Transkutane Vagusnervstimulation bei einem Kind mit Dravet-Syndrom

Vagus nerve stimulation has become established as an effective and safe adjuvant therapy for drug-resistant epilepsy. In addition to invasive vagus nerve stimulation (i-VNS), transcutaneous vagus nerve stimulation (t-VNS) is also now available, where electrical pulses are generated by a stimulator unit connected to a special ear electrode. This article reports the case of an 11-year-old girl with Dravet syndrome. A therapy trial with t-VNS together with a combination therapy of zonisamide and phenobarbital was performed. The existing medication was maintained. The NEMOS® t-VNS device developed by the company Cerbomed was used. The child tolerated t-VNS well and for the most part the planned daily 4 h stimulation times were complied with. After 4 months, without changing the drug regimen, a 57?% reduction in seizure frequency (specifically from 30 to 13 seizures per month) was noted. No side effects were observed.     

Update zur Vagusnervstimulation

Despite the use of a large variety of modern anticonvulsants in the management of epileptic seizures, there is a special patient population without measureable profit. This group of patients is amenable to new therapeutic approaches, such as vagus nerve stimulation (VNS) as a non-pharmacological treatment. This article elucidates the importance of VNS in the treatment of epilepsies, illustrates the procedure after implantation (e.g. ramp up and managing different duty cycles), summarizes the results of long-term VNS in different study groups and gives an insight into a new therapy vision. Over the years VNS has become established as an adjunct therapy for treatment of pharmacoresistant epilepsy and offers an innovative approach by a newly developed on demand autostimulation for the treatment of seizures.     

Vagusnervstimulation bei epileptischen Enzephalopathien

Epileptic encephalopathies encompass a heterogeneous group of childhood epilepsies with poor prognosis, and treatment is a special challenge considering the possible impairments in neurocognitive development. Early diagnosis and successful treatment are, therefore, crucial for this patient group. Four patients with progressive epilepsies, who responded outstandingly well to vagus nerve stimulation (VNS), are presented. The epilepsies of all patients were drug-resistant and surgical treatment was not an option. VNS, not as a first-line therapy but considered early after delineation of a progressive epilepsy course, represents an important therapeutic option in patients with epileptic encephalopathies.     

Transkutane elektrische Trigeminusnervstimulation

External electrical stimulation of cranial nerves V and X add to the therapeutic armamentarium for patients with pharmacoresistant epilepsy who are not suitable for or do not want surgery. Stimulation of these nerves induces activation of various brain stem nuclei and the ascending reticular activating system (ARAS) which in turn desynchronizes cortical electrical activity. The anticonvulsive effect of external electrical stimulation of the cranial nerve V (eTNS) has been demonstrated in animal studies. Three small non-randomized human studies in patients with epilepsy and one study of patients with major depression showed good anticonvulsive and antidepressive effects. One small randomized controlled phase II trial in epilepsy patients comparing treatment with active control showed a statistically significant superiority of the treatment only after 18 weeks of treatment probably due to a strong transient placebo effect in the active control group. A phase III trial is being designed. Own experiences with eTNS showed good patient tolerance and few side effects. Most patients reported favorable effects on mood. The data remain preliminary and are insufficient to report antiepileptic efficacy.     

Vagusnervstimulation bei Menschen mit Epilepsie und geistiger Behinderung

Zeitschrift für Epileptologie - In Anbetracht der nach wie vor hohen Zahl von therapieresistenten Epilepsieverläufen ist es entscheidend, den Stellenwert nichtmedikamentöser...