Intervention Review

Vagus nerve stimulation for partial seizures

  1. Michael D Privitera1,*,
  2. Timothy T E Welty2,
  3. David D M Ficker1,
  4. Jeffrey Welge3

Editorial Group: Cochrane Epilepsy Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 15 JUN 2010

DOI: 10.1002/14651858.CD002896

Database Title

Additional Information

How to Cite

Privitera MD, Welty TTE, Ficker DDM, Welge J. Vagus nerve stimulation for partial seizures. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002896. DOI: 10.1002/14651858.CD002896.

Author Information

  1. 1

    University of Cincinnati Medical Center (525), Department of Neurology, Cincinnati, Ohio, USA

  2. 2

    Samford University, McWhorter School of Pharmacy, Birmingham, Alabama 35229, USA

  3. 3

    University of Cincinnati Medical Center, Department of Psychiatry & Center for Biostatistical Services, Cincinnati, OH, USA

*Michael D Privitera, Department of Neurology, University of Cincinnati Medical Center (525), 231 Albert B. Sabin Way, Cincinnati, Ohio, 45267-0525, USA. michael.privitera@uc.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

This is an updated version of the original Cochrane review published in Issue 1, 2002.

Vagus nerve stimulation (VNS) has been introduced as an adjunct for treating people with seizures. The aim of this systematic review was to overview the current evidence for the effects of vagus nerve stimulation when used as an adjunctive treatment for people with drug-resistant partial epilepsy.

Objectives

To determine the effects of VNS high-level stimulation compared to low-level (presumed subtherapeutic dose) stimulation.

Search strategy

We searched the Cochrane Epilepsy Group's Specialized Register (January 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2010), and MEDLINE (1950 to January 2010). No language restrictions were imposed.

Selection criteria

Randomized, double-blind controlled trials of VNS comparing high and low stimulation paradigms. Studies in adults or children with drug-resistant partial seizures.

Data collection and analysis

Two review authors independently selected trials for inclusion and extracted data. The following outcomes were assessed: (a) 50% or greater reduction in total seizure frequency; (b) treatment withdrawal (any reason); (c) adverse effects. Primary analyses were intention-to-treat. Sensitivity best and worst case analyses were also undertaken. Summary odds ratios (ORs) were estimated for each outcome.

Main results

Results of the overall efficacy analysis show that VNS stimulation using the high stimulation paradigm was significantly better than low stimulation. The overall OR (95% confidence interval (CI)) for 50% responders across all studies is 1.93 (95% CI 1.1 to 3.4). This effect did not vary substantially and remained statistically significant for both the best and worst case scenarios. Results for the outcome "withdrawal of allocated treatment" suggest that VNS is well tolerated as no significant difference was found between the high and low stimulation groups, and withdrawals were rare. Statistically significant adverse effects associated with implantation (low versus baseline) were hoarseness, cough, pain, and paresthesia. Statistically significant adverse effects associated with stimulation (high versus low) were hoarseness and dyspnea, suggesting the implantation is associated with hoarseness, but the stimulation produces additional hoarseness.

Authors' conclusions

VNS for partial seizures appears to be an effective and well tolerated treatment. Adverse effects of hoarseness, cough, pain, paresthesias, and dyspnea are associated with the treatment but appear to be reasonably well tolerated as dropouts were rare. Typical central nervous system adverse effects of antiepileptic drugs such as ataxia, dizziness, fatigue, nausea, and somnolence were not statistically significantly associated with VNS treatment.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Vagus nerve stimulation for partial seizures

Vagus nerve stimulator is a device that is effective as add-on treatment for drug-resistant partial epilepsy.

Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Most seizures can be controlled by a single antiepileptic drug but sometimes seizures are drug-resistant. The review of trials found that vagus nerve stimulation is effective when used with one or more antiepileptic drugs to reduce the number of seizures for people with drug-resistant partial epilepsy. Adverse effects were hoarseness, cough, and neck pain. More research is needed to compare this treatment to antiepileptic drugs currently available.

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