ABSTRACT
OBJECTIVE: The purpose of this multicenter, add-on, double-blind, randomized, active-control study was to compare the efficacy and safety of presumably therapeutic (high) vagus nerve stimulation with less (low) stimulation. BACKGROUND: Chronic intermittent left vagus nerve stimulation has been shown in animal models and in preliminary clinical trials to suppress the occurrence of seizures. METHODS: Patients had at least six partial-onset seizures over 30 days involving complex partial or secondarily generalized seizures. Concurrent antiepileptic drugs were unaltered. After a 3-month baseline, patients were surgically implanted with stimulating leads coiled around the left vagus nerve and connected to an infraclavicular subcutaneous programmable pacemaker-like generator. After randomization, device initiation, and a 2-week ramp-up period, patients were assessed for seizure counts and safety over 3 months. The primary efficacy variable was the percentage change in total seizure frequency compared with baseline. RESULTS: Patients receiving high stimulation (94 patients, ages 13 to 54 years) had an average 28% reduction in total seizure frequency compared with a 15% reduction in the low stimulation group (102 patients, ages 15 to 60 year; p = 0.04). The high-stimulation group also had greater improvements on global evaluation scores, as rated by a blinded interviewer and the patient. High stimulation was associated with more voice alteration and dyspnea. No changes in physiologic indicators of gastric, cardiac, or pulmonary functions occurred. CONCLUSIONS: Vagus nerve stimulation is an effective and safe adjunctive treatment for patients with refractory partial-onset seizures. It represents the advent of a new, nonpharmacologic treatment for epilepsy.
Subject(s)
Electric Stimulation Therapy , Epilepsies, Partial/therapy , Vagus Nerve/physiology , Adolescent , Adult , Anticonvulsants/administration & dosage , Double-Blind Method , Epilepsies, Partial/drug therapy , Epilepsies, Partial/psychology , Female , Humans , Male , Middle Aged , Pain Measurement , Patient Participation , Patient Satisfaction , Prospective Studies , Prostheses and ImplantsABSTRACT
Twelve cases of large- and medium-sized cerebral artery stenosis and/or occlusion associated with bacterial meningitis occurred. Neurological complication due to arterial involvement developed in seven patients on the third and fourth days of illness; in one patient, it developed on the fifth day, and in another it developed on the 14th day. In three cases, this could not be determined. Arterial stenosis is considered primarily to result from arterial spasm due to humoral factors that may be elaborated within the CSF or arterial wall, as in the cases of ruptured aneurysm; and secondarily, from to inflammatory involvement of major vessels at the base of the brain and from irritation by angiographic contrast material.
Subject(s)
Arteritis/complications , Cerebral Arteries , Meningitis/complications , Arteritis/diagnostic imaging , Cerebral Angiography , Child, Preschool , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
Guillain-Barré syndrome (GBS) is a self-limited and uncommon acquired neurologic syndrome in childhood. It is not thought of as a problem of infancy and is not always included in the differential diagnosis of the floppy infant. This case report describes GBS ina 1-month-old infant. In addition this infant developed hydrocephalus concurrent with the appareance of high CSF protein levels. This patient is described to demonstrate that GBS can occur at all ages and that hydrocephalus may occur particularly when the CSF protein is at an unusually high level.
