The role of vagus nerve stimulation in refractory epilepsy

Tatiana Von Hertwig Fernandes de Oliveira; Alexandre Novicki Francisco; Zeferino Demartini Junior; Sergio Leandro Stebel

doi:10.1590/0004-282X20170113

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(09): 657-666
DOI: 10.1590/0004-282X20170113

VIEWS AND REVIEWS

The role of vagus nerve stimulation in refractory epilepsy

O papel da estimulação do nervo vago na epilepsia refratária

Tatiana Von Hertwig Fernandes de Oliveira

¹Universidade Tecnológica Federal do Paraná, Programa de Pós-Graduação em Engenharia Biomédica, Curitiba PR, Brasil;

,

Alexandre Novicki Francisco

²Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba PR, Brasil.

,

Zeferino Demartini Junior

²Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Curitiba PR, Brasil.

,

Sergio Leandro Stebel

¹Universidade Tecnológica Federal do Paraná, Programa de Pós-Graduação em Engenharia Biomédica, Curitiba PR, Brasil;

› Author Affiliations

Abstract

ABSTRACT

Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.

RESUMO

A estimulação vagal é uma terapia paliativa utilizada no tratamento de pacientes com epilepsia refratária que não são candidatos à cirurgia ressectiva ou naqueles com evolução insatisfatória após o procedimento cirúrgico. Seu mecanismo de ação ainda não foi completamente elucidado mas possivelmente envolve a modulação do locus coeruleus, tálamo e circuito límbico através de projeções noradrenérgicas e serotoninérgicas. Atualmente há evidência suficiente para corroborar o uso desta terapia em pacientes com epilepsia focal e outros tipos de crise, com resultados que, apesar de não imediatos, melhoram progressivamente no longo prazo. Os eventos adversos são, em sua maioria, relacionados à estimulação e auto-limitados. Perspectivas futuras para aumentar a eficácia e reduzir os efeitos colaterais como a utilização de baterias com maior durabilidade, estimulação transcutânea e identificação de fatores prognósticos devem ser investigadas.

vagus nerve stimulation - epilepsy

estimulação do nervo vago - epilepsia

Full Text

References

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