Key result
Vagus nerve stimulation did not alter cardiac autonomic function after three months of neurostimulation, with all patients presenting normal responses to sympathetic and vagal activation tests.
Why the study?
While the positive effects of VNS in drug-resistant epilepsy are thought to be mediated by afferent pathways, the efferent pathways may influence cardiac autonomic activity.
Does vagus nerve stimulation alter cardiac autonomic modulation in patients with drug-resistant epilepsy?
Observational (n=5)
No
Does vagus nerve stimulation alter cardiac autonomic modulation in patients with drug-resistant epilepsy?
Vagus nerve stimulation for drug-resistant epilepsy does not appear to adversely alter cardiac autonomic function or induce arrhythmias over three months of therapy.
No cardiac autonomic disruption seen with VNS; leaves open whether HRV monitoring refines epilepsy patient selection.
The positive effect of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy is considered to be mediated by the afferent pathways of the vagus nerve, but the efferent pathways may influence the cardiac autonomic activity. AIM OF THE STUDY: To assess the effects of VNS on cardiac autonomic modulation in epilepsy patients, over three months of neurostimulation. CLINICAL RATIONALE FOR THE STUDY: Linear and non-linear heart rate variability (HRV) analysis can provide information on the sympathovagal balance and reveal particