Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41
Filtrar
1.
Presse Med ; 48(12): 1507-1519, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31767248

RESUMO

Vagus nerve stimulation (VNS) is an old, yet new, option for treatment-resistant depression. Despite several clinical trials over the last 15 years showing a consistent benefit-risk balance of the technic, VNS still struggles to find its place in our therapeutic algorithms. This is especially true in France, where only a few surgeries have been performed nationwide, all in the last year. The reasons behind this lag are manifolds; (1) psychiatrists usually do not consider surgical treatments, even when they are minimally invasive and reversible, (2) early VNS trials stumbled on methodological difficulties that are common to all invasive neurostimulation technics, and initially failed to provide strong evidence for its efficacy, and (3) VNS requires multidisciplinary teams involving psychiatrists and neurosurgeons that did not exist then. Nevertheless, studies of the past twenty years support VNS as a treatment of depression endowed with a unique efficacy profile: a long runner best at maintaining remission in hard-to-stabilize depression, even in the context of ECT withdrawal, and irrespective of whether it is unipolar or bipolar. Thus, VNS potentially addresses the unmet medical needs of some of the most severe and chronic patients with depression. This review aims at introducing VNS as a treatment option for depression, summarizing available evidence for its efficacy and tolerance, and delineating patient profiles that might benefit the most of such treatment.


Assuntos
Depressão/terapia , Estimulação do Nervo Vago , Depressão/epidemiologia , Depressão/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/terapia , França/epidemiologia , Humanos , Resultado do Tratamento , Nervo Vago/fisiologia , Estimulação do Nervo Vago/efeitos adversos , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
2.
J Clin Neurosci ; 68: 13-19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375306

RESUMO

Implantable neurostimulation devices provide a direct therapeutic link to the nervous system and can be considered brain-computer interfaces (BCI). Under this definition, BCI are not simply science fiction, they are part of existing neurosurgical practice. Clinical BCI are standard of care for historically difficult to treat neurological disorders. These systems target the central and peripheral nervous system and include Vagus Nerve Stimulation, Responsive Neurostimulation, and Deep Brain Stimulation. Recent advances in clinical BCI have focused on creating "closed-loop" systems. These systems rely on biomarker feedback and promise individualized therapy with optimal stimulation delivery and minimal side effects. Success of clinical BCI has paralleled research efforts to create BCI that restore upper extremity motor and sensory function to patients. Efforts to develop closed loop motor/sensory BCI is linked to the successes of today's clinical BCI.


Assuntos
Interfaces Cérebro-Computador/tendências , Estimulação Encefálica Profunda/tendências , Doenças do Sistema Nervoso/terapia , Estimulação do Nervo Vago/tendências , Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Humanos , Estimulação do Nervo Vago/instrumentação , Estimulação do Nervo Vago/métodos
3.
Brain Stimul ; 12(6): 1448-1455, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31289015

RESUMO

BACKGROUND: Drug use causes the formation of strong cue/reward associations which persist long after cessation of drug-taking and contribute to the long-term risk of relapse. Extinguishing these associations may reduce cue-induced craving and relapse. Previously, we found that pairing vagus nerve stimulation (VNS) with extinction of cocaine self-administration reduces cue-induced reinstatement; however, it remains unclear whether this was primarily caused by extinguishing the context, the instrumental response, or both. OBJECTIVE: Hypothesis: We hypothesized that VNS can facilitate the extinction of both contextual cues and instrumental responding. METHODS: Extinction of context was first tested using Pavlovian conditioned place preference (CPP). Next, the impact of VNS on the extinction of instrumental responding was assessed under ABA and AAA context conditions. In each extinction context separate groups of rats were either provided the opportunity to perform the instrumental response, or the levers were retracted for the duration of extinction training. Reinstatement was induced by reintroduction of the conditioned stimuli and/or the drug-paired context. Data were analyzed using one-way or two-way repeated measures ANOVAs. RESULTS: VNS during extinction reduced reinstatement of CPP. VNS also reduced cue- and context-induced reinstatement of the instrumental response under both AAA and ABA conditions. The subjects' ability to engage with the lever during extinction was crucial for this effect. P values < 0.05 were considered significant. CONCLUSIONS: Craving occurs in response to a range of conditioned stimuli and contexts; VNS may improve outcomes of behavioral therapy by facilitating extinction of both an instrumental response and/or contextual cues.


Assuntos
Cocaína/administração & dosagem , Condicionamento Clássico/fisiologia , Fissura/fisiologia , Extinção Psicológica/fisiologia , Estimulação do Nervo Vago/métodos , Animais , Condicionamento Clássico/efeitos dos fármacos , Condicionamento Operante/efeitos dos fármacos , Condicionamento Operante/fisiologia , Fissura/efeitos dos fármacos , Sinais (Psicologia) , Masculino , Ratos , Ratos Sprague-Dawley , Recompensa , Autoadministração , Estimulação do Nervo Vago/tendências
4.
Int J Neurosci ; 129(10): 1013-1023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092102

RESUMO

The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson's disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação Elétrica Nervosa Transcutânea/tendências , Ensaios Clínicos como Assunto/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
5.
Neuromodulation ; 22(5): 580-585, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30328647

RESUMO

OBJECTIVES: Primary Sjögren's syndrome (pSS) sufferers have rated chronic fatigue as the most important symptom needing improvement. Emerging data suggest that stimulation of the vagus nerve can modulate immunological responses. The gammaCore device (electroCore), developed to stimulate the cervical vagus nerve noninvasively, was used to assess the effects of vagus nerve activation on immune responses and clinical symptoms of pSS. MATERIALS AND METHODS: Fifteen female pSS subjects used the nVNS device twice daily a 26-day period. At baseline, blood was drawn before and after application of the gammaCore device for 90 sec over each carotid artery. The following fatigue-related outcome measures were collected at baseline, day 7 and day 28: EULAR patient reported outcome index, profile of fatigue (Pro-F), visual analogue scale of abnormal fatigue, and Epworth sleepiness scale (ESS). Whole blood samples were stimulated with 2 ng/mL lipopolysaccharide (LPS) and the supernatant levels of IFNγ, IL12-p70, TNFα, MIP-1α, IFNα, IL-10, IL-1ß, IL-6, and IP-10 were measured at 24 hours. In addition, clinical hematology and flow cytometric profiles of whole blood immune cells were analyzed. RESULTS: Pro-F and ESS scores were significantly reduced across all three visits. LPS-stimulated production of IL-6, IL-1ß, IP-10, MIP-1α, and TNFα were significantly reduced over the study period. Patterns of NK- and T-cell subsets also altered significantly over the study period. Interestingly, lymphocyte counts at baseline visit correlated to the reduction in fatigue score. CONCLUSION: The vagus nerve may play a role in the regulation of fatigue and immune responses in pSS and nVNS may reduce clinical symptoms of fatigue and sleepiness. However, a sham-controlled follow-up study with a larger sample size is required to confirm the findings.


Assuntos
Fadiga/imunologia , Fadiga/terapia , Imunidade Celular/fisiologia , Síndrome de Sjogren/imunologia , Síndrome de Sjogren/terapia , Estimulação do Nervo Vago/métodos , Adulto , Idoso , Fadiga/sangue , Feminino , Humanos , Células Matadoras Naturais/imunologia , Células Matadoras Naturais/metabolismo , Pessoa de Meia-Idade , Síndrome de Sjogren/sangue , Linfócitos T/imunologia , Linfócitos T/metabolismo , Resultado do Tratamento , Estimulação do Nervo Vago/tendências
6.
Rev. neurol. (Ed. impr.) ; 67(10): 382-386, 16 nov., 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-175271

RESUMO

Introducción. La epilepsia afecta a 50 millones de personas. Hasta un 30% no se controla con fármacos antiepilépticos. El estimulador del nervio vago (ENV) constituye una alternativa terapéutica que hay que valorar. Objetivo. Determinar el efecto del ENV en una cohorte pediátrica con epilepsia refractaria. Pacientes y métodos. Estudio retrospectivo de niños con ENV implantado entre 2008 y 2017 en un hospital terciario. Se han analizado datos epidemiológicos, etiológicos, clínicos, electrofisiológicos y parámetros del ENV. Resultados. Se incluyó a 35 pacientes, con una mediana de edad de implantación de 12,84 años (rango: 3,1-18,7 años) y una mediana de evolución entre el inicio de la epilepsia y la implantación de 7,2 años (rango: 1,3-17,7 años). La etiología fue estructural en el 62,9% de los casos. Cuadros epilépticos más frecuentes: síndrome de Lennox-Gastaut y epilepsia focal, con predominio de las crisis tónicas (57,1%). El videoelectroencefalograma mostró anomalías multifocales (54%) y un patrón de encefalopatía epiléptica (34,3%). El 94% asociaba discapacidad intelectual. La media de fármacos antiepilépticos previos fue de 9,6 ± 3 (rango: 4-16). El 43% fueron respondedores (>= 50% reducción de crisis), con una media de reducción del 67,3%, mejor cuanto mayor era la edad de inicio de la epilepsia. Tres pacientes quedaron libres de crisis (8,5%). La reducción de crisis fue del 33% a los 6 meses y del 47,4% a los 24 meses. Mejoría cognitiva (57%) y conductual (53%). El 28% tuvo efectos secundarios, generalmente leves. Conclusiones. El ENV es una opción válida en la epilepsia refractaria con mejoría no sólo de las crisis, sino también cognitiva y conductual, con la importancia que ello tiene para la población pediátrica


