Favorable combinations of antiseizure medication with vagus nerve stimulation to improve health-related quality of life in patients with epilepsy.

BACKGROUND: Vagus nerve stimulation (VNS) is a non-pharmacological treatment of refractory epilepsy, which also has an antidepressive effect. The favorable combinations of VNS with specific mechanisms of action of antiseizure medication (ASM) on mood and health-related quality of life (HrQol) have not yet been studied. The objective was to identify favourable combinations of specific ASMs with VNS for the HrQoL and depression in refractory epilepsy. METHODS: We performed an observational study including patients with refractory epilepsy and an implanted VNS (N = 151). In the first 24 months after VNS implantation, all patients were on stable ASM therapy. We used the standardized questionnaires QOLIE10, EQVAS and EQ5D to evaluate HrQoL as well as the Beck Depression Inventory (BDI). Multiple regression analysis was performed to evaluate the synergistic combinations of ASM with VNS for HrQoL. RESULTS: At the year-two follow-up (N = 151, age 45.2 ± 17.0 years), significant improvement (p < 0.05) in BDI scores was found for combination of VNS with SV2A modulators (58.4 %) or AMPA antagonists (44.4 %). A significant increase of HrQoL by at least 30 % (p < 0.05) was measured for a combination of VNS with SV2A modulators (brivaracetam, levetiracetam) or slow sodium channel inhibitors (eslicarbazepine, lacosamide). CONCLUSION: The results of our study suggests a favorable effect of the combination of SV2A modulators or slow sodium channel inhibitors with VNS on the HrQoL in comparison to other ASMs. Besides the possible synergistic effects on the seizure frequency, the amelioration of behavioral side effects of SV2A modulators by VNS is an important factor of HrQoL-improvement in these combinations.

Use of a new acellular dermal matrix for treatment of nonhealing wounds in the lower extremities of patients with diabetes.

INTRODUCTION: Acellular dermal matrices (ADMs) have successfully been used in the treatment of nonhealing wounds in patients with diabetes. METHODS: A new decellularized biological scaffold derived from human skin, D-ADM, (DermACELL, LifeNet Health, Virginia Beach, VA), has shown increased cell infiltration, host tissue integration, and vascularization in comparison to other ADMs. This clinical investigation evaluated the wound closing properties of D-ADM on 18 full-thickness lower extremity wounds in 15 patients with diabetes over a period of 12 weeks. RESULTS: A complete wound closure (100% epithelialization) rate of 58% (7/12) and an average duration of 10 weeks was demonstrated. Wound healing, defined as ≥ 95% wound closure, was established in 83% of the wounds (10/12) by the end of the study treatment. CONCLUSION: These results compare favorably with other methods of advanced wound care treatment options that utilize skin substitutes to accelerate the healing of difficult-to-treat or chronic wounds.