Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We described a 12-year-old girl with systemic lupus erythematosus (SLE) associated with myasthenia gravis (MG). She had absence seizures from 6 years old. She admitted to our hospital at 12 years of age because of absence seizures and dyspnea. The diagnosis of SLE was made on the basis of convulsion, arthritis, pleurisy, and positive antinuclear factor and was started therapy with prednisolone. The clinical course was complicated by the appearance of dysphagia and hoarseness. On the basis of positive Tensilon test and a high level of serum anti-acetylcholine receptor antibody, we made a diagnosis of the systemic type of MG. Her condition was improved by methylprednisolone pulse therapy and gamma-globulin therapy after plasmapheresis. The association of early-onset SLE with MG is rare.
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PMID:[A childhood case of systemic lupus erythematosus associated with myasthenia gravis]. 929 15

We studied physiological and sensory effects of left cervical vagal stimulation in six adult patients receiving this stimulation as adjunctive therapy for intractable epilepsy. Stimulus strength varied among subjects from 0.1 to 2.1 microCoulomb (microC) per pulse, delivered in trains of 30-45 s at frequencies from 20 to 30 Hz; these stimulation parameters were standard in a North American study. The stimulation produced no systematic changes in ECG, arterial pressure, breathing frequency tidal volume or end-expiratory volume. Five subjects experienced hoarseness during stimulation. Three subjects with high stimulus strength (0.9-2.1 microC) recalled shortness of breath during stimulation when exercising; these sensations were seldom present during stimulation at rest. No subjects reported the thoracic burning sensation or cough previously reported with chemical stimulation of pulmonary C fibers. Four of six subjects (all those receiving stimuli at or above 0.6 microC) experienced a substantial reduction in monthly seizure occurrence at the settings used in our studies. Although animal models of epilepsy suggest that C fibers are the most important fibers mediating the anti-seizure effect of vagal stimulation, our present findings suggest that the therapeutic stimulus activated A fibers (evidenced by laryngeal effects) but was not strong enough to activate B or C fibers.
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PMID:Cardiorespiratory variables and sensation during stimulation of the left vagus in patients with epilepsy. 1023 89

Vagus nerve stimulation is an empirically based method for treatment of epilepsy by repeated stimulation of the left vagus nerve through implanted electrodes. Despite studies in animals and man, which show changes in brain electrophysiology, metabolism and neurochemistry, the mode of action remains unknown. Clinical testing has presented methodological challenges, as it is difficult to assess under double blind conditions a treatment which requires surgery and produces a sensation every time the stimulator comes on. This has nevertheless been successfully addressed in parallel design, controlled trials comparing high and low stimulation schedules. These have been performed in adults with medically intractable partial seizures, and demonstrated efficacy, safety and good tolerability. Efficacy, both in the controlled trials and in numerous reports arising from the considerable post-marketing experience is modest. Some 30% of patients achieve a 50% seizure reduction after 3 months of treatment, but this proportion progressively increases to about 50% after 18 months. Side-effects comprise: discomfort in the face or neck when the stimulator is activated, coughing, breathlessness on exertion and hoarseness of voice. All are related to intensity of stimulation and rapidly habituate in most subjects. In those patients who respond, a stimulus level can therefore generally be found which is acceptable to the subject. No indication other than refractory partial seizures in adults has been the subject of controlled trials, but post-marketing experience and uncontrolled reports indicate comparable efficacy and safety in a wide range of epilepsies, partial and generalized, idiopathic, cryptogenic, or symptomatic, in patients of all ages.
Seizure 2000 Apr
PMID:Vagus nerve stimulation for epilepsy: a review. 1077 11

Lennox-Gastaut syndrome is a severe age-specific epilepsy syndrome that presents with medication-resistant seizures in childhood. Antiepileptic drugs are the mainstay of treatment. Nonpharmacologic treatments include corpus callosum section and the ketogenic diet. However, no single treatment is safe and effective. We treated 13 patients with Lennox-Gastaut syndrome between the ages of 4 and 44 years (mean, 16.7 years) with vagus nerve stimulation. During the first 6 months of treatment, vagus nerve stimulation produced a median seizure rate reduction of 52% (range, 0% to 93%; P = .04). At 6 months of follow-up, three patients had a greater than 90% reduction in seizures, two had a greater than 75% reduction, one had a greater than 50% reduction, and six had at least a 25% reduction. One patient did not improve. No patient worsened after initial improvement. Side effects, including hoarseness, coughing, and pain in the throat, were transient and tolerable. No patient discontinued vagus nerve stimulation. Our results suggest that vagus nerve stimulation could be an effective and safe adjunct therapy for the treatment of Lennox-Gastaut syndrome.
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PMID:Vagus nerve stimulation treatment for Lennox-Gastaut syndrome. 1096 88