Introduction. Fifty million people are aff ected by epilepsy. Up to 30% are not controlled with the aid of antiepileptic drugs. The vagus nerve stimulator (VNS) is a therapeutic alternative that must be taken into account. Aim. To determine the eff ect of the VNS in a cohort of paediatric patients with refractory epilepsy. Patients and methods. A retrospective study of children with a VNS implanted between 2008 and 2017 in a tertiary hospital. Epidemiological, aetiological, clinical and electrophysiological data, along with VNS parameters were analysed. Results. The study included 35 patients, with a mean age when the VNS was implanted of 12.84 years (range: 3.1-18.7 years) and a mean time between onset of epilepsy and implantation of 7.2 years (range: 1.3-17.7 years). The causation was structural in 62.9% of cases. The most frequent epileptic conditions were: Lennox-Gastaut syndrome and focal epilepsy, with a redominance of tonic seizures (57.1%). The video electroencephalogram showed multifocal anomalies (54%) and a pattern of epileptic encephalopathies (34.3%). Intellectual disability was associated in 94% of the cases. The mean of previous antiepileptic drugs was 9.6 } 3 (range: 4-16). 43% responded to treatment (≥ 50% reduction in number of seizures), with a mean reduction of 67.3%, which improved with higher ages of onset of epilepsy. Three patients were seizure-free (8.5%). The number of seizures decreased by 33% at six months and by 47.4% at 24 months. There was also a notable degree of cognitive (57%) and behavioural improvement (53%). In 28% of cases there were some side eff ects, but in general they were mild. Conclusions. The VNS is a valid option in refractory epilepsy, with improvements not only in terms of seizures but also regarding cognitive-behavioural aspects, this being very important for the paediatric population


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Estimulação do Nervo Vago/métodos , Epilepsia/epidemiologia , Epilepsia/etiologia , Eletrofisiologia/métodos , Reprodutibilidade dos Testes , Estimulação do Nervo Vago/tendências , Estudos Retrospectivos , Eletroencefalografia/métodos , Anticonvulsivantes , Neuropsicologia
7.
J Int Adv Otol ; 14(2): 267-272, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30256201

RESUMO

OBJECTIVES: We aimed to assess the clinical significance of the intensity of transcutaneous vagus nerve stimulation (tVNS) in chronic tinnitus. MATERIALS AND METHODS: Four sessions of tVNS were performed over a 2-week period for 24 patients with unilateral, non-pulsatile chronic tinnitus. The cavum, cymba, and tragus were sequentially stimulated to the maximal sensory thresholds. One month later, after the four sessions, the level of tinnitus distress and changes in stimulus intensity were assessed. RESULTS: The stimulus intensity did not differ according to sex or laterality. However, a moderate positive correlation between tinnitus distress and the initial stimulus intensity was observed. This correlation was not observed during the subsequent sessions. The stimulus intensity at the cavum changed significantly (p=0.018), and notable differences in tinnitus annoyance were observed between the responders and non-responders (p=0.006). CONCLUSION: The effect of stimulus intensity on the treatment outcome seems to be limited. An increasing trend in the stimulus intensity for tinnitus annoyance at the cavum was observed in the responders. Therefore, the cavum may be an optimal stimulation site for tVNS.


