Vagus nerve stimulation for epilepsy: A narrative review of factors predictive of response

\ua9 2024 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy. However, there is a lack of reliable predictors of VNS response in clinical use. The identification of factors predictive of VNS response is important for patient selection and stratification as well as tailored stimulation programming. We conducted a narrative review of the existing literature on prognostic markers for VNS response using clinical, demographic, biochemical, and modality-specific information such as from electroencephalography (EEG), magnetoencephalography, and magnetic resonance imaging (MRI). No individual marker demonstrated sufficient predictive power for individual patients, although several have been suggested, with some promising initial findings. Combining markers from underresearched modalities such as T1-weighted MRI morphometrics and EEG may provide better strategies for treatment optimization

The Psychological and Cognitive Landscape of Adult Idiopathic Intracranial Hypertension A Scoping Review

\ua9 2024 Lippincott Williams and Wilkins. All rights reserved.Purpose of Review Idiopathic intracranial hypertension (IIH) is a chronic headache disorder with increasing prevalence. Although characterized by raised intracranial pressure causing papilledema with a risk of visual impairment, psychological symptoms such as depression, anxiety, and cognitive impairment are frequently seen but are understudied and under-reported. Together, these can negatively affect quality of life. These were explored through a systematic PRISMA scoping review. OVID, EMBASE, Cochrane, and PubMed databases were searched in April 2023, limited to those in English and published during January 2000–March 2023. PROSPERO ID CRD42023399410. Recent Findings From 454 identified studies, 24 relevant articles were identified from a range of countries including the United Kingdom, the United States, Israel, Egypt, Canada, Germany, and Brazil. Data on study design, participants, tests performed, and outcomes were collated. There is a considerable burden of psychiatric, affective, and cognitive conditions, as well as impaired quality of life, in adult patients with IIH. Notably, these were independently correlated with the presence of headache in a number of studies and with obesity in others. Summary Aside from optimizing symptom control, including reducing the severity of headaches and protecting visual function, clinicians should be mindful of the biopsychosocial difficulties and potential cognitive impairments patients with IIH face. Assistance may be required with managing concurrent depression and anxiety, as well as optimizing cognitive function. Incorporating neuropsychological assessment and individualized management strategies may be beneficial at the point of diagnosis and throughout the illness. Introduction Once termed “benign” intracranial hypertension, this term has fallen out of use in acknowledgment of the significant challenges patients diagnosed with idiopathic intracranial hypertension (IIH) often face. IIH is a chronic headache disorder characterized by raised intracranial pressure (ICP) in the absence of an identifiable cause and is associated with raised body mass index (BMI), especially acute weight gain and female sex.1 Treatment is predominantly medical, and in certain cases, surgical intervention may be considered, particularly if visual function is threatened.2 Treatment-refractory headaches, visual impairment, and the tribulations of surgical intervention can inevitably affect psychosocial functioning. The economic burden upon both the individual and society is substantial.2 As with many other chronic neurologic disorders, the quality of life (QoL) experienced by patients with IIH is reduced and is, therefore, increasingly becoming the focus of research.3 A potential link between psychological symptoms and IIH has been recognized since the early 2000s.4 Some hypotheses posit that IIH is a neurometabolic disorder5 with emerging evidence implicating the neuroendocrine axis dysfunction seen in IIH6 in the pathogenesis of mood symptoms. The morbidity associated with IIH and its potential coexistence with psychiatric and cognitive symptoms remain understudied and is of significance given the rising incidence and prevalence of IIH.2 Moreover, there are reports of increased rates of death by suicide in IIH when compared with the general population.7 The literature within these areas is often limited to one of these factors in isolation and unconnected to the other factors that may influence outcome in patients with IIH.8 We undertook a scoping review of psychological and cognitive comorbidity within IIH, along with studies examining QoL because these factors are interlinked and there are no studies that compare and contrast these. A scoping review methodology was undertaken because it provides a comprehensive overview of existing literature in an emerging field of literature.9 This approach enables exploration of and insight into the biopsychosocial factors within IIH and highlights areas for further investigation

Idiopathic normal pressure hydrocephalus: an important differential diagnosis.

Idiopathic normal pressure hydrocephalus, an uncommon but important differential diagnosis for ataxia, cognitive impairment and urinary incontinence, is surgically treatable, unlike many of its differential diagnoses. This article discusses its assessment, investigation and therapeutic interventions

In-House Intraoperative Monitoring in Neurosurgery in England - Benefits and Challenges

Background: Intraoperative neurophysiological monitoring (IOM) is a valuable adjunct for neurosurgical operative techniques, and has been shown to improve clinical outcomes in cranial and spinal surgery. It is not necessarily provided by NHS hospitals so may be outsourced to private companies, which are expensive and at cost to the NHS trusts. We discuss the benefits and challenges of developing an in-house service. Methods: We surveyed NHS neurosurgical departments across England regarding their expenditure on IOM over the period January 2018 - December 2022 on cranial neurosurgery and spinal surgery. Out of 24 units, all responded to our Freedom of Information requests and 21 provided data. The standard NHS England salary of NHS staff who would normally be involved in IOM, including physiologists and doctors, was also compiled for comparison. Results: The total spend on outsourced IOM, across the units who responded, was over \ua38 million in total for the four years. The annual total increased, between 2018 and 2022, from \ua31.1 to \ua33.5 million. The highest single unit yearly spend was \ua3568,462. This is in addition to salaries for staff in neurophysiology departments. The mean NHS salaries for staff is also presented. Conclusion: IOM is valuable in surgical decision-making, planning, and technique, having been shown to lead to fewer patient complications and shorter length of stay. Current demand for IOM outstrips the internal NHS provision in many trusts across England, leading to outsourcing to private companies. This is at significant cost to the NHS. Although there is a learning curve, there are many benefits to in-house provision, such as stable working relationships, consistent methods, training of the future IOM workforce, and reduced long-term costs, which planned expansion of NHS services may provide