *Stromblad LG* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Stro\ mblad+LG%22%5BAuthor%5D>, *Rosen I* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Rose\ n+I%22%5BAuthor%5D>. Department of Paediatrics, University Hospital, SE-221 85 Lund, Sweden. The study purpose was to evaluate sleep structure following Vagus Nerve Stimulation (VNS) in 15 children with therapy resistant epilepsy and to correlate possible alterations with changes in epileptiform activity and clinical effects. Fifteen children were examined with ambulatory polysomnographic recordings initially, and after 3 and 9 months of VNS-treatment. Sleep parameters, all-night delta power activity and movement times (MTs), used to account for arousals were estimated. Epileptiform activity was evaluated by spike detection. Seizure frequency was recorded in a diary. The severity of the seizures was scored with the National Hospital Seizure Severity Scale (NHS3). Quality of life (QOL) was assessed by a visual analogue scale. Behaviour problems were quantified by using the total score of the Child Behaviour Checklist (CBCL). VNS induces a significant increase in slow wave sleep (SWS) and a decrease in sleep latency and in stage 1 sleep. The number and density of MTs during total night sleep were significantly increased. There was also a significant increase in the number of MTs immediately related to the VNS stimulation periods. Of the 14 children with increased MTs, 10 had a reduction in epileptiform activity, and in clinical seizures, all had an improvement in NHS3, and 11 in QOL. Of the 10 children with increased SWS, eight also improved in QOL and eight in behaviour. Our findings indicate that VNS counteracts known adverse effects of epilepsy on sleep and increases slow wave sleep. This possibly contributes to the reported improvement in well-being. We also see an increase in MTs. This arousal effect seems to be of minor importance for QOL and could possibly be related to the antiepileptic mechanisms in VNS. PMID: 16257548 [PubMed - as supplied by publisher] ------------------------------------------------------------------------ *2: *Seizure. <javascript:AL_get(this, 'jour', 'Seizure.');> 2005 Oct;14(7):504-13. Epub 2005 Sep 19. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16176878> Links <javascript:PopUpMenu2_Set(Menu16176878);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048 & uid=16176878 & db=\ pubmed & url=http://linkinghub.elsevier.com/retrieve/pii/S1059-1311%2805%2900150-0\ > *Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood.* *Hallbook T* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Hall\ book+T%22%5BAuthor%5D>, *Lundgren J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Lund\ gren+J%22%5BAuthor%5D>, *Stjernqvist K* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Stje\ rnqvist+K%22%5BAuthor%5D>, *Blennow G* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Blen\ now+G%22%5BAuthor%5D>, *Stromblad LG* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Stro\ mblad+LG%22%5BAuthor%5D>, *Rosen I* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Rose\ n+I%22%5BAuthor%5D>. Department of Paediatrics, University Hospital, SE-221 85 Lund, Sweden. tove.hallbook@... PURPOSE: Vagus nerve stimulation (VNS) is a neurophysiologic treatment for patients with refractory epilepsy. There is growing evidence of additional quality of life (QOL) benefits of VNS. We report the effects of VNS on seizure frequency and severity and how these changes are related to cognitive abilities, QOL, behaviour and mood in 15 children with medically refractory and for surgery not eligible epilepsy. METHODS: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with Bayley Scales of Infant Development (BSID), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R), Wechlser Intelligence Scales for Children (WISC-III) depending on the child's level of functioning, a Visual Analogue Scale for validating QOL, Child Behaviour Checklist (CBCL) for quantifying behaviour problems, Dodrill Mood Analogue Scale and Birleson Depression Self-Rating Scale, and the National Hospital Seizure Severity Scale (NHS3). A diary of seizure frequency was collected. RESULTS: Six of 15 children showed a 50% or more reduction in seizure frequency; one of these became seizure-free. Two children had a 25-50% seizure reduction. Two children showed increased seizure frequency. In 13 of 15 children there was an improvement in NHS3. The parents reported shorter duration of seizure and recovery phase. There were no changes in cognitive functioning. Twelve children showed an improvement in QOL. Eleven of these also improved in seizure severity and mood and five also in depressive parameters. CONCLUSION: This study has shown a good anti-seizure effect of VNS, an improvement in seizure severity and in QOL and a tendency to improvement over time regarding behaviour, mood and depressive parameters. The improvement in seizure severity, QOL, behaviour, mood and depressive parameters was not related to the anti-seizure effect. PMID: 16176878 [PubMed - in process] ------------------------------------------------------------------------ *3: *Neuroimmunomodulation. <javascript:AL_get(this, 'jour', 'Neuroimmunomodulation.');> 2005;12(5):307-9. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16166810> Links <javascript:PopUpMenu2_Set(Menu16166810);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3030 & uid=16166810 & db=\ pubmed & url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext & file=N\ IM2005012005307> *The effects of vagus nerve stimulation on pro- and anti-inflammatory cytokines in humans: a preliminary report.