Palavras-chave
Como Citar
Resumo
Introdução: A epilepsia refratária representa um desafio na neurologia, afetando a qualidade de vida dos pacientes que não respondem às terapias farmacológicas convencionais. A Estimulação do Nervo Vago (ENV) surge como uma abordagem promissora. Metodologia: Esta revisão integrativa foi baseada em 29 estudos sobre a ENV no tratamento da epilepsia refratária. Utilizou-se a estratégia PICO para a construção da pergunta de pesquisa e os artigos foram selecionados de bases de dados como MEDLINE/PubMed, Science Direct e LILACS. Resultados: A ENV mostrou-se eficaz na redução da frequência das crises epilépticas, com cerca de 8% dos pacientes alcançando liberdade de convulsões. Efeitos colaterais, como cefaleia e irritação da pele, foram leves e bem tolerados. A terapia foi especialmente benéfica para pacientes com síndromes epilépticas específicas. No entanto, o alto custo da ENV pode ser uma barreira para muitos pacientes. Conclusão: A ENV é uma abordagem segura e eficaz para o tratamento da epilepsia refratária. A intervenção precoce pode ser particularmente benéfica, especialmente em pacientes pediátricos. Futuras inovações tecnológicas podem tornar a ENV mais acessível e eficaz.
Referências
Beghi E, et al. Global, regional, and national burden of epilepsy, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(4):357–375.
Howland RH. Vagus nerve stimulation. Curr Behav Neurosci Rep. 2014;1(2):64–73.
Pan American Health Organization. Mais da metade das pessoas com epilepsia na América Latina e no Caribe não recebem tratamento [Internet]. 2019 [cited 2023 Oct 6]. Available from: https://www.paho.org/pt/noticias/24-1-2019-mais-da-metade-das-pessoas-com-epilepsia-na-america-latina-e-no-caribe-nao.
Löscher W, et al. Drug resistance in epilepsy: Clinical impact, potential mechanisms, and new innovative treatment options. Pharmacol Rev. 2020;72(3):606–638.
Morris GL, et al. Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(16):1453–1459.
Abassi Z, et al. Factors Affecting Vagus Nerve Stimulation Outcomes in Epilepsy. Front Neurol. 2019;10:916.
Fang S, et al. Neuroimmunomodulation of vagus nerve stimulation and the therapeutic implications. J Neuroimmunol. 2023;367:577585.
Fan L, et al. Research progress of vagus nerve stimulation in the treatment of epilepsy. Front Neurosci. 2019;13:819.
González R, et al. Vagus nerve stimulation for the treatment of epilepsy. Seizure. 2019;68:52-60.
Kavčič A. Early Intervention with Vagus Nerve Stimulation in Pediatric Patients with Drug-Resistant Epilepsy: A Single-Center Experience. Neuromodulation. 2019;22(1):85-90.
Lampros IL, et al. The long-term outcome of vagus nerve stimulation in patients with refractory epilepsy. Epilepsy Behav. 2021;114:107313.
Marras CE, et al. Cost-effectiveness of Vagus Nerve Stimulation (VNS) in the Treatment of Patients with Drug-Resistant Epilepsy. Front Neurol. 2020;11:160.
He X, et al. Cirurgia ressectiva para epilepsia pós-traumática resistente a medicamentos: preditores de resultado de convulsão. J Neurocirurgia. 2019;133:1568–1575.
Brown MG, et al. Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy. Epilepsy Behav. 2022;129:108653.
Nair DR, et al. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244-e1256.
Martorell-Llobregat C, et al. The role of vagus nerve stimulation in the treatment of refractory epilepsy: clinical outcomes and impact on quality of life. Neurologia (Engl Ed). 2022;37(6):450-458.
Thompson SL, et al. A Review of Parameter Settings for Invasive and Non-Invasive Vagus Nerve Stimulation (VNS) Applied in Neurological and Psychiatric Disorders. Front Neurosci. 2021;15. doi: 10.3389/fnins.2021.709436.
Fan J-J, et al. Research Progress of Vagus Nerve Stimulation in the Treatment of Epilepsy. CNS Neuroscience & Therapeutics. 2019;25(11):1222–1228. doi: 10.1111/cns.13209.
Abbasi M, et al. Factors Affecting Vagus Nerve Stimulation Outcomes in Epilepsy. Neurology Research International. 2021;2021:1-12. doi: 10.1155/2021/9927311.
