Vagal Nerve Stimulation for epilepsy

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VNS FOR UNCONTROLLED SEIZURES

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  • I like this representation of 40 slides. I got much information about Vagus Nerve Stimulation. A very short electric bursts are sent to the brain via Vagus nerve which is locates in the neck. http://www.whatisall.com/health/what-is-vagus-nerve-stimulation.html
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  • One of the most common vagus nerve disorders is nerve pain in hands and wrists. As for the carpal tunnel syndrome, patients experience swelling and inflammation in the wrists, hands and forearms, and possibly tingling in the fingers. This is often caused damage to the median nerve may be compressed as it passes through the carpal tunnel in the wrist. By an ulnar nerve dysfunction is another common problem associated with nerve pain in hands. So take care of your nerves the help of people who have no idea of how a shock of losing the full use of hands can have in your life until you experience it.
    http://www.whatisguide.net/0103-vagus-nerve-stimulation.html
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Vagal Nerve Stimulation for epilepsy

  1. 1. VAGAL NERVE STIMULATION
  2. 2. INTRODUCTION <ul><li>a new non-pharmacological antiepileptic therapy, approved in 1997 by the US Food and Drug Administration </li></ul><ul><li>adjunctive therapy for adults and adolescents over 12 years of age whose partial onset seizures are refractory to antiepileptic medications. </li></ul>
  3. 3. Schematic drawing of the general placement of the vagus nerve stimulation system and bipolar stimulating lead
  4. 4. VNS Therapy: components <ul><li>Programmable pulse generator </li></ul><ul><li>bipolar lead </li></ul><ul><li>programming wand with accompanying software </li></ul><ul><li>tunnelling tool </li></ul><ul><li>hand-held magnets </li></ul>
  5. 5. PULSE GENERATOR & BIPOLAR LEAD
  6. 6. The Model 400 NCP Tunneling Tool is used during implantation to create a subcutaneous path between the device in the chest and the vagus nerve in the neck
  7. 7. Programming wand
  8. 8. MAGNETS
  9. 9. procedure <ul><li>Incisions1&2 </li></ul><ul><li>Electrode pin placing </li></ul><ul><li>Vagus nerve connection </li></ul><ul><li>Generator connection </li></ul><ul><li>Checking system </li></ul><ul><li>Setting parameters </li></ul><ul><li>Replacement of generator </li></ul>
  10. 10. VNS
  11. 11. Lead connections close-up
  12. 12. Use of programming wand to adjust generator stimulator parameters
  13. 13. programming
  14. 14. stimulation parameter settings
  15. 15. Vagus nerve anatomy and mechanism of action of VNS
  16. 16. Mechanism of action <ul><li>NTS-PBN-THALAMIC CIRCUIT </li></ul><ul><li>HIGH FREQUENCY STIMULATION-UNMYELINATED FIBRES-EEG DESYNCHRONIZATION </li></ul><ul><li>LOW FREQUENCY STIMULATION-MYELINATED FIBRES-EEG SYNCHRONIZATION </li></ul>
  17. 17. Mechanism of action <ul><li>In 1993, McLachlan posited that VNS decreased cortical epileptiform activity indirectly by influencing the reticular activating system. </li></ul><ul><li>Krahl et al demonstrated that the anticonvulsant effect of VNS could be reduced experimentally by lesioning the locus ceruleus. </li></ul><ul><li>Henry et al reported that VNS causes measurable changes in cerebral blood flow in the cerebellum, thalamus, and cortex and may activate inhibitory structures in the brain </li></ul>
  18. 18. Indication <ul><li>FDA indication: &quot;... adjunctive therapy in reducing the frequency of seizures in adults and adolescents over 12 years of age with partial onset seizure, which are refractory to antiepileptic medications.&quot; </li></ul><ul><li>Although the FDA indication for VNS excludes other types of epilepsy (ie, those without partial seizure), most epileptologists agree that the VNS indications are probably broader than that </li></ul>
  19. 19. indications <ul><li>CPS </li></ul><ul><li>GTCS </li></ul><ul><li>LGS </li></ul><ul><li>EPILEPTIC ENCEPHALOPATHIES </li></ul><ul><li>ATONIC </li></ul><ul><li>ABSENCE </li></ul><ul><li>JME </li></ul>
  20. 20. Efficacy, LABAR etal <ul><li>24 pts,- medication resistant GTCS </li></ul><ul><li>Idipathic-7,symptomatic -17 </li></ul><ul><li>Seizure frequency reduced by 46% after 3 months, </li></ul><ul><li>11 pts had >50% reduction </li></ul>
  21. 21. Hosain etal in LGS <ul><li>AGE 4-14 ,13 PTS </li></ul><ul><li>52% REDUCTION IN SEIZURE RATE IN 6 MONTHS </li></ul><ul><li>3 HAD >90% REDUCTION </li></ul><ul><li>2 HAD >75% REDUCTION </li></ul><ul><li>ONE HAD >50% REDUCTION </li></ul>
  22. 22. MURPHY etal, <ul><li>12 children </li></ul><ul><li>4-16 yrs, medically&surgically refractory seizures </li></ul><ul><li>5 had >90% red. </li></ul><ul><li>4 pts able to reduce AED doses </li></ul>
  23. 23. MURPHY etal, <ul><li>60 children , pharmacoresistant epilepsy ,27%-GTCS </li></ul><ul><li>After 6 months med.red.in frequency of seizures 31% </li></ul><ul><li>After 12 months 34% </li></ul><ul><li>After 18 months 42% </li></ul>
  24. 24. PARKER etal, <ul><li>16 children with epileptic encephalopathy </li></ul><ul><li>50% red. In 1yr </li></ul><ul><li>significant improvement in </li></ul><ul><li>EEG </li></ul><ul><li>adaptive behaviour </li></ul><ul><li>QOL </li></ul><ul><li>language performance </li></ul>
  25. 25. PATWARDAN etal, <ul><li>38 children </li></ul><ul><li>10-18 months follow up </li></ul><ul><li>Seizure reduction in atonic-80%,absence -65%,CPS-48%,GTCS-45% </li></ul>
  26. 26. Sirven etal, <ul><li>Refractory epilepsy in 45 pts </li></ul><ul><li>50 yrs or older </li></ul><ul><li>After 3 months,12 had >50% red </li></ul><ul><li>At 1 yr 21 had >>50% red </li></ul>
  27. 27. RESPONDER RATES.E03,E05 STUDIES
  28. 28. EFFICACY
  29. 29. LONG TERM CONTROL
  30. 30. responder rates for several of the newer AEDs with VNS <ul><li>compares responder rates for several of the newer AEDs with VNS. Odds ratios (OR) and associated 95% confidence intervals for at least a 50% decrease in seizure frequency in response to gabapentin,lamotrigine,topiramate,tiagabine, or VNS </li></ul>
  31. 32. OTHER BENEFITS
  32. 33. Non epileptic indications <ul><li>ALZHEIMER’S DISEASE </li></ul><ul><li>OBESITY </li></ul><ul><li>BIPOLAR DISORDER </li></ul><ul><li>OCD </li></ul><ul><li>PTSD </li></ul><ul><li>CHRONIC MIGRAINE </li></ul><ul><li>ANXIETY DISORDERS </li></ul>
  33. 34. Safety&tolerability <ul><li>Mechanical and electrical safety </li></ul><ul><li>Environmental considerations </li></ul><ul><li>Laboratory values </li></ul><ul><li>Long-term safety and tolerability,(mortality,pregnancy,swallowing defects,obstructive sleep apnea) </li></ul><ul><li>Effects on mood and behaviour in patients with epilepsy </li></ul>
  34. 35. safety
  35. 36. Adverse events,E05 STUDY
  36. 37. Clinical use of VNS for epilepsy
  37. 38. Clinical usage,programming <ul><li>Increments of current </li></ul><ul><li>Reviewed after 6-9 months </li></ul><ul><li>Off time reduction </li></ul><ul><li>Rapid cycling </li></ul>
  38. 39. Efficacy of rapid cycling vagus nerve stimulation in pharmaco-resistant epilepsy <ul><li>Rapid cycling is more efficacious than SC in pediatric group, but not in adult group. Lennox-Gastaut syndrome in pediatric patients yields a greater response to RC. </li></ul><ul><li>Suresh G GURBANI etal, Neurology Asia 2004; </li></ul>
  39. 40. To conclude <ul><li>Untill 2008 ;nearly 43,000 pts were treated with VNS WORLD WIDE </li></ul><ul><li>Patient education </li></ul><ul><li>Surgical implantation </li></ul><ul><li>Follow up programming visits </li></ul><ul><li>Titrate stimulation </li></ul>

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