Assuntos
Zumbido/terapia , Estimulação do Nervo Vago/métodos , Nervo Vago/fisiopatologia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Limiar Sensorial/fisiologia , Zumbido/diagnóstico , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Estimulação do Nervo Vago/tendências
8.
Epilepsy Behav ; 85: 200-204, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30032808

RESUMO

OBJECTIVE: The objective of this research was to evaluate a cohort of children with both autism spectrum disorder (ASD) and drug-resistant epilepsy (DRE) after epilepsy surgery to determine predictors of best outcome. METHODS: Retrospective chart review was done for 29 children ages 2 to 18 years with ASD and DRE who had neurosurgical intervention for seizure management over 15 years at one institution. All subjects had at least 1 year of follow-up. Data abstraction included demographic information, seizure diagnosis, treatment, investigations, surgical intervention, neuropsychological assessment, and outcome. Statistical analysis software (SAS) was used for statistical analysis. Engel classification was used to assess seizure outcome. RESULTS: Fifteen subjects had resective surgery. Fourteen had palliative surgery with vagal nerve stimulator (VNS) insertion (13) and corpus callosotomy (1). Of the 29 subjects, 35% had class I outcome (all in the resective group). When combining all subjects (resective and palliative), 66% of subjects benefited with class I-III outcomes. In the total cohort, age at time of surgery was significant, with class I outcome more frequently seen in the younger age group when compared with classes II-IV (p = 0.01). CONCLUSION: A subset of children with ASD can benefit from resective surgery, and for those who are not candidates, a VNS can offer significant improvements in seizure control.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/cirurgia , Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Estimulação do Nervo Vago/métodos , Adolescente , Transtorno do Espectro Autista/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Coortes , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/tendências , Psicocirurgia/métodos , Psicocirurgia/tendências , Estudos Retrospectivos , Resultado do Tratamento , Estimulação do Nervo Vago/tendências
9.
Epilepsy Behav ; 88S: 2-10, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30017839

RESUMO

Epilepsy affects millions of people worldwide. Approximately one-third have pharmacoresistant epilepsy, and of these, the majority are not candidates for epilepsy surgery. Vagus nerve stimulation (VNS) therapy has been an option to treat pharmacoresistant seizures for 30 years. In this update, we will review the clinical data that support the device's efficacy in children, adolescents, and adults. We will also review its side-effect profile, quality of life and cost benefits, and the impact the device has on sudden unexpected death in epilepsy (SUDEP). We will then discuss candidate selection and provide guidance on dosing and future models. Vagus nerve stimulation therapy is an effective treatment for many seizure types and epilepsy syndromes with a predictable and benign side-effect profile that supports its role as the most commonly prescribed device to treat pharmacoresistant epilepsy. "This article is part of the Supplement issue Neurostimulation for Epilepsy."


Assuntos
Epilepsia Resistente a Medicamentos/terapia , Estimulação do Nervo Vago/métodos , Adolescente , Adulto , Criança , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/psicologia , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Convulsões/diagnóstico , Convulsões/prevenção & controle , Convulsões/psicologia , Resultado do Tratamento , Nervo Vago/fisiologia , Estimulação do Nervo Vago/tendências , Adulto Jovem
10.
Epilepsy Behav ; 83: 168-174, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29709876

RESUMO

OBJECTIVE: Vagus nerve stimulation (VNS) is an adjunctive treatment in drug-resistant epilepsy. The alterations in heart rate dynamics through VNS are not well understood. This study aimed to determine changes in heart rhythm complexity in association with VNS and to relate the findings to the outcome of VNS treatment in patients with drug-resistant epilepsy. METHODS: We prospectively analyzed 32 patients with drug-resistant epilepsy, who underwent VNS implantation, and 32 age- and sex-matched healthy control subjects. The interictal heartbeat intervals were analyzed using the heart rhythm complexity with multiscale entropy (MSE) and traditional heart rate variability (HRV) analyses based on ambulatory 24-hour electrocardiograms (ECGs). RESULTS: Patients had significantly decreased complexity indices (Slope 5, Area 1-5, Area 6-15, Area 6-20) on MSE analysis and decreased HRV measurements (standard deviation of the heartbeat interval (SDNN), square root of the mean of sum of squares of the differences between adjacent RR intervals (RMSSD), pNN50, very low frequency (VLF), low frequency (LF), high frequency (HF), total power (TP)) in time and frequency domain analyses. After one year of VNS treatment in patients with drug-resistant epilepsy, there was a trend in an elevated MSE profile with significant higher values between the scales 1 and 9. Vagus nerve stimulation induces a more significant increase of MSE in VNS responders than those in the nonresponders. The conventional HRV measurements did not change. CONCLUSION: Our results suggest that heart rhythm complexity is impaired in patients with drug-resistant epilepsy, and this is at least partially reversed by VNS treatment. Furthermore, VNS-induced effects on heart rate complexity may be associated with the therapeutic response to VNS in patients with drug-resistant epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Entropia , Frequência Cardíaca/fisiologia , Estimulação do Nervo Vago/métodos , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo Vago/fisiologia , Estimulação do Nervo Vago/tendências , Adulto Jovem
11.
Epilepsia ; 59(3): 562-572, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29336017

