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γ-aminobutyric acid or GABA, plays a pivotal role as an inhibitory neurotransmitter in the brain. GABA pathway potentiators, also known as GABAergic drugs, are a class of pharmaceutical agents designed to enhance the functioning of the GABAergic system. These medications primarily treat epilepsy, a neurological disorder characterized by recurrent seizures.
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Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression
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Combined VNS-RNS Neuromodulation for Epilepsy.

Pouya Khankhanian1, Angelica M Lee2, Cornelia N Drees3

  • 1Department of Neurology, Center for Neuro-engineering and Therapeutics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|February 7, 2022
PubMed
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Concurrent use of vagus nerve stimulator (VNS) and responsive nerve stimulator (RNS) shows synergistic effects for drug-resistant epilepsy. Temporarily disabling VNS increased seizures, highlighting its crucial role alongside RNS in managing intractable epilepsy.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Vagus nerve stimulator (VNS) and responsive nerve stimulator (RNS) are established treatments for drug-resistant epilepsy.
  • Previous studies have focused on individual device efficacy, with limited data on concurrent use.

Purpose of the Study:

  • To investigate the synergistic effects of concurrent VNS and RNS therapy in patients with intractable bilateral mesial temporal epilepsy.
  • To assess the impact of temporary VNS deactivation on seizure control and electrocorticographic activity during RNS therapy.

Main Methods:

  • Case report of two patients with bilateral mesial temporal epilepsy treated with concurrent VNS and bilateral mesial temporal RNS.
  • Temporary deactivation of the VNS device to compare RNS recordings and efficacy with and without simultaneous VNS stimulation.
  • Analysis of clinical and electrocorticographic seizure data.

Main Results:

  • Temporary VNS cessation resulted in increased clinical and electrocorticographic seizures, despite ongoing anti-seizure medications and RNS stimulation.
  • In one case, VNS alone controlled seizures from one epileptogenic zone, while combined VNS and RNS were needed for the contralateral side.
  • VNS demonstrated efficacy in reducing seizure spread to the symptomatogenic zone in another case.

Conclusions:

  • Concurrent VNS and RNS therapy demonstrates synergistic neuromodulation in intractable bitemporal epilepsy.
  • VNS plays a critical role in seizure control, even when RNS is active.
  • These findings support the combined use of VNS and RNS for optimizing treatment outcomes in complex epilepsy cases.