Vagus nerve stimulation magnet activation for seizures

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Vagus nerve stimulation magnet activation for seizures: a critical review

Source: Acta Neurol Scand D01: 10.111 / ane.12888.
Authors: Fisher, R.S., Eggleston, K.S. & Wright, C.W.

Purpose:

to gain insight in what is known about the use, effectiveness, and safety of magnet mode stimulation of vagus nerve stimulation (VNS) therapy.

Methods:

literature search conducted in January 2014 using PubMed. 9 primary articles were found; 11 additional articles (2 found after reviewing the reference lists of the 9 primary and 9 known to the authors) were included as well as 5 preclinical articles. So, in total 20 clinical and 5 pre-clinical articles – all reporting outcomes for magnet mode activation – were reviewed and summarized.

Results:

all pre-clinical studies showed that acute delivery of VNS immediately before or after the onset of experimentally induced seizures could attenuate or abort seizures. In the 20 clinical studies 829 patients were included; adults as well as children as young as 2 years of age, whereas 5 studies reported exclusively on children. Study designs were primarily retrospective or prospective case series of data based on patient and caregiver report. Benefit of magnet stimulation was reported in a weighted average of 45%; seizure cessation was reported in a weighted average of 28% of patients. Some patients reported decrease of intensity or duration of seizures, or of duration of post-ictal period. One study reported one patient with worsening with magnet stimulation. Concerning safety issues identical non-serious adverse events were reported on manual magnet stimulation as were seen in VNS therapy.

Discussion:

no randomized studies (magnet mode stimulation vs no magnet activation in response to seizure) were found. The reported benefit varied widely; from 11 – 89%. In reviewing the data it was impossible to differentiate between direct impact of magnet stimulation and other factors such as inhibition of seizure by alerting and mobilising necessary to use the magnet , placebo effect, etc.

http://www.ncbi.nlm.nih.gov/pubmed/25145652

Comments reviewer, prof Van Nieuwenhuizen:

this review provides important data: about 50% of patients report benefit of manual magnet stimulation; 28% report seizure cessation. Therefore magnet stimulation may be considered to be effective. This forms the indication for automatic activation of stimulation. Changes in heart rate at or near seizure onset enable automated responsive stimulation. This is an important approach as 40 – 60% of patients with epilepsy are unaware of their seizures.

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