* *Corcoran C* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Corc\ oran+C%22%5BAuthor%5D>, *Connor TJ* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Conn\ or+TJ%22%5BAuthor%5D>, *O'Keane V* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22O%27\ Keane+V%22%5BAuthor%5D>, *Garland MR* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Garl\ and+MR%22%5BAuthor%5D>. Department of Psychiatry, Beaumont Hospital, and Royal College of Surgeons in Ireland, Dublin, Ireland. OBJECTIVE: Vagus nerve stimulation (VNS) is a novel therapy in resistant epilepsy, and is undergoing clinical trials in resistant depression. The mechanism of action of VNS is assumed to be due to modulation of deep brain structures via its afferent connections. As the vagus nerve has potentially important immunological actions that may have relevance to its therapeutic effects, we hypothesised that an additional mechanism may occur via vagally mediated actions on cytokine synthesis. METHODS: Patients (n=10) with resistant depression were studied in the weeks prior to, and 3 months following, implantation of a vagus nerve stimulator. No medication changes were made during the course of the study. High-sensitivity ELISA kits were used to measure plasma IL-1 beta, IL-6, TNF-alpha, IL-10 and TGF-beta concentrations. C-reactive protein (CRP) was measured using a high sensitivity immunonephelometry assay. RESULTS: There were highly significant increases in the plasma levels of IL-6, TNF-alpha and TGF-beta. Increases seen with IL-10 and IL-1 beta were not significant. Plasma CRP levels were unchanged. CONCLUSION: VNS is associated with marked peripheral increases in pro- and anti-inflammatory circulating cytokines. Such changes are unlikely to be non-specific inflammatory reactions, reflected by CRP levels. In view of gathering evidence supporting a role for the immune system in modulating affect, as well as seizure activity, these effects of VNS may be therapeutically relevant. Copyright © 2005 S. Karger AG, Basel. PMID: 16166810 [PubMed - in process] ------------------------------------------------------------------------ *4: *J Neurosurg. <javascript:AL_get(this, 'jour', 'J Neurosurg.');> 2005 Mar;102(2 Suppl):213-7. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16156232> Links <javascript:PopUpMenu2_Set(Menu16156232);> *Vagus nerve stimulation for induced spinal cord seizures: insights into seizure cessation.* *Tubbs RS* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Tubb\ s+RS%22%5BAuthor%5D>, *Killingsworth CR* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Kill\ ingsworth+CR%22%5BAuthor%5D>, *Rollins DL* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Roll\ ins+DL%22%5BAuthor%5D>, * WM* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Smit\ h+WM%22%5BAuthor%5D>, *Ideker RE* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Idek\ er+RE%22%5BAuthor%5D>, *Wellons JC 3rd* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Well\ ons+JC+3rd%22%5BAuthor%5D>, *Blount JP* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Blou\ nt+JP%22%5BAuthor%5D>, *Oakes WJ* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Oake\ s+WJ%22%5BAuthor%5D>. Department of Cell Biology, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Alabama 35233, USA. richard.tubbs@... OBJECT: Vagus nerve stimulation is known to decrease the frequency, duration, and intensity of some types of intracranial seizures in both humans and animals. Although many theories abound concerning the mechanism for this action, the true cause remains speculative. To potentially elucidate a pathway in which vagus nerve stimulation aborts seizure activity, seizures were initiated not in the cerebral cortex but in the spinal cord and then vagus nerve stimulation was performed. METHODS: Ten pigs were anesthetized and placed in the lateral position, and a small laminectomy was performed in the lumbar region. Topical penicillin, a known epileptogenic drug to the cerebral cortex and spinal cord, was applied to the dorsal surface of the exposed cord. With the exception of two animals that were used as controls, once seizure activity was discernible via motor convulsion or increased electrical activity the left vagus nerve, which had been previously isolated in the neck, was stimulated. Following multiple stimulations of the vagus nerve and with seizure activity confirmed, the cord was transected in the midthoracic region and vagus nerve stimulation was performed. Vagus nerve stimulation resulted in cessation of spinal cord seizure activity in all (87.5%) but one experimented animal. Transection of the spinal cord superior to the site of seizure induction resulted in the ineffectiveness of vagus nerve stimulation to cause cessation of seizure activity in all study animals. CONCLUSIONS: The effects of vagus nerve stimulation on induced spinal cord seizures involve descending spinal pathways. The authors believe that this experiment is the first to demonstrate that spinal cord neuronal hyperactivity can be suppressed by stimulation of a cranial nerve. These data may aid in the development of alternative mechanisms for electrical stimulation in patients with medically intractable seizures. Further studies are now necessary to isolate which specific tracts, nuclei, and neurotransmitters are involved in this process. PMID: 16156232 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *5: *Epileptic Disord. <javascript:AL_get(this, 'jour', 'Epileptic Disord.');> 2005 Sep;7 Suppl 1:22-6. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16120490> Links <javascript:PopUpMenu2_Set(Menu16120490);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3050 & uid=16120490 & db=\ pubmed & url=http://www.john-libbey-eurotext.fr/medline.md?issn=1294-9361 & vol=7%20\ Suppl%201 & iss= & page=22> *VNS Therapy versus the latest antiepileptic drug.