RESUMO

OBJECTIVE: Limited data are available regarding the evolution over time of the rate of sudden unexpected death in epilepsy patients (SUDEP) in drug-resistant epilepsy. The objective is to analyze a database of 40 443 patients with epilepsy implanted with vagus nerve stimulation (VNS) therapy in the United States (from 1988 to 2012) and assess whether SUDEP rates decrease during the postimplantation follow-up period. METHODS: Patient vital status was ascertained using the Centers for Disease Control and Prevention's National Death Index (NDI). An expert panel adjudicated classification of cause of deaths as SUDEP based on NDI data and available narrative descriptions of deaths. We tested the hypothesis that SUDEP rates decrease with time using the Mann-Kendall nonparametric trend test and by comparing SUDEP rates of the first 2 years of follow-up (years 1-2) to longer follow-up (years 3-10). RESULTS: Our cohort included 277 661 person-years of follow-up and 3689 deaths, including 632 SUDEP. Primary analysis demonstrated a significant decrease in age-adjusted SUDEP rate during follow-up (S = -27 P = .008), with rates of 2.47/1000 for years 1-2 and 1.68/1000 for years 3-10 (rate ratio 0.68; 95% confidence interval [CI] 0.53-0.87; P = .002). Sensitivity analyses confirm these findings. SIGNIFICANCE: Our data suggest that SUDEP risk significantly decreases during long-term follow-up of patients with refractory epilepsy receiving VNS Therapy. This finding might reflect several factors, including the natural long-term dynamic of SUDEP rate, attrition, and the impact of VNS Therapy. The role of each of these factors cannot be confirmed due to the limitations of the study.


Assuntos
Morte Súbita/prevenção & controle , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Vigilância da População , Estimulação do Nervo Vago/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Morte Súbita/epidemiologia , Epilepsia Resistente a Medicamentos/mortalidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
12.
Childs Nerv Syst ; 34(3): 395-400, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29350262

RESUMO

BACKGROUND: We describe three children with Angelman syndrome and medically refractory epilepsy. METHODS: Case series of three pediatric patients with Angelman syndrome and medically refractory epilepsy. All three patients failed medical treatment and were recommended for vagal nerve stimulator (VNS) implantation. RESULTS: Following VNS implantation, all three patients experienced reduction in seizure frequency greater than that afforded by medication alone. CONCLUSION: We present vagal nerve stimulator implantation as a viable treatment option for medically refractory epilepsy associated with Angelman syndrome.


Assuntos
Síndrome de Angelman/diagnóstico , Síndrome de Angelman/terapia , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Estimulação do Nervo Vago/métodos , Síndrome de Angelman/complicações , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/complicações , Feminino , Humanos , Masculino , Estimulação do Nervo Vago/tendências
13.
Cephalalgia ; 38(5): 959-969, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29231763

RESUMO

Background Clinical observations and results from recent studies support the use of non-invasive vagus nerve stimulation (nVNS) for treating cluster headache (CH) attacks. This study compared nVNS with a sham device for acute treatment in patients with episodic or chronic CH (eCH, cCH). Methods After completing a 1-week run-in period, subjects were randomly assigned (1:1) to receive nVNS or sham therapy during a 2-week double-blind period. The primary efficacy endpoint was the proportion of all treated attacks that achieved pain-free status within 15 minutes after treatment initiation, without rescue treatment. Results The Full Analysis Set comprised 48 nVNS-treated (14 eCH, 34 cCH) and 44 sham-treated (13 eCH, 31 cCH) subjects. For the primary endpoint, nVNS (14%) and sham (12%) treatments were not significantly different for the total cohort. In the eCH subgroup, nVNS (48%) was superior to sham (6%; p < 0.01). No significant differences between nVNS (5%) and sham (13%) were seen in the cCH subgroup. Conclusions Combing both eCH and cCH patients, nVNS was no different to sham. For the treatment of CH attacks, nVNS was superior to sham therapy in eCH but not in cCH. These results confirm and extend previous findings regarding the efficacy, safety, and tolerability of nVNS for the acute treatment of eCH.


