Evidence-based guideline update

Vagus nerve stimulation for the treatment of epilepsy: Report of the guideline development subcommittee of the american academy of neurology

George L. Morris, David Gloss, Jeffrey Buchhalter, Kenneth J. Mack, Katherine C Nickels, Cynthia Harden

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

Objective: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years. Methods: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology. Results: VNS is associated with a >50%seizure reduction in 55%-95% confidence interval [CI] 50%-59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%-64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ∼ 7% from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time. Recommendations: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation.

Original languageEnglish (US)
Pages (from-to)1453-1459
Number of pages7
JournalNeurology
Volume81
Issue number16
DOIs
StatePublished - Oct 15 2013

Fingerprint

Vagus Nerve Stimulation
Neurology
Epilepsy
Guidelines
Seizures
Therapeutics
Confidence Intervals
Stimulation
Nerve
Generalized Epilepsy
Partial Epilepsy
Infection
Odds Ratio

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Evidence-based guideline update : Vagus nerve stimulation for the treatment of epilepsy: Report of the guideline development subcommittee of the american academy of neurology. / Morris, George L.; Gloss, David; Buchhalter, Jeffrey; Mack, Kenneth J.; Nickels, Katherine C; Harden, Cynthia.

In: Neurology, Vol. 81, No. 16, 15.10.2013, p. 1453-1459.

Research output: Contribution to journalArticle

Morris, George L. ; Gloss, David ; Buchhalter, Jeffrey ; Mack, Kenneth J. ; Nickels, Katherine C ; Harden, Cynthia. / Evidence-based guideline update : Vagus nerve stimulation for the treatment of epilepsy: Report of the guideline development subcommittee of the american academy of neurology. In: Neurology. 2013 ; Vol. 81, No. 16. pp. 1453-1459.
@article{82bfbaa1a88f4c018b5190c9c2684eb6,
title = "Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy: Report of the guideline development subcommittee of the american academy of neurology",
abstract = "Objective: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years. Methods: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology. Results: VNS is associated with a >50{\%}seizure reduction in 55{\%}-95{\%} confidence interval [CI] 50{\%}-59{\%}) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50{\%} seizure reduction in 55{\%} (95{\%} CI 46{\%}-64{\%}) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50{\%} seizure frequency reduction rates of ∼ 7{\%} from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95{\%} CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time. Recommendations: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation.",
author = "Morris, {George L.} and David Gloss and Jeffrey Buchhalter and Mack, {Kenneth J.} and Nickels, {Katherine C} and Cynthia Harden",
year = "2013",
month = "10",
day = "15",
doi = "10.1212/WNL.0b013e3182a393d1",
language = "English (US)",
volume = "81",
pages = "1453--1459",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "16",

}

TY - JOUR

T1 - Evidence-based guideline update

T2 - Vagus nerve stimulation for the treatment of epilepsy: Report of the guideline development subcommittee of the american academy of neurology

AU - Morris, George L.

AU - Gloss, David

AU - Buchhalter, Jeffrey

AU - Mack, Kenneth J.

AU - Nickels, Katherine C

AU - Harden, Cynthia

PY - 2013/10/15

Y1 - 2013/10/15

N2 - Objective: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years. Methods: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology. Results: VNS is associated with a >50%seizure reduction in 55%-95% confidence interval [CI] 50%-59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%-64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ∼ 7% from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time. Recommendations: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation.

AB - Objective: To evaluate the evidence since the 1999 assessment regarding efficacy and safety of vagus nerve stimulation (VNS) for epilepsy, currently approved as adjunctive therapy for partial-onset seizures in patients >12 years. Methods: We reviewed the literature and identified relevant published studies. We classified these studies according to the American Academy of Neurology evidence-based methodology. Results: VNS is associated with a >50%seizure reduction in 55%-95% confidence interval [CI] 50%-59%) of 470 children with partial or generalized epilepsy (13 Class III studies). VNS is associated with a >50% seizure reduction in 55% (95% CI 46%-64%) of 113 patients with Lennox-Gastaut syndrome (LGS) (4 Class III studies). VNS is associated with an increase in ≥50% seizure frequency reduction rates of ∼ 7% from 1 to 5 years postimplantation (2 Class III studies). VNS is associated with a significant improvement in standard mood scales in 31 adults with epilepsy (2 Class III studies). Infection risk at the VNS implantation site in children is increased relative to that in adults (odds ratio 3.4, 95% CI 1.0-11.2). VNS is possibly effective for seizures (both partial and generalized) in children, for LGS-associated seizures, and for mood problems in adults with epilepsy. VNS may have improved efficacy over time. Recommendations: VNS may be considered for seizures in children, for LGS-associated seizures, and for improving mood in adults with epilepsy (Level C). VNS may be considered to have improved efficacy over time (Level C). Children should be carefully monitored for site infection after VNS implantation.

UR - http://www.scopus.com/inward/record.url?scp=84887972774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887972774&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3182a393d1

DO - 10.1212/WNL.0b013e3182a393d1

M3 - Article

VL - 81

SP - 1453

EP - 1459

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 16

ER -