Trigeminal nerve stimulation

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Trigeminal nerve stimulation: A new way of treatment of refractory seizures

Authors:  Mahammed Zare, Mansoor Salehi, Jafar Mahvari, Mohammed Reza Najafi, Azam Moradi, Moitaba Heshmati Pour, Mojtaba Akbari

Source: Adv Biomed Res 2014; 4: 81

Aim:

to assess the antiepileptic effect of percutaneous trigeminal nerve stimulation in refractory epilepsy patients

Methods:

18 patients (age between 18-55 years; three or more partial or generalized seizures per month; use of at least two antiepileptic drugs in sufficient dosages; no serious or progressive medical disorder and no obvious history of cardiac arrhythmia) were randomly selected. Self-adhesive stimulating electrodes were used for stimulation of the frontal branches of the trigeminal nerve. Stimulation was supplied at 120 Hz, 250μsec, 5 sec “on” and 5 sec “off”. Intensity of stimulation was adjustable between 1-8 scales. After 4 weeks baseline pre-treatment period stimulation started. Average daily seizure frequency was calculated at the end of the 6 months. Dosage of AED’s remained unchanged during the stimulation period.

Results:

8 patients completed the six month period; a mean reduction in their daily seizure frequency of 47.9% was demonstrated. In the other 10 patients who did not complete the six month period, reasons to leave the study were: interference of the external device with work (2 p); difficulty in the constant use of the device (4 p); fear of attracting the attention of others or ridicule (4 p) and doubting the efficacy of the study (2 p). Many patients did not tolerate intensity scales greater than 2. Adverse effects were sensation of pressure on the head , pain, skin reaction and tingling.

PMID: 24761389

[PubMed] PMC3988608

Comments by reviewer, Prof van Nieuwenhuizen:

this study is difficult to understand. The exact distribution in 8 scales of intensity is not explained. The number of patients who did not complete the six month period is considerable (8 out of 18 p). However, findings of this study are confirmed by a RCT carried out by De Giorgio et al (Neurology 2012, 80 (9): 786-91). They showed a responder rate (seizure reduction > 50%) of 17.8% at 6 weeks and 40.5% at 18 weeks.

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