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Operative Neuromodulation pp 273–280Cite as

Clinical experience with vagus nerve stimulation and deep brain stimulation in epilepsy

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Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/2))

Abstract

Patients with refractory epilepsy present a particular challenge to new therapies. Vagus nerve stimulation (VNS) for the control of intractable seizures has become available since 1989. VNS is a relatively noninvasive treatment. It reduces seizure frequency by ≥50% in 1/3 of patients; an additional 1/3 of patients experience a worthwhile reduction of seizure frequency between 30 and 50%. In the remaining 1/3 of the patients there is little or no effect. Efficacy has a tendency to improve with longer duration of treatment up to 18 months postoperatively. Deep brain stimulation (DBS) or direct electrical stimulation of brain areas is an alternative neurostimulation modality. The cerebellum, various thalamic nuclei, the pallidum, and, more recently, medial temporal lobe structures have been chosen as targets. DBS for epilepsy is beyond the stage of proof-of-concept but still needs thorough evaluation in confirmatory pilot studies before it can be offered to larger patient populations. Analysis of larger patient groups and insight in the mode of action may help to identify patients with epileptic seizures or syndromes that respond better either to VNS or to DBS. Randomized and controlled studies in larger patient series are mandatory to identify the potential treatment population and optimal stimulation paradigms. Further improvements of clinical efficacy may result from these studies.

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Authors and Affiliations

  1. Reference Center for Refractory Epilepsy, Department of Neurosurgery, Ghent University Hopsital, De Pintelaan 185, B-9000, Ghent, Belgium

    Paul Boon, V. De Herdt, K. Vonck & D. Van Roost

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  1. Paul Boon
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  2. V. De Herdt
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  3. K. Vonck
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  4. D. Van Roost
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Corresponding author

Correspondence to Paul Boon .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Athens, Athens, Greece

    Damianos E. Sakas

  2. University Hospital of Wales, Cardiff, UK

    Brian A. Simpson

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Boon, P., De Herdt, V., Vonck, K., Van Roost, D. (2007). Clinical experience with vagus nerve stimulation and deep brain stimulation in epilepsy. In: Sakas, D.E., Simpson, B.A. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/2. Springer, Vienna. https://doi.org/10.1007/978-3-211-33081-4_30

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  • DOI: https://doi.org/10.1007/978-3-211-33081-4_30

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33080-7

  • Online ISBN: 978-3-211-33081-4

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