Cervical Noninvasive Vagus Nerve Stimulation for Migraine and Cluster Headache: A Systematic Review and Meta-Analysis.

BACKGROUND: Noninvasive vagus nerve stimulation (nVNS) has been proposed as a new neuromodulation therapy to treat primary headache disorders. The purpose of this study was to analyze the effectiveness and safety of peripheral nerve stimulation of the cervical branch of the vagal nerve for primary headache disorders. METHODS: A systematic review and meta-analysis of the literature was carried out on randomized controlled trials of nVNS for treating headaches. We searched the Medline, Embase, and CENTRAL databases until January 29, 2019. A random-effects model was used to report all outcomes. The primary outcomes were a reduction in headache days or attacks and pain-free status within 30 min. Secondary outcomes were: the pain-relief status within 30 min, the pain-relief status at 60 min, abortive medication use, ≥50% responder rate, pain-free status in ≥50% of treated attacks, adverse events, and satisfaction. RESULTS: In total, 983 patients were included from six trials. We found that nVNS was effective in achieving a pain-free status within 30 min (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.16~4.44; p = 0.02), pain-relief status within 30 min (OR, 1.8; 95% CI, 1.17~2.78; p = 0.007), pain-relief status at 60 min (OR, 1.93; 95% CI, 1.2~3.1; p = 0.006), a reduction in abortive medication use (OR, 0.61; 95% CI, 0.41~0.92; p = 0.02), and pain-free status in ≥50% of treated attacks (OR, 2.15; 95% CI, 1.27~3.66; p = 0.005) compared to sham-device treatment. There were no significant differences in decreased headache days (standardized mean difference (SMD), -0.159; 95% CI, -0.357~0.04; p = 0.117), adverse events (OR, 1.084; 95% CI, 0.559~2.104; p = 0.811), or satisfaction (OR, 1.45; 95% CI, 0.97~2.17; p = 0.07) between nVNS and sham-device treatment. The ≥50% responder rate could not be determined (OR, 3.34; 95% CI, 0.83~13.33; p = 0.09; I 2 = 73%). CONCLUSIONS: Cervical nVNS is effective for acute pain relief for migraine and cluster headache. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42019126009.

Prognostic factors of developmental outcome in neonatal seizures in term infants.

BACKGROUND: The purpose of this study was to identify prognostic indicators of neurodevelopmental outcome in term infants who experienced clinical neonatal seizure. METHODS: This is a retrospective, observational hospital-based study. Term infants who experienced clinical neonatal seizure between January 1999 and December 2009 were enrolled. Adverse outcomes were defined as death, cerebral palsy, global developmental delay, and/or epilepsy. The associations between adverse outcomes and 17 variables, including sex, mode of delivery, being small of gestational age, maternal illness, perinatal insults, meconium stained liquor, Apgar score at 1 and 5 minutes, seizure onset age, seizure type, etiology, electroencephalography (EEG) findings, antiepileptic drug efficacy, presence of metabolic acidosis, and cranial ultrasonographic findings, and presence of congenital heart disease were analyzed. RESULTS: Among the 232 enrolled infants, 125 had a normal outcome and 14 had mild functional disability (59.9%), and 55 (23.7%) survived with one or more neurodevelopmental impairments (7 with cerebral palsy, 48 with global developmental delay), and 38 (16.4%) died. Forty-seven (23.0%) of the 204 patients who survived after the first discharge had epilepsy. Ten variables were associated with adverse outcome on univariate analysis, but only four variables, i.e., including abnormal cranial ultrasonography findings, abnormal anterior cerebral artery resistance index, abnormal EEG findings, and presence of congenital heart disease were independent predictors on multivariate logistic regression analysis. CONCLUSION: In term infants with neonatal seizures, several risk factors related to adverse outcome were recognized. Physicians should pay more attention to these factors when handling patients with neonatal seizures.