Assuntos
Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/terapia , Estimulação do Nervo Vago/métodos , Doença Aguda , Adulto , Doença Crônica , Cefaleia Histamínica/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Estudos Prospectivos , Resultado do Tratamento , Estimulação do Nervo Vago/tendências
14.
Int J Cardiol ; 244: 229-234, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-28663046

RESUMO

BACKGROUND: The NECTAR-HF study evaluated safety and feasibility of vagal nerve stimulation (VNS) for the treatment of heart failure patients. The first six-month randomized phase of the study did not show improvement in left ventricular remodelling in response to VNS. This study reports the 18-month results and provides novel findings aiming to understand the lack of efficacy of VNS, including a new technique assessing the effects of VNS. METHODS: Ninety-six patients were randomized 2:1 to active or inactive VNS for 6months, thereafter VNS was activated for all patients. The primary safety endpoint was 18-month all-cause mortality. RESULTS: Ninety-one patients continued in the long-term evaluation with active VNS. The on-therapy survival estimate at 18months was 95% with a 95% one-sided lower confidence limit of 91%, (better than the predefined criterion). Left ventricular systolic volume decreased in the crossover group (VNS OFF→ON; 144±37 to 139±40, p<0.05) after VNS activation; LVESD (5.02±0.77 to 4.96±0.82, p>0.05) and LVEF (33.2±4.9 to 33.3±6.5, p>0.05) did not change. A new technique to detect subtle heart rate changes during Holter recordings, i.e. "heat maps", revealed that VNS evoked heart rate response in only 13/106 studies (12%) at 6 and 12months with active VNS. CONCLUSIONS: Although a favourable long-term safety profile was found, improvements in the efficacy endpoints were not seen with VNS. A new technique for detecting acute heart rate responses to VNS suggests that the recruitment of nerve fibres responsible for heart rate changes were substantially lower in NECTAR-HF than in pre-clinical models.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Estimulação do Nervo Vago/tendências , Idoso , Eletrocardiografia Ambulatorial/mortalidade , Eletrocardiografia Ambulatorial/tendências , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estimulação do Nervo Vago/mortalidade
15.
J Neural Eng ; 14(6): 066005, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28628030

RESUMO

OBJECTIVE: Neural reflexes regulate immune responses and homeostasis. Advances in bioelectronic medicine indicate that electrical stimulation of the vagus nerve can be used to treat inflammatory disease, yet the understanding of neural signals that regulate inflammation is incomplete. Current interfaces with the vagus nerve do not permit effective chronic stimulation or recording in mouse models, which is vital to studying the molecular and neurophysiological mechanisms that control inflammation homeostasis in health and disease. We developed an implantable, dual purpose, multi-channel, flexible 'microelectrode' array, for recording and stimulation of the mouse vagus nerve. APPROACH: The array was microfabricated on an 8 µm layer of highly biocompatible parylene configured with 16 sites. The microelectrode was evaluated by studying the recording and stimulation performance. Mice were chronically implanted with devices for up to 12 weeks. MAIN RESULTS: Using the microelectrode in vivo, high fidelity signals were recorded during physiological challenges (e.g potassium chloride and interleukin-1ß), and electrical stimulation of the vagus nerve produced the expected significant reduction of blood levels of tumor necrosis factor (TNF) in endotoxemia. Inflammatory cell infiltration at the microelectrode 12 weeks of implantation was limited according to radial distribution analysis of inflammatory cells. SIGNIFICANCE: This novel device provides an important step towards a viable chronic interface for cervical vagus nerve stimulation and recording in mice.


Assuntos
Eletrodos Implantados , Estimulação do Nervo Vago/instrumentação , Estimulação do Nervo Vago/métodos , Nervo Vago/fisiologia , Potenciais de Ação/fisiologia , Animais , Vértebras Cervicais , Estimulação Elétrica/métodos , Eletrodos Implantados/tendências , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Microeletrodos/tendências , Estimulação do Nervo Vago/tendências
16.
Neurol Sci ; 38(Suppl 1): 45-50, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28527055

