Cargando…
Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus
INTRODUCTION: Resistance to drug therapy is a major hurdle in new-onset refractory status epilepticus (NORSE) treatment and there is urgent need to develop new treatment approaches. Non-drug approaches such as neuromodulation offer significant benefits and should be investigated as new adjunct treat...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157031/ https://www.ncbi.nlm.nih.gov/pubmed/37153661 http://dx.doi.org/10.3389/fneur.2023.1172898 |
_version_ | 1785036658693898240 |
---|---|
author | Mantoan Ritter, Laura Selway, Richard |
author_facet | Mantoan Ritter, Laura Selway, Richard |
author_sort | Mantoan Ritter, Laura |
collection | PubMed |
description | INTRODUCTION: Resistance to drug therapy is a major hurdle in new-onset refractory status epilepticus (NORSE) treatment and there is urgent need to develop new treatment approaches. Non-drug approaches such as neuromodulation offer significant benefits and should be investigated as new adjunct treatment modalities. An important unanswered question is whether desynchronizing networks by vagal nerve stimulation (VNS) may improve seizure control in NORSE patients. MAIN TEXT: We present a summary of published NORSE cases treated with VNS and our own data, discuss possible mechanisms of action, review VNS implantation timing, stimulation setting titration protocols and outcomes. Further, we propose avenues for future research. DISCUSSION: We advocate for consideration of VNS for NORSE both in early and late stages of the presentation and hypothesize a possible additional benefit from implantation in the acute phase of the disease. This should be pursued in the context of a clinical trial, harmonizing inclusion criteria, accuracy of documentation and treatment protocols. A study planned within our UK-wide NORSE-UK network will answer the question if VNS may confer benefits in aborting unremitting status epilepticus, modulate ictogenesis and reduce long-term chronic seizure burden. |
format | Online Article Text |
id | pubmed-10157031 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101570312023-05-05 Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus Mantoan Ritter, Laura Selway, Richard Front Neurol Neurology INTRODUCTION: Resistance to drug therapy is a major hurdle in new-onset refractory status epilepticus (NORSE) treatment and there is urgent need to develop new treatment approaches. Non-drug approaches such as neuromodulation offer significant benefits and should be investigated as new adjunct treatment modalities. An important unanswered question is whether desynchronizing networks by vagal nerve stimulation (VNS) may improve seizure control in NORSE patients. MAIN TEXT: We present a summary of published NORSE cases treated with VNS and our own data, discuss possible mechanisms of action, review VNS implantation timing, stimulation setting titration protocols and outcomes. Further, we propose avenues for future research. DISCUSSION: We advocate for consideration of VNS for NORSE both in early and late stages of the presentation and hypothesize a possible additional benefit from implantation in the acute phase of the disease. This should be pursued in the context of a clinical trial, harmonizing inclusion criteria, accuracy of documentation and treatment protocols. A study planned within our UK-wide NORSE-UK network will answer the question if VNS may confer benefits in aborting unremitting status epilepticus, modulate ictogenesis and reduce long-term chronic seizure burden. Frontiers Media S.A. 2023-04-20 /pmc/articles/PMC10157031/ /pubmed/37153661 http://dx.doi.org/10.3389/fneur.2023.1172898 Text en Copyright © 2023 Mantoan Ritter and Selway. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Mantoan Ritter, Laura Selway, Richard Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title | Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title_full | Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title_fullStr | Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title_full_unstemmed | Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title_short | Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
title_sort | perspective: vagal nerve stimulation in the treatment of new-onset refractory status epilepticus |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157031/ https://www.ncbi.nlm.nih.gov/pubmed/37153661 http://dx.doi.org/10.3389/fneur.2023.1172898 |
work_keys_str_mv | AT mantoanritterlaura perspectivevagalnervestimulationinthetreatmentofnewonsetrefractorystatusepilepticus AT selwayrichard perspectivevagalnervestimulationinthetreatmentofnewonsetrefractorystatusepilepticus |