Vagus nerve stimulation (VNS) is an alternative treatment for medically or surgically refractory epilepsy. The long-term efficacy and safety of VNS were evaluated in a large patient series at Ghent University Hospital and Dartmouth-Hitchcock Medical Center. Between March 1995 and February 2003, seizure frequency and type as well as prescribed antiepileptic drugs and side effects were prospectively assessed in 131 patients treated with VNS in either center. Patients with a minimum follow-up duration of 6 months were included in the efficacy and safety analysis. A total of 118 of 131 implanted patients had a minimum postimplantation follow-up period of 6 months (mean, 33 months). The mean age of these patients was 32 years and the mean duration of refractory epilepsy was 22 years. The mean reduction in monthly seizure frequency in all patients was 55% (range, 0-100; SD = 31.6). Seven percent of patients were free of seizures with impaired consciousness, 50% of patients had a seizure frequency reduction of more than 50%, and 21% of patients were nonresponders. Fifteen patients reported stimulation-related side effects such as hoarseness or gagging. In a large patient series from two geographically distinct epilepsy centers located in two different continents, VNS proved to be efficacious and safe during long-term follow-up.
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PMID:Vagus nerve stimulation for refractory epilepsy: a transatlantic experience. 1550 17

More than 16,000 vagal nerve stimulators (VNSs) have been implanted for refractory epileptic seizures. The most commonly reported side effect is hoarseness. This study examines the effects of VNS placement on vocal fold function. Eleven patients who had undergone VNS placement at our institution were recruited. Subjective evaluation by a panel of speech and language pathologists of both connected speech and videolaryngoscopy recordings were used both at rest and during VNS activation. Additional subjective evaluation included use of the Voice Handicap Index for the study group. These results were compared to data from age- and sex-matched controls. Objective data included maximum phonation time in the study and control groups, as well as laryngeal electromyography performed on the VNS-implanted patients only. Motor unit potential morphology and recruitment, as well as spontaneous activity, were analyzed bilaterally for the cricothyroid and thyroarytenoid muscles. Significant differences were found between the study and control groups subjectively for vocal quality and videolaryngoscopy parameters. Vocal fold tension, supraglottic muscular hyperfunction, and reduced vocal fold mobility were the most common findings during VNS activation. Two of 10 patients had immobile left vocal folds in the absence of active stimulation. The maximum phonation time was generally reduced in the subject group, but this reduction did not reach statistical significance. Finally, 6 of 10 patients had abnormal electromyographic results, including large-amplitude polyphasic motor unit potentials and decreased recruitment. We conclude that implantation of a VNS can affect vocal fold function. The effects are magnified during periods of active stimulation. There is the potential for nerve degeneration after prolonged repetitive stimulation, and there may be a trend toward greater vocal fold dysfunction with higher stimulation parameters.
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PMID:Vagal nerve stimulation: clinical and electrophysiological effects on vocal fold function. 1569 56

Pertussis in adolescents and adults is common, endemic, and epidemic worldwide, and its incidence is reportedly increasing. Although a number of individuals suffer only a mild cough, many others have symptoms typical of pertussis, causing prolonged cough illness, frequent use of health care resources, missed work and a variety of complications. Symptoms experienced by adolescents and adults include sleep disturbance, weight loss, pharyngeal discomfort, influenza-like symptoms, sneezing attacks, hoarseness, sinus pain, headaches and sweating attacks. Even when symptoms are typical of pertussis, the diagnosis is often not considered in adolescents and adults because of a low awareness of the disease in these age groups. Contrary to common perceptions, complications of pertussis, including some that are serious, are not infrequent in adolescents and adults. These include urinary incontinence, rib fracture, pneumothorax, inguinal hernia, aspiration, pneumonia, seizures and otitis media. Despite underreporting, hospitalization of adults and adolescents does occur. Many believe that adolescents and adults are the groups most commonly infected with pertussis and are now the major source of contagion to infants and young children. Because of the considerable health burden, there is a need for improved vaccination strategies to prevent disease in adolescents and adults and to reduce the risk of transmission to vulnerable infants.
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PMID:Health burden of pertussis in adolescents and adults. 1587 23