RESUMO

Cluster headache is characterized by severe, unilateral headache attacks of orbital, supraorbital or temporal pain lasting 15-180 min accompanied by ipsilateral lacrimation, rhinorrhea and other cranial autonomic manifestations. Cluster headache attacks need fast-acting abortive agents because the pain peaks very quickly; sumatriptan injection is the gold standard acute treatment. First-line preventative drugs include verapamil and carbolithium. Other drugs demonstrated effective in open trials include topiramate, valproic acid, gabapentin and others. Steroids are very effective; local injection in the occipital area is also effective but its prolonged use needs caution. Monoclonal antibodies against calcitonin gene-related peptide are under investigation as prophylactic agents in both episodic and chronic cluster headache. A number of neurostimulation procedures including occipital nerve stimulation, vagus nerve stimulation, sphenopalatine ganglion stimulation and the more invasive hypothalamic stimulation are employed in chronic intractable cluster headache.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina/antagonistas & inibidores , Cefaleia Histamínica/terapia , Terapia por Estimulação Elétrica/tendências , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/metabolismo , Terapia por Estimulação Elétrica/métodos , Previsões , Humanos , Sumatriptana/administração & dosagem , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências , Verapamil/administração & dosagem
17.
Neuromodulation ; 20(4): 375-382, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27873376

RESUMO

OBJECTIVES: Invasive vagal nerve stimulation (iVNS) is an established treatment option for drug-resistant focal seizures and has been assumed to diminish frequent co-incidental daily headache/migraine. However, long-term effects on cognitive/affective head pain perception, headache intensity/frequency are lacking. We therefore investigated potential iVNS-induced effects in patients with drug-resistant focal seizure and daily headache/migraine. MATERIALS AND METHODS: A clinical database was used to select 325 patients with drug-resistant epilepsy treated by either iVNS plus best medical treatment (BMT) or BMT alone, compared to a healthy control group (HC). We assessed headache intensity (VAS), headache frequency, affective/cognitive pain perception (PASS; FSVA), migraine disability scores (MIDAS), sleep architecture (PSQI), depressive symptoms (BDI), and body weight (BMI). RESULTS: Nineteen patients with daily headache/migraine composed the clinical groups (10 iVNS and 9 BMT; iVNS mean age 49 years, range 36-61 years; BMT mean age 45 years, range 23-63 years; equally distributed gender). Cervical iVNS was applied from 5-13 years (mean 8 years) with following stimulation patterns: 1.3 mA (0.5-2 mA), 20 Hz, 250 µsec, 30 sec on/1.9 min off (0.5-5 min). The iVNS group had significantly lower VAS scores (iVNS 5.4; BMT 7.8; p = 0.03) and PASS cognitive/anxiety subscores (iVNS 21; BMT 16; p = 0.02) compared to BMT and HC. Global PASS (p = 0.07), FSVA, PSQI, BDI, and BMI scores did not differ significantly between groups. CONCLUSIONS: iVNS appears to have positive modulatory long-term effects on headache and affective/cognitive head pain perception in patients with drug-resistant focal epilepsy, thus deserving further attention.


Assuntos
Cognição/fisiologia , Epilepsia Resistente a Medicamentos/terapia , Percepção da Dor/fisiologia , Convulsões/terapia , Estimulação do Nervo Vago/tendências , Adulto , Epilepsia Resistente a Medicamentos/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Convulsões/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Estimulação do Nervo Vago/métodos , Adulto Jovem
18.
Childs Nerv Syst ; 32(9): 1703-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27465677

RESUMO

PURPOSE: Dravet syndrome (DS), also known as severe myoclonic epilepsy of infancy (SMEI), is a rare genetic disorder that results in severe childhood-onset epilepsy. Children with DS initially present with seizures in the first year of life that are often associated with fevers. With age, multiple seizure types develop. There are few reports and no guidelines regarding palliative surgical treatment for DS. Therefore, we reviewed our surgical experience with DS. METHODS: We conducted a retrospective review of all patients with genetically confirmed DS who underwent either vagal nerve stimulator (VNS) implantation or corpus callosotomy (CC) from May 2001 to April 2014 at our institution. All inpatient and outpatient relevant documentation were reviewed. Demographic information, genetic mutation, operation performed, and preoperative and postoperative seizure frequency were recorded. Inclusion criteria required greater than one-year postoperative follow-up. RESULTS: Seven children with DS were assessed. Six patients were treated with VNS and one patient was treated with CC. In one child, VNS was followed by CC as a secondary procedure. Therefore, in total, eight surgeries were performed on seven patients during the study period. At least 1 year elapsed from presentation to our hospital and surgery for all patients. Average time after the first seizure to VNS was 4.1 years, and the average time after the first seizure to CC was 7.6 years. The mean age of patients undergoing VNS implantation was 4.3 years, and the mean age for patients undergoing CC was eight. Average follow-up for all seven patients was 6.6 years. Seizures were decreased in five of the six patients with VNS and decreased in the two patients after CC. Four of the six patients who had VNS implanted had a greater than 50 % reduction in seizure frequency, and one of the six patients who had VNS implanted had a less than 50 % reduction in seizure frequency. One patient did not respond effectively to the VNS and had very limited change in seizure frequency. Both patients who had a CC had a greater than 50 % reduction in seizure frequency. CONCLUSIONS: Both VNS and CC in patients with DS can be effective at reducing seizure frequency. Patients with DS may benefit from earlier and more aggressive surgical intervention. Studies using larger patient cohorts will help clarify the role that surgery may play in the multidisciplinary approach to controlling seizures in DS. Further studies will help determine the appropriate timing of and type of surgical intervention.


