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Vagus nerve stimulation for drug-resistant epilepsy
  1. Laura Pérez-Carbonell1,
  2. Howard Faulkner2,
  3. Sean Higgins1,
  4. Michalis Koutroumanidis3,
  5. Guy Leschziner1,3
  1. 1Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2Neurology, Southmead Hospital, Bristol, UK
  3. 3Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Laura Pérez-Carbonell, Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; laurapcarbonell{at}gmail.com

Abstract

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

  • epilepsy
  • sleep apnoea
  • vagus nerve stimulation
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Footnotes

  • Contributors LP-C and HF performed the literature search and contributed to the writing of the article. SH and MK contributed to the writing of the article. GL had the idea and contributed to the writing of the article. All authors have seen and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HF has contributed patients to the V-COMPAS and CORE-VNS trials.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by Rob Powell, Swansea, UK, Sofia Eriksson, London, UK, Malisa Pierri, Cardiff, UK.

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