Pro AED: The central issue in medical decision-making is risk-benefit assessment. Surgery of any type is still considered to be a major undertaking. To warrant these risks, the patient has a right to expect that they have a greater chance of a good outcome with an invasive therapy than with a non-invasive one. The main question is when, if ever, this becomes the case when comparing implantation of a VNS Therapy System versus adding an antiepileptic drug (AED)? After the first drug? The second? After all AEDs have failed? To date, no randomized trial comparing the addition of an AED against vagus nerve stimulation (VNS Therapy) has been undertaken, although several are currently being contemplated. Without this information, it is more difficult to make a case for early implementation of VNS Therapy. Unfortunately, few data are available regarding the potential for patients to become seizure-free after implantation of a VNS Therapy System. Another issue is side effects. It is important to remember that VNS Therapy also produces adverse events, albeit very different in character than those associated with AEDs, to which physicians have become accustomed. These include cough, dyspnea, pharyngitis, voice alteration and sleep apnea. A less frequently discussed, potentially negative consequence of VNS Therapy relates to the ability to obtain imaging of the patient. Patients who have undergone VNS Therapy System implantation are not candidates for imaging of the chest, breast, or abdomen. A second issue is that imaging of the brain can only be performed with MRI scanners that meet certain requirements, and as MRI technology develops, scanners meeting these requirements may become harder to find. However, to summarize, VNS Therapy is an excellent and useful treatment choice. Fortunately, the choice between AEDs and VNS Therapy is not an "either/or" decision. Each has a role in the treatment of patients with epilepsy, and the advantages and disadvantages of each should be kept in perspective. Pro VNS Therapy: VNS Therapy is no longer a new treatment for patients with refractory epilepsy. The first implant was performed in l988, and since then more than 30,000 patients have received this therapy. It is no longer considered an unusual or dangerous procedure, but it is still used almost exclusively for refractory epilepsy patients and it has not been generally accepted for use as a first line or even second line therapy. However, compared to the new AEDs, VNS Therapy has similar efficacy results in clinical trials and in many epilepsy syndromes and the long-term efficacy results are even more positive, with continued improvement in seizure reduction for up to two years. Two of the major reasons for not using VNS Therapy early are that it is a surgical procedure, and its safety during MRI procedures, especially with 3 Tesla, has not yet been elucidated. The safety profile of VNS Therapy is very favorable; the side effects being totally different from those seen with AEDs. The most important aspects are that there have been no pharmacological interactions, cognitive or sedative side effects reported, and it is safe for use in all age groups. Side effects are restricted to local irritation, hoarseness, coughing and, in a few cases, swallowing difficulties when the stimulator is on, but these tend to disappear with time. No idiosyncratic side effect has emerged during the 16 years of use. Compliance is guaranteed. The cost of the implantation of the VNS Therapy System, when spread out over 8 years (battery life), is actually less than the cost of using a new AED over an eight-year period, and real savings as regards hospital costs due to seizures can be expected.
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PMID:VNS Therapy versus the latest antiepileptic drug. 1612 Apr 90

Vagal nerve stimulation therapy is a new adjunctive treatment for drug-resistant epilepsy and depression. It consists of a pulse generator that transmits impulses to the left vagus nerve via an implantable electrode and can be performed by surgeons familiar with the anatomy of the cervical vagus nerve. The minimum age for vagal nerve stimulation therapy for epilepsy is 12 years, and for depression, 18 years. Hoarseness and cough are the most common side effects. Response rates to vagal nerve stimulation therapy vary and depend on several other factors. If used as adjunctive therapy, vagal nerve stimulation has shown better control of seizures or depression at smaller doses of antiepileptic or antidepressive medications and also results in decreased dose-dependent side effects. Vagal nerve stimulation therapy appears safe as an adjunctive treatment for drug-resistant epilepsy and depression. Long-term data are needed to better define its ultimate role in various subsets of patients.
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PMID:Vagus nerve stimulation therapy for treatment of drug-resistant epilepsy and depression. 1735 Dec 2

We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved alertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events.
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PMID:Vagus nerve stimulation in intractable childhood epilepsy: a Korean multicenter experience. 1759 51


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