Assuntos
Corpo Caloso/cirurgia , Epilepsias Mioclônicas/diagnóstico , Epilepsias Mioclônicas/cirurgia , Cuidados Paliativos/tendências , Estimulação do Nervo Vago , Eletroencefalografia/tendências , Epilepsias Mioclônicas/fisiopatologia , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Epilepsia/cirurgia , Feminino , Humanos , Lactente , Masculino , Estimulação do Nervo Vago/tendências
19.
J Neural Eng ; 13(4): 041002, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27351347

RESUMO

OBJECTIVE: Neural signals along the vagus nerve (VN) drive many somatic and autonomic functions. The clinical interest of VN stimulation (VNS) is thus potentially huge and has already been demonstrated in epilepsy. However, side effects are often elicited, in addition to the targeted neuromodulation. APPROACH: This review examines the state of the art of VNS applied to two emerging modulations of autonomic function: heart failure and obesity, especially morbid obesity. MAIN RESULTS: We report that VNS may benefit from improved stimulation delivery using very advanced technologies. However, most of the results from fundamental animal studies still need to be demonstrated in humans.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Fenômenos Fisiológicos do Sistema Nervoso , Estimulação do Nervo Vago/tendências , Animais , Sistema Nervoso Autônomo/anatomia & histologia , Epilepsia/fisiopatologia , Humanos , Nervo Vago/fisiologia
20.
Physiol Rep ; 4(9)2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27173672

RESUMO

Cardiovascular disease degrades the regulatory function of the autonomic nervous system. Cyclic vagus nerve stimulation (VNS) is an already FDA-approved therapy for drug-resistant epilepsy and depression, and has been shown to normalize autonomic function and improve objective measures of heart function and subjective measures of heart failure symptoms. However, it remains unclear whether VNS may induce negative effects in patients with potentially healthy hearts where VNS can be used for epileptic patients. Hence, this study aims to investigate the effects of VNS on the hearts of healthy rats with normal autonomic balance. Sprague-Dawley rats were implanted with stimulators and randomized to either Sham or VNS groups. Rats in VNS group received 10 weeks of chronic intermittent VNS via stimulation of the right cervical vagus nerve. Echocardiography was performed at Baseline (prior to VNS), Week 2, and Week 9. After 10 weeks, high-resolution optical mapping was performed in ex vivo perfused hearts to evaluate the electrophysiological remodeling that occurs in the heart as a result of the VNS therapy. Chronic VNS modified the electrophysiological properties of healthy rat hearts by reducing the action potential duration at 50% (APD50) and 80% (APD80) repolarization. Chronic VNS also affected the restitution properties of the heart at the APD50 level and increased myocardial conduction velocity (CV). VNS did not induce any significant changes to ventricular ejection fraction (EF) and spatial dispersion of APD, thus indicating that VNS did not negatively affect cardiac function. VNS also reduced the susceptibility to ventricular arrhythmias (ventricular fibrillation [VF] and ventricular tachycardia [VT]) during ex vivo programmed electrical stimulation. In summary, chronic application of cyclic VNS induces changes to the electrophysiological properties of healthy rat hearts. The observed decrease in APD and increase in CV suggest that the beneficial effects of VNS do not require the presence of existing autonomic imbalance.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Fenômenos Eletrofisiológicos/fisiologia , Coração/fisiologia , Estimulação do Nervo Vago/métodos , Animais , Masculino , Ratos , Ratos Sprague-Dawley , Volume Sistólico/fisiologia , Fatores de Tempo , Estimulação do Nervo Vago/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA