VNS Therapy
A small pacemaker like generator placed in the Left chest with a lead that is anchored to the L vagus nerve
What is VNS Therapy?
The ILAE definition of DRE
What is the failure of 2 appropriately chosen and tolerated AEDs (whether as monotherapies or in combination) to control seizures when used for an adequate period of time?
The rate per year of SUDEP cases in adults in the US per 1000 people.
What is 1 per 1000
The brain's major excitatory and inhibitory neurotransmitters.
What is glutamate and GABA?
This study looks at conventional versus legacy VNS devices and showed a __ % had a 50% or more mean reduction in seizeures at __ months.
What is Hamilton, 59%, and 13 months.
4 common side effects of VNS therapy
What is hoarseness, cough, paresthesia, and shortness of breath
The core message we gain from the Kwan, Chen, and Brodie publications.
What is "In spite of multiple additional AEDs becoming available, the epilepsy population that is considered drug resistant, continues to be about 1/3 of the population?
The only neurological disease mortality burden that is greater than SUDEP
What is stroke?
This type of seizure will not show unusual activity in the brain on EEG
What is PNES or psychogenic non-epileptic seizure
The _____ article looked at efficacy of these two neuromodulatory devices and found they had similar efficacy
What is Ellens, VNS, and RNS?
The three proposed mechanisms of action for VNS therapy
What is increased cerebral blood flow, alteration of neurotransmitters, and interruption of abnormally synchronized eeg rhythms?
Greater than 60% of patients with epilepsy have this co-morbidity.
What is depression?
The 3 risk factors outlined by the AAN and AES that are associated with SUDEP
What is lack of nocturnal supervision, GTCS, and uncontrolled epilepsy?
Some examples of things that can cause a provoked seizure
What is alcohol, injury, drugs, metabolic changes, fever, infection.
In the Elliott 436 study, what percentage of subjects experienced a greater than or equal to 90% reduction in seizures.
What is 23%
The US indication for VNS therapy
What is "indicated as an adjunctive therapy for patients, ages 4 and up, with partial onset seizures that are refractory to medications."
Surgical intervention, diet based therapies, and neuromodulation
What are 3 common treatment options considered for DRE?
76% of SUDEP cases occur during this age range
What is 21-50 years of age
The three most basic types of seizures outlined by the ILAE
What is focal, generalized, and unknown onset?
This was the mean reduction of seizures at 8 years in the Elliott 65 study.
What is 76%
The quality of life marker mentioned in the Englot study as improved by 63% in VNS patients
What is alertness?
The time frame highlighted in the Helmers study in which the cost of VNS implant is recovered through healthcare cost savings in LOS, Hospitalizations, and ER visits.
What is 6 quarters?
The consistent sequence of events often noted with SUDEP
Rapid breathing, a period of post ictal EEG suppression, cardiorespiratory dysfunction, terminal apnea.
The five non-motor onset behaviors used in ILAE seizure classification
What is behavior arrest, autonomic, cognitive, emotional and sensory?
In the Ryvlin SUDEP paper, this was the SUDEP rate for the 3-10 year post VNS implant cohort.
What is 1.68