Vagus nerve stimulation: Clinical experience in drug-resistant pediatric epileptic patients

n/

Vagal nerve stimulation in intractable epilepsy: clinical experience on 100 patients and review of the literature

Introduction: Vagus Nerve Stimulation (VNS) is an effective alternative treatment for patients with refractory epilepsy. Nevertheless, information regarding VNS is still limited. Materials and Methods: In the present non randomized, prospectic study we report our clinical safety and effectiveness of VNS in 100 patients (52 Males and 48 Females) with drug resistant epilepsy. Patient’s age at implant ranged from 0,64 to 51,04 years (mean age 15.3 years). The mean follow-up time was 54,8 months ( range 2 to 108,3 months). Seventeen patients suffered from Lennox-Gastaut Syndrome, 34 patients suffered from partial epilepsy with drop attacks and secondary bysinchronism on the EEG (Lennox Gastaut-like) and 49 patients had Partial Epilepsy without drop attacks. Data collection forms were designed for prospectively gathering data on each patient’s history, seizures, drug therapy, implant device settings and side effects. Patients were assessed prior the implant and 3, 12 and 24 months after surgery. Results: Seventy-eight patients completed the 24 months follow-up session. VNS produced a mean seizure rate reduction of 32% at 3 months, 41% at 12 months, and 45% at 24 months. At 24 months, only the Partial Epilepsy patients showed a seizures reduction of 50%, which is considered clinically significant. Moreover both the age at implant and epilepsy duration were inversely correlated with the percentage of seizure reduction at 24 months. Side effects were minor and transient; the most common were voice alteration and coughing during stimulation. In 7 patients electrode breakage occurred three years after the surgical procedure. Conclusion: In our study, clinical effectiveness is higher in younger children implanted before than 12 years with shorter epilepsy duration suggesting a precocious useful role of VNS. Patients with Lennox Gastaut Syndrome show a worse clinical response rather than other epileptic syndromes

Malattia di Parkinson dalla riabilitazione alla stimolazione cerebrale profonda

Epidemiologia, eziopatogenesi, sintomatologia clinica e proposte riabilitative della malattia di Parkinson: nell’articolo viene presentata un’ampia disamina di quali possono essere i metodi riabilitativi nei diversi stadi della malattia in funzione dei sintomi per poi analizzare nello specifico la stimolazione cerebrale profonda e quale riabilitazione è possibile dopo la chirurgia funzionale

Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration

The aim of the study was to compare the outcome with respect to age of implant, aetiology and duration of epilepsy

[11C]-Methionine Positron Emission Tomography in the Postoperative Imaging and Followup of Patients with Primary and Recurrent Gliomas

We investigated the sensitivity and specificity of [(11)C]-methionine positron emission tomography ([(11)C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [(11)C]-MET PET scans (N = 249) and parallel contrast-enhanced MRI (N = 193) and/or CT (N = 113) controls. In low grade glioma patients, MRI or CT findings associated with [(11)C]-MET PET additional data allowed discrimination residual disease from postsurgical changes in 96.22% of these cases. [(11)C]-MET PET early allowed detection of malignant progression from low grade to anaplastic astrocytoma with high sensitivity (91.56%) and specificity (95.18%). In anaplastic astrocytomas, we registered high sensitivity (93.97%) and specificity (95.18%) in the postoperative imaging and during the followup of these patients. In GBM patients, CT and/or MRI scans with additional [(11)C]-MET PET data registered a sensitivity of 96.92% in the postsurgical evaluation and in the tumour assessment during temozolomide therapy. A significant correlation was found between [(11)C]-MET mean uptake index and histologic grading (P < 0.001). These findings support the notion that complementary information derived from [(11)C]-MET PET may be helpful in postoperative and successive tumor assessment of glioma patient