Fang Y-T, et al. Neuroimmunomodulation of Vagus Nerve Stimulation and the Therapeutic Implications. Front Aging Neurosci. 2023;15:1173987.
Marras CE, et al. Health Technology Assessment Report on Vagus Nerve Stimulation in Drug-Resistant Epilepsy. Int J Environ Res Public Health. 2020;17(17):6150.
Lampros M, et al. Transcutaneous Vagus Nerve Stimulation (T-VNS) and Epilepsy: A Systematic Review of the Literature. Seizure. 2021;91:40-48.
National Guideline Centre (UK). Evidence Review: Vagus Nerve Stimulation: Epilepsies in Children, Young People and Adults: Diagnosis and Management: Evidence Review 14. London: National Institute for Health and Care Excellence (NICE); 2022.
Bakhtiarzadeh F, et al. Neurostimulation as a Putative Method for the Treatment of Drug-Resistant Epilepsy in Patient and Animal Models of Epilepsy. Basic Clin Neurosci. 2023;14(1):1-18.
Kavčič A. Efficacy and Tolerability of Vagus Nerve Stimulation Therapy (VNS) in Slovenian Epilepsy Patients: Younger Age and Shorter Duration of Epilepsy Might Result in Better Outcome. Acta Clin Croatica. 2019.
Wredem R, et al. Transcutaneous Auricular Vagus Nerve Stimulation Induces Stabilizing Modifications in Large-Scale Functional Brain Networks: Towards Understanding the Effects of TaVNS in Subjects with Epilepsy. Sci Rep. 2021;11(1).
Wan L, et al. Clinical characteristics and treatment outcomes of pediatric patients with postencephalitic epilepsy characterized by epileptic spasms. Seizure. 2021;84:116-121.
Guery D, Rheims S. Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies. Neuropsychiatr Dis Treat. 2021;17:2229-2242.
von Wrede R, Surges R. Transcutaneous vagus nerve stimulation in the treatment of drug-resistant epilepsy. Auton Neurosci. 2021;235:102840.
Li ST, et al. Therapeutic effects of children with refractory epilepsy after vagus nerve stimulation in Taiwan. Pediatrics Neonatol. 2020;61(6):606-612.
Spindler P, Vajkoczy P, Schneider UC. Closed-loop vagus nerve stimulation. Patient-tailored therapy or undirected treatment? Interdiscip Neurosurg. 2021;23:101003.
Muthiah N, et al. Comparison of traditional and closed loop vagus nerve stimulation for treatment of pediatric drug-resistant epilepsy: A propensity-matched retrospective cohort study. Seizure. 2022;94:74-81.
Youn SE, et al. Long-term results of vagus nerve stimulation in children with Dravet syndrome: Time-dependent, delayed antiepileptic effect. Epilepsy Res. 2021;174:106665.
Brodtkorb E, et al. Epilepsy patients with and without perceived benefit from vagus nerve stimulation: A long-term observational single center study. Seizure. 2019;72:28-32.
Hödl S, et al. Pre-ictal heart rate variability alterations in focal onset seizures and response to vagus nerve stimulation. Seizure. 2021;86:175-180.
Martorell-Llobregat C, et al. The role of vagus nerve stimulation in the treatment of refractory epilepsy: Clinical outcomes and impact on quality of life. Papel de la estimulación del nervio vago en el tratamiento de la epilepsia refractaria. Resultados clínicos e impacto en la calidad de vida. Neurologia. 2019.
Kobayashi Y, et al. Clinical manifestations and epilepsy treatment in Japanese patients with pathogenic CDKL5 variants. Brain Dev. 2021;43(4):505-514.
Abdelmoity SA, et al. The efficacy and tolerability of auto-stimulation-VNS in children with Lennox-Gastaut syndrome. Seizure. 2021;86:168-174.
Oliveira TVHF, et al. Reducing VNS stimulation parameters: Is it safe? É seguro reduzir parâmetros de estimulação do VNS? Arq Bras Neurocir. 2022;41(1):e19–e25.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Gustavo Fernandes do Vale, Leticia De Queiroz Cunha, Maria Clara Cardoso Felipe , Luiz Felipe De Azevedo Assunção, Maria Oitava Rosado Cantídio , Fernando Marinho Filho, Keren Suely Rocha Bezerra, Maria Beatriz Leandro Bezerra, Edson Jovino de Oliveira, Ana Larissa Fernandes de Holanda