Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus
IntroductionResistance 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 treatme...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1172898/full |
| _version_ | 1797843756240601088 |
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| author | Laura Mantoan Ritter Laura Mantoan Ritter Richard Selway |
| author_facet | Laura Mantoan Ritter Laura Mantoan Ritter Richard Selway |
| author_sort | Laura Mantoan Ritter |
| collection | DOAJ |
| description | IntroductionResistance 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 textWe 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.DiscussionWe 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. |
| first_indexed | 2024-04-09T17:11:08Z |
| format | Article |
| id | doaj.art-1de0baca6ece46ce9b889fd506e795d4 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T17:11:08Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-1de0baca6ece46ce9b889fd506e795d42023-04-20T05:55:09ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-04-011410.3389/fneur.2023.11728981172898Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticusLaura Mantoan Ritter0Laura Mantoan Ritter1Richard Selway2Epilepsy Centre, Clinical Neurosciences Department, King's College NHS Foundation Trust, London, United KingdomMaurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United KingdomEpilepsy Centre, Clinical Neurosciences Department, King's College NHS Foundation Trust, London, United KingdomIntroductionResistance 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 textWe 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.DiscussionWe 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.https://www.frontiersin.org/articles/10.3389/fneur.2023.1172898/fullfebrile infection-related epilepsy syndrome (FIRES)new onset refractory status epilepticus (NORSE)vagal nerve stimulation (VNS)neuromodulationrefractory status epilepticus (RSE) |
| spellingShingle | Laura Mantoan Ritter Laura Mantoan Ritter Richard Selway Perspective: Vagal nerve stimulation in the treatment of new-onset refractory status epilepticus Frontiers in Neurology febrile infection-related epilepsy syndrome (FIRES) new onset refractory status epilepticus (NORSE) vagal nerve stimulation (VNS) neuromodulation refractory status epilepticus (RSE) |
| 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 | febrile infection-related epilepsy syndrome (FIRES) new onset refractory status epilepticus (NORSE) vagal nerve stimulation (VNS) neuromodulation refractory status epilepticus (RSE) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1172898/full |
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