* *Ben-Menachem E* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Ben%\ 2DMenachem+E%22%5BAuthor%5D>, *A French J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22A+Fr\ ench+J%22%5BAuthor%5D>. Department of Clinical Neuroscience, Sahlgren University Hospital, Sweden. Pro AED: The central issue in medical decision-making is risk-benefit assessment. Surgery of any type is still considered to be a major undertaking. To warrant these risks, the patient has a right to expect that they have a greater chance of a good outcome with an invasive therapy than with a non-invasive one. The main question is when, if ever, this becomes the case when comparing implantation of a VNS Therapy System versus adding an antiepileptic drug (AED)? After the first drug? The second? After all AEDs have failed? To date, no randomized trial comparing the addition of an AED against vagus nerve stimulation (VNS Therapy) has been undertaken, although several are currently being contemplated. Without this information, it is more difficult to make a case for early implementation of VNS Therapy. Unfortunately, few data are available regarding the potential for patients to become seizure-free after implantation of a VNS Therapy System. Another issue is side effects. It is important to remember that VNS Therapy also produces adverse events, albeit very different in character than those associated with AEDs, to which physicians have become accustomed. These include cough, dyspnea, pharyngitis, voice alteration and sleep apnea. A less frequently discussed, potentially negative consequence of VNS Therapy relates to the ability to obtain imaging of the patient. Patients who have undergone VNS Therapy System implantation are not candidates for imaging of the chest, breast, or abdomen. A second issue is that imaging of the brain can only be performed with MRI scanners that meet certain requirements, and as MRI technology develops, scanners meeting these requirements may become harder to find. However, to summarize, VNS Therapy is an excellent and useful treatment choice. Fortunately, the choice between AEDs and VNS Therapy is not an " either/or " decision. Each has a role in the treatment of patients with epilepsy, and the advantages and disadvantages of each should be kept in perspective.Pro VNS Therapy: VNS Therapy is no longer a new treatment for patients with refractory epilepsy. The first implant was performed in l988, and since then more than 30,000 patients have received this therapy. It is no longer considered an unusual or dangerous procedure, but it is still used almost exclusively for refractory epilepsy patients and it has not been generally accepted for use as a first line or even second line therapy. However, compared to the new AEDs, VNS Therapy has similar efficacy results in clinical trials and in many epilepsy syndromes and the long-term efficacy results are even more positive, with continued improvement in seizure reduction for up to two years. Two of the major reasons for not using VNS Therapy early are that it is a surgical procedure, and its safety during MRI procedures, especially with 3 Tesla, has not yet been elucidated. The safety profile of VNS Therapy is very favorable; the side effects being totally different from those seen with AEDs. The most important aspects are that there have been no pharmacological interactions, cognitive or sedative side effects reported, and it is safe for use in all age groups. Side effects are restricted to local irritation, hoarseness, coughing and, in a few cases, swallowing difficulties when the stimulator is on, but these tend to disappear with time. No idiosyncratic side effect has emerged during the 16 years of use. Compliance is guaranteed. The cost of the implantation of the VNS Therapy System, when spread out over 8 years (battery life), is actually less than the cost of using a new AED over an eight-year period, and real savings as regards hospital costs due to seizures can be expected. PMID: 16120490 [PubMed - in process] ------------------------------------------------------------------------ *6: *Semin Pediatr Neurol. <javascript:AL_get(this, 'jour', 'Semin Pediatr Neurol.');> 2005 Jun;12(2):106-13. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16114176> Links <javascript:PopUpMenu2_Set(Menu16114176);> *Nonpharmacological treatment options for epilepsy.* *Sheth RD* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Shet\ h+RD%22%5BAuthor%5D>, *Stafstrom CE* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Staf\ strom+CE%22%5BAuthor%5D>, *Hsu D* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Hsu+\ D%22%5BAuthor%5D>. Department of Neurology, University of Wisconsin, Madison, Madison, WI 53792-5132, USA. sheth@... Approximately one third of children with epilepsy have persistent seizures despite trials of multiple antiepileptic medications. For some of these patients, epilepsy surgery may provide freedom from seizures. However, in many cases, epilepsy surgery is not a viable treatment option. Nonpharmacological approaches are a useful adjunct to help manage seizures in these children. This review examines the role of vagus nerve stimulation, the ketogenic diet, and various forms of EEG biofeedback therapy in children with intractable epilepsy. Although the mechanism of action is not known precisely for any of these adjunctive therapies, they add an important and evolving dimension to the management of difficult to control epilepsy in children. In addition, pyridoxine-dependent seizures are discussed as an example of an etiology of refractory seizures that responds well to replacement therapy. Publication Types: * Review <javascript:AL_get(this, 'ptyp', 'Review');> * Review, Tutorial <javascript:AL_get(this, 'ptyp', 'Review, Tutorial');> PMID: 16114176 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *7: *Seizure. <javascript:AL_get(this, 'jour', 'Seizure.');> 2005 Aug 9; [Epub ahead of print] Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16098769> Links <javascript:PopUpMenu2_Set(Menu16098769);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048 & uid=16098769 & db=\ pubmed & url=http://linkinghub.elsevier.com/retrieve/pii/S1059-1311%2805%2900123-8\ > *Long term effects on epileptiform activity with vagus nerve stimulation in children.* *Hallbook T* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Hall\ book+T%22%5BAuthor%5D>, *Lundgren J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Lund\ gren+J%22%5BAuthor%5D>, *Blennow G* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Blen\ now+G%22%5BAuthor%5D>, *Stromblad LG* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Stro\ mblad+LG%22%5BAuthor%5D>, *Rosen I* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Rose\ n+I%22%5BAuthor%5D>. Department of Paediatrics, University Hospital, SE-221 85 Lund, Sweden. PURPOSE:: We report long-term effects of vagus nerve stimulation (VNS) on epileptiform activity in 15 children, and how these changes are related to activity stage and to clinical effects on seizure reduction, seizure severity (NHS3) and quality of life (QOL). METHODS:: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with 24h ambulatory EEG monitoring for spike detection. The number of interictal epileptiform discharges (IEDs) and the inter spike intervals (ISIs) were analysed during 2h in the awake state, and 1h of rapid eye movement (REM)-, spindle- and delta-sleep, respectively. Total number and duration of electrographic seizure episodes were also analysed. RESULTS:: At 9 months the total number of IEDs was significantly reduced (p=0.04). There was a tendency of reduction in all activity stages, and significantly so in delta-sleep (p=0.008). Total electrographic seizure number was significantly reduced in the 24h EEG at 3 and 9 months (p=0.03, 0.05). There was a significant concordance in direction of changes in epileptiform activity and electrographic seizures at 9 months (p=0.04). Concordance in direction of changes was seen in 9 of 15 children between clinical seizures and IED (p>0.3), in 10 of 15 children between QOL and IED (p=0.3) and in 8 of 15 children between NHS3 and IED (p>0.3). There was no direct correlation between the extent of improvement in these clinical data and the degree of spike reduction. CONCLUSION:: This study shows that VNS reduces IEDs especially in REM and delta sleep, as well as the number of electrographic seizures. It also shows a concordance between reduction in IEDs and electrographic seizures. PMID: 16098769 [PubMed - as supplied by publisher] ------------------------------------------------------------------------ *8: *Epilepsy Curr. <javascript:AL_get(this, 'jour', 'Epilepsy Curr.');> 2004 Nov-Dec;4(6):215-22. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16059506> Links <javascript:PopUpMenu2_Set(Menu16059506);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3494 & uid=16059506 & db=\ pubmed & url=http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed & pubmedid=\ 16059506> *Dietary approaches to epilepsy treatment: old and new options on the menu.* *Stafstrom CE* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Staf\ strom+CE%22%5BAuthor%5D>. Department of Neurology, University of Wisconsin, Madison, USA. stafstrom@... Dietary therapies represent a potentially valuable adjunct to other epilepsy treatments, such as anticonvulsant medications, epilepsy surgery, and vagus nerve stimulation. Although the ketogenic diet (high fat, adequate protein, low carbohydrate) is the most well-established dietary therapy for epilepsy, other possible approaches include the Atkins diet (high fat, high protein, low carbohydrate), a diet enriched in polyunsaturated fatty acids, or overall restriction of calorie intake. This review discusses the current clinical status of each of these dietary approaches and suggests possible mechanisms by which they might suppress neuronal hyperexcitability and seizures. PMID: 16059506 [PubMed] ------------------------------------------------------------------------ *9: *Epilepsy Behav. <javascript:AL_get(this, 'jour', 'Epilepsy Behav.');> 2005 Sep;7(2):182-9. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16054872> Links <javascript:PopUpMenu2_Set(Menu16054872);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048 & uid=16054872 & db=\ pubmed & url=http://linkinghub.elsevier.com/retrieve/pii/S1525-5050%2805%2900219-2\ > *Transcranial magnetic stimulation treatment for epilepsy: can it also improve depression and vice versa?* *Fregni F* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Freg\ ni+F%22%5BAuthor%5D>, *Schachter SC* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Scha\ chter+SC%22%5BAuthor%5D>, *Pascual-Leone A* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Pasc\ ual%2DLeone+A%22%5BAuthor%5D>. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. ffregni@... Comorbidity with depression is an important determinant of the quality of life for patients with epilepsy. Antidepressant medications can effectively treat depression in epileptic patients, but drug-drug interactions and epileptogenic effects of these drugs pose therapeutic challenges. The mood-stabilizing effects of antiepileptic medications may not be sufficient to treat depression. Therefore, treatments that alleviate the burden of depression without increasing seizure risk or, better yet, with the possibility of improving seizure control are worth exploring. Neuroimaging techniques, such as functional magnetic resonance imaging, are providing novel insights into the pathophysiology of depression in epilepsy. For example, there appears to be prominent brain prefrontal hypoactivity, which may be sustained by the hyperactivity of the seizure focus. If so, neuromodulatory approaches that suppress epileptic focus hyperactivity and concurrently enhance prefrontal activity may be ideally suited. Indeed, vagus nerve stimulation has been shown to yield simultaneous antiseizure and mood effects. Another neuromodulatory technique, transcranial magnetic stimulation (TMS), can also modulate brain activity, but in a noninvasive, painless, and focal manner. Depending on the stimulation parameters, it is possible to enhance or reduce activity in the targeted brain region. Furthermore, TMS has been shown to be effective in treating depression, and preliminary data suggest that this treatment may also be effective for epilepsy treatment. This article reviews these data and explores further the question of whether depression and epilepsy can be simultaneously treated with TMS for optimal therapeutic impact. PMID: 16054872 [PubMed - in process] ------------------------------------------------------------------------ *10: *Surg Neurol. <javascript:AL_get(this, 'jour', 'Surg Neurol.');> 2005 Aug;64(2):170-3. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=16051017> Links <javascript:PopUpMenu2_Set(Menu16051017);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048 & uid=16051017 & db=\ pubmed & url=http://linkinghub.elsevier.com/retrieve/pii/S0090-3019%2804%2900944-9\ > *Control of refractory status epilepticus precipitated by anticonvulsant withdrawal using left vagal nerve stimulation: a case report.* *Patwardhan RV* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Patw\ ardhan+RV%22%5BAuthor%5D>, *Dellabadia J Jr* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Dell\ abadia+J+Jr%22%5BAuthor%5D>, *Rashidi M* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Rash\ idi+M%22%5BAuthor%5D>, *Grier L* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Grie\ r+L%22%5BAuthor%5D>, *Nanda A* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Nand\ a+A%22%5BAuthor%5D>. Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71130-3932, USA. OBJECTIVE: To describe a case of left vagal nerve stimulation (VNS) resulting in immediate cessation of status epilepticus (SE) with good neurological outcome. CASE DESCRIPTION: A 30-year-old man with medically intractable seizures including episodes of SE was successfully treated using left VNS. After requiring discontinuation of phenytoin, valproic acid, carbamazepine, and topiramate because of severe allergic reactions resembling s- syndrome, the patient required pentobarbital coma along with phenobarbital, tiagabine, and levetiracetam for seizure frequency reduction. He underwent left vagal nerve stimulator placement after nearly 9 days of barbiturate-induced coma, with stimulation initiated in the operating room. On the following day, electroencephalography revealed resolution of previously observed periodic lateral epileptiform discharges and the patient was free of seizures. Prestimulation seizure frequency was recorded at 59 times a day, with some seizures enduring 45 minutes despite barbiturate coma. Poststimulation, the patient has been free of seizures for 19 days and is presently taking only levetiracetam and phenobarbital, from which he continues to be successfully weaned without seizures. He is awake, alert, and can recall events leading up to his seizures, with good long-term memory and residual left upper extremity and lower extremity weakness. CONCLUSION: This case illustrates the role of left vagal stimulation in the treatment of SE and otherwise medically intractable seizures caused by allergic reactions. To our knowledge, this is the first case in the world literature for adults reporting cessation of SE after VNS. Another case with a similar improvement has been reported in the pediatric population. Publication Types: * Case Reports <javascript:AL_get(this, 'ptyp', 'Case Reports');> PMID: 16051017 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *11: *Neurology. <javascript:AL_get(this, 'jour', 'Neurology.');> 2005 Jun 28;64(12 Suppl 3):S2-11. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15994220> Links <javascript:PopUpMenu2_Set(Menu15994220);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3051 & uid=15994220 & db=\ pubmed & url=http://www.neurology.org/cgi/pmidlookup?view=long & pmid=15994220> *Current treatments of epilepsy.* *Nadkarni S* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Nadk\ arni+S%22%5BAuthor%5D>, *LaJoie J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22LaJo\ ie+J%22%5BAuthor%5D>, *Devinsky O* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Devi\ nsky+O%22%5BAuthor%5D>. Comprehensive Epilepsy Center, NYU School of Medicine, 403 East 34th Street, 4th Floor, New York, NY 10016, USA. siddhu@... Medical therapy is the mainstay for epilepsy, with most patients well controlled on a single antiepileptic drug (AED). In this non-refractory group, many patients have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled on medications. These patients are often receiving multiple AEDs, with disabling seizures and side effects. Although second-generation AEDs are safer and better tolerated than the older AEDs, there are scant data to support significant advantages in efficacy. In VA studies with older AEDS, therapy with two AEDs improved seizure control in 40% of patients but seizure freedom was achieved in only 9%. A meta-analysis of the second-generation AEDs used as adjunctive therapies shows that 12% to 29% of patients had a 50% or greater reduction in seizure frequency. Surgery and the vagus nerve stimulator provide important therapeutic options in patients whose seizures are not controlled by AEDs. Special considerations about epilepsy care must be made in pediatric populations, those with developmental delays, women, and the elderly. Publication Types: * Review <javascript:AL_get(this, 'ptyp', 'Review');> PMID: 15994220 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *12: *Expert Opin Investig Drugs. <javascript:AL_get(this, 'jour', 'Expert Opin Investig Drugs.');> 1997 Oct;6(10):1327-35. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15989504> Links <javascript:PopUpMenu2_Set(Menu15989504);> *Vagus nerve stimulation: current status and clinical applications.* *Schachter SC* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Scha\ chter+SC%22%5BAuthor%5D>. Comprehensive Epilepsy Program, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Sschacht@... Despite the recent introduction of new anti-epileptic drugs (AEDs), many patients with epilepsy, especially those with partial-onset seizures, continue to have seizures that are refractory to pharmacotherapy. Other patients are unable to tolerate the side-effects of AEDs given singly or in combination. Cerebral resective surgery may be an option for a sub-group of these patients; however, many patients with refractory partial epilepsy are not optimal candidates for epilepsy surgery. Consequently, the introduction of left vagus nerve stimulation (VNS) for those patients who have been afflicted by seizures or medication side-effects has opened up a new, non-pharmacological approach to epilepsy treatment. The mechanism of action of VNS is uncertain. VNS exerts an anticonvulsant effect in a variety of animal seizure models; has no effect on hepatic metabolic processes, serum concentrations of AEDS, or laboratory values; and has no clinically significant effect on vagally-mediated physiological processes. VNS is safe and well-tolerated in patients with long-standing, medically-refractory, partial-onset epilepsy. Adverse effects are usually mild to moderate in severity and related to stimulation, and almost always resolve with adjustment in stimulation settings. Controlled studies of patients on AED therapy show that adjunctive VNS is effective for partial-onset seizures when given every 5 min for 30 s intervals. Results of studies in paediatric patients are encouraging. PMID: 15989504 [PubMed] ------------------------------------------------------------------------ *13: *Epilepsia. <javascript:AL_get(this, 'jour', 'Epilepsia.');> 2005;46 Suppl 5:94-7. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15987260> Links <javascript:PopUpMenu2_Set(Menu15987260);> *The acute and chronic effect of vagus nerve stimulation in genetic absence epilepsy rats from Strasbourg (GAERS).* *Dedeurwaerdere S* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Dede\ urwaerdere+S%22%5BAuthor%5D>, *Vonck K* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Vonc\ k+K%22%5BAuthor%5D>, *Van Hese P* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Van+\ Hese+P%22%5BAuthor%5D>, *Wadman W* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Wadm\ an+W%22%5BAuthor%5D>, *Boon P* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Boon\ +P%22%5BAuthor%5D>. Reference Centre for Refractory Epilepsy and Laboratory for Clinical and Experimental Neurophysiology, Department of Neurology, Ghent University Hospital, Ghent, Belgium. Stefanie.Dedeurwaerdere@... PURPOSE: The aim of this study was to evaluate the efficacy of acute and chronic vagus nerve stimulation (VNS) in genetic absence epilepsy rats from Strasbourg (GAERS). This is a validated model for absence epilepsy, characterized by frequent spontaneous absences concomitant with spike and wave discharges (SWD) on the EEG. Although absences are a benign form of seizures, it is conceptually important to investigate the efficacy of VNS in a controlled study by using this chronic epilepsy model. METHODS: Both control and stimulated GAERS were implanted with five epidural EEG electrodes and a stimulation electrode around the left vagus nerve. In the first experiment, VNS was given when SWD occurred in the EEG; this was repeated the next day. A randomized crossover design (n = 8) was used. In the chronic experiment, GAERS underwent EEG monitoring during a first baseline week. During the second week, the treated group (n = 18) received VNS; controls (n = 13), on the other hand, only underwent EEG recordings. RESULTS: On day 1 of the acute VNS experiment, the mean duration of the SWD when VNS was applied was higher than in baseline conditions (p < 0.05). However, on day 2, there was no difference in mean duration of the SWD. In the chronic VNS experiment, no statistically significant differences were found between control and stimulated GAERS. CONCLUSIONS: Acute VNS applied shortly after the onset of SWD prolonged the mean duration of SWD in GAERS at least during the first day of VNS. Chronic stimulation hardly affected SWD in GAERS. PMID: 15987260 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *14: *Curr Treat Options Neurol. <javascript:AL_get(this, 'jour', 'Curr Treat Options Neurol.');> 2005 Jul;7(4):261-271. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15967089> Links <javascript:PopUpMenu2_Set(Menu15967089);> *Experimental Electrical Stimulation Therapy for Epilepsy.* *Oommen J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Oomm\ en+J%22%5BAuthor%5D>, *Morrell M* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Morr\ ell+M%22%5BAuthor%5D>, *Fisher RS* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Fish\ er+RS%22%5BAuthor%5D>. Stanford Department of Neurology, Room A343, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA. rfisher@.... Electrical stimulation of the nervous system is an attractive possible therapy for intractable epilepsy, but only stimulation of the vagus nerve has been subjected to large, controlled, and completed clinical trials. Controlled trials are in progress for intermittent cycling stimulation of the anterior nuclei of the thalamus, and for cortical stimulation at a seizure focus, responsive to detection of seizure onset. Anecdotal experience has been gathered with stimulation of cerebellum, centromedian thalamus, subthalamus, caudate, hippocampus, and brainstem. All stimulation of the central nervous system for epilepsy must be considered experimental. PMID: 15967089 [PubMed - as supplied by publisher] ------------------------------------------------------------------------ *15: *Neuropsychobiology. <javascript:AL_get(this, 'jour', 'Neuropsychobiology.');> 2005;51(4):265-8. Epub 2005 May 18. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15905632> Links <javascript:PopUpMenu2_Set(Menu15905632);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3030 & uid=15905632 & db=\ pubmed & url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext & file=N\ PS2005051004265> *Cerebral blood flow during vagus nerve stimulation--a transcranial Doppler study.* *Neu P* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Neu+\ P%22%5BAuthor%5D>, *Heuser I* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Heus\ er+I%22%5BAuthor%5D>, *Bajbouj M* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Bajb\ ouj+M%22%5BAuthor%5D>. Department of Psychiatry and Psychotherapy, Charite Berlin, Campus lin, Eschenallee 1, DE-14050 Berlin, Germany. peter.neu@... BACKGROUND AND OBJECTIVES: Vagus nerve stimulation (VNS) is an approved treatment of partial onset seizures and has recently shown antidepressant effects in patients with treatment-resistant depression. This study was conducted to investigate whether acute VNS has an influence on cerebral blood flow (CBF) in humans. METHODS: This investigation was designed as an add-on study. In 10 patients with an implanted stimulator who participated in a multicenter clinical trial to evaluate the efficacy of VNS in depression, CBF was investigated by functional transcranial Doppler at baseline (before the stimulator was turned on for the first time) and during stimulation with three different stimulation intensities in a randomized order. RESULTS: Immediately after every increase of the current, CBF velocity showed a nonsignificant increase. Otherwise, no change of CBF above standard deviation could be registered. CONCLUSION: Acute VNS does not have an influence on CBF velocity in depressive patients. Copyright © 2005 S. Karger AG, Basel. Publication Types: * Clinical Trial <javascript:AL_get(this, 'ptyp', 'Clinical Trial');> * Multicenter Study <javascript:AL_get(this, 'ptyp', 'Multicenter Study');> * Randomized Controlled Trial <javascript:AL_get(this, 'ptyp', 'Randomized Controlled Trial');> PMID: 15905632 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *16: *Br Med Bull. <javascript:AL_get(this, 'jour', 'Br Med Bull.');> 2005 Apr 21;72:135-48. Print 2004. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15845748> Links <javascript:PopUpMenu2_Set(Menu15845748);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3051 & uid=15845748 & db=\ pubmed & url=http://bmb.oxfordjournals.org/cgi/pmidlookup?view=long & pmid=15845748> *Advances in epilepsy.* *Kelso AR* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Kels\ o+AR%22%5BAuthor%5D>, *Cock HR* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Cock\ +HR%22%5BAuthor%5D>. Epilepsy Group, Centre for Clinical Neurosciences, St 's University of London, UK. Advances in understanding of both the causes and consequences of epilepsy have been paralleled by a number of recent reports and clinical guidelines highlighting the complexities involved in both diagnosing and treating epilepsy. We review recent developments, including comments on the evolution of clinical guidelines, anti-epileptic drugs, epilepsy surgery and new treatment approaches in development. Epilepsy genetics and emerging evidence on mechanisms of drug resistance in epilepsy will also be discussed. Issues with respect to pregnancy and epilepsy are considered, together with more recently identified dilemmas including bone health in epilepsy and whether seizures themselves cause brain damage. Imaging in epilepsy has recently been reviewed elsewhere, and will not be discussed. Publication Types: * Review <javascript:AL_get(this, 'ptyp', 'Review');> * Review, Tutorial <javascript:AL_get(this, 'ptyp', 'Review, Tutorial');> PMID: 15845748 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *17: *Epilepsy Behav. <javascript:AL_get(this, 'jour', 'Epilepsy Behav.');> 2005 May;6(3):417-23. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15820352> Links <javascript:PopUpMenu2_Set(Menu15820352);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3048 & uid=15820352 & db=\ pubmed & url=http://linkinghub.elsevier.com/retrieve/pii/S1525-5050%2805%2900039-9\ > *Vagus nerve stimulation therapy: 2-year prospective open-label study of 40 subjects with refractory epilepsy and low IQ who are living in long-term care facilities.* *Huf RL* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Huf+\ RL%22%5BAuthor%5D>, *Mamelak A* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Mame\ lak+A%22%5BAuthor%5D>, *Kneedy-Cayem K* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Knee\ dy%2DCayem+K%22%5BAuthor%5D>. Epilepsy and Brain Mapping Program, Huntington Memorial Hospital, Pasadena, CA, USA. karacayem@... Treating seizures among patients with mental retardation/developmental disabilities (MR/DD) is difficult owing in large part to the presence of additional comorbidities and the resulting need for polytherapy. Therefore, a nonpharmacological treatment option is needed for this population. This prospective, open-label study documented the long-term outcome of 40 low-IQ (<70) patients living in long-term care facilities who received vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy. Subjects were seen every 1 to 3 months by their neurologist (R.H.). Seizure frequency, antiepileptic medication, and quality-of-life information were documented preimplantation and quarterly thereafter through 2 years. The surgery and therapy were well tolerated. Seizures were reduced by at least 50% for 11 subjects. Antiepileptic medications were reduced from 3.3 per subject at baseline to an average of 2.3 per subject after 2 years. According to caregiver reports, overall quality of life improved for the majority of subjects; also, using the Client Development Evaluation Report (CDER), statistically significant improvements were reported at both 1 and 2 years in attention span, word usage, clarity of speech, standing balance, washing dishes, and household chores. VNS is a viable treatment option for low-IQ patients with pharmacoresistant epilepsy who are living in long-term care facilities. Publication Types: * Clinical Trial <javascript:AL_get(this, 'ptyp', 'Clinical Trial');> PMID: 15820352 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *18: *Actas Esp Psiquiatr. <javascript:AL_get(this, 'jour', 'Actas Esp Psiquiatr.');> 2005 Mar-Apr;33(2):130-4. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15768321> Links <javascript:PopUpMenu2_Set(Menu15768321);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=4287 & uid=15768321 & db=\ pubmed & url=http://www.arsxxi.com/Revistas/mostrararticulo.php?idarticulo=5111011\ 9> *[Vagus nerve stimulation and psychosis. A single case report]* [Article in Spanish] *Adan J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Adan\ +J%22%5BAuthor%5D>, *Escosa M* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Esco\ sa+M%22%5BAuthor%5D>, *Ayuso-Mateos JL* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Ayus\ o%2DMateos+JL%22%5BAuthor%5D>. Servicio de Psiquiatria, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid. jaumeson@... The appearance of behavioral disorders in the context of a decrease in the number of seizures in epileptic patients is a fact that was already described in Landolt's theory of forced normalization in the middle of the XX century. Through this clinical case, we propose several mechanisms that aim to give a general explanation to the physiopathology of this condition. Among them, the theory which suggests increased alertness as a result of inhibitory mechanisms secondary to a long lasting epileptic condition stands out. In addition, we consider the possibility that left vagus nerve stimulation (VNS), a procedure used as a second line treatment in epileptic patients refractory to multiple drug therapy, may cause an inhibitory reaction of similar characteristics as the previously described, and could therefore lead to different psychiatric disorders. Lastly, we bring up several alternatives that will try to throw some light on the physiopathological condition that leads to the chronification of this disease, the theory regarding a cognitive deterioration associated to the appearance of negative symptoms in patients with temporal lobe epilepsy standing out. Publication Types: * Case Reports <javascript:AL_get(this, 'ptyp', 'Case Reports');> PMID: 15768321 [PubMed - indexed for MEDLINE] ------------------------------------------------------------------------ *19: *J Neurol Neurosurg Psychiatry. <javascript:AL_get(this, 'jour', 'J Neurol Neurosurg Psychiatry.');> 2005 Mar;76(3):384-9. Related Articles, <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Display & dopt=pubmed\ _pubmed & from_uid=15716532> Links <javascript:PopUpMenu2_Set(Menu15716532);> Click here to read <http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3051 & uid=15716532 & db=\ pubmed & url=http://jnnp.bmjjournals.com/cgi/pmidlookup?view=long & pmid=15716532> *Vagus nerve stimulation: predictors of seizure freedom.* *Janszky J* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Jans\ zky+J%22%5BAuthor%5D>, *Hoppe M* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Hopp\ e+M%22%5BAuthor%5D>, *Behne F* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Behn\ e+F%22%5BAuthor%5D>, *Tuxhorn I* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Tuxh\ orn+I%22%5BAuthor%5D>, *Pannek HW* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Pann\ ek+HW%22%5BAuthor%5D>, *Ebner A* <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Search & term=%22Ebne\ r+A%22%5BAuthor%5D>. Epilepsie-Zentrum Bethel, Mara Krankenhaus, Maraweg 21, Bielefeld 33617, Germany. OBJECTIVES: To identify predictive factors for the seizure-free outcome of vagus nerve stimulation (VNS). METHODS: All 47 patients who had undergone VNS implantation at one centre and had at least one year of follow up were studied. They underwent complete presurgical evaluation including detailed clinical history, magnetic resonance imaging, and long term video-EEG with ictal and interictal recordings. After implantation, adjustment of stimulation parameters and concomitant antiepileptic drugs were at the discretion of the treating physician. RESULTS: Mean (SD) age of the patients was 22.7 (11.6) years (range 7 to 53). Six patients (13%) became seizure-free after the VNS implantation. Only two variables showed a significant association with the seizure-free outcome: absence of bilateral interictal epileptiform discharges (IED) and presence of malformation of cortical development (MCD). Epilepsy duration showed a non-significant trend towards a negative association with outcome. By logistic regression analysis, only absence of bilateral IED correlated independently with successful VNS treatment (p<0.01, odds ratio = 29.2 (95% confidence interval, 2.4 to 353)). Bilateral IED (independent or bilateral synchronous) was found in one of six seizure-free patients and in 33 of 41 non-seizure-free patients. When bilateral IED were absent, the sensitivity for seizure-free outcome was 0.83 (0.44 to 0.97), and the specificity was 0.80 (0.66 to 0.90). CONCLUSIONS: Bilateral IED was independently associated with the outcome of VNS. These results are preliminary because they were based on a small patient population. They may facilitate prospective VNS studies enrolling larger numbers of patients to confirm the results. Publication Types: * Clinical Trial <javascript:AL_get(this, 'ptyp', 'Clinical Trial');> PMID: 15716532 Liz Mumper wrote: > Hi, : > > Noted ref #247 in the citation list: Park YD. The effects of vagus > nerve stimulation therapy on pts with intractable seizures and L-K or > autism. Epilepsy Behav 2003 June > > Have a patient who wants to try it. Do you have other references at > your fingertips? > > Liz > > > Quote Link to comment Share on other sites More sharing options...
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