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VNS for pasienter med epilepsi Overlege Hrisimir Kostov   Avdeling for nevrodiagnostikk, Nevroklinikken, RH Spesialsykehuset for epilepsi   Sandvika - Norge
Alternativer for farmakoresistente pasienter ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hvorfor  n.vagus(X ) ?  Hvorfor venstre? ,[object Object],[object Object],[object Object],[object Object],[object Object],Henry TR.  Neurology.  2002;59(suppl 4):S3-S14.
VNS – virkningsmekanismer  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS  -  NCP (neurocybernetic prosthesis system)   fra  Cyberonics, Houston, Texas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Generator –fra Modell 100 til 103
VNS  -  behandling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Modell 220 Magneter Pasientsett   (Modell 220 ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hvilke pasienter er VNS-kandidater? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS  – andre indikasjoner  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS - Kontraindikasjoner ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mest brukte parameter kombinasjoner ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS Therapy – Long-term trials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term trials  - barn ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS i Norge ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS – Pasienter (n=232, til 31.12.2005) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results – responder rate
Prosent   ”respondere ”  etter 3   og   12   mnd med VNS   og ellers uforandret   AEDs -behandling /269 pas ./ Labar D., 2004
Early use of VNS (n=120) Renfroe, J. B. et al. Neurology 2002
Uventede forandringer i anfallssituasjonen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Response predictors?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Seizure reduction after VNS therapy in patients with IGE Kostov et al, 2007
Responder rates (>50% seizure reduction) in all patients (n=12) and in the different IGE-syndromes Kostov et al, 2007
Response predictors? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS og Katastrofal epilepsi hos barn ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS og Rett syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ketogen Diet og Vagus Nerve Stimulation:  Rasjonell Polytherapy? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kossoff et al, Epilepsia 2007
Effekt av behandlingskombinasjon KD+VNS
Diett og VNS-parametrer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Kossoff et al, Epilepsia 2007
Tilleggseffekter ved VNS-behandling  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VNS –  Bivirkninger ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pasienter, som fortsetter med behandlingen etter 3 år Ben-Menachem, E.  Lancet . 2002; 1:477-482
VNS – forsiktighetsregler  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Konklusjon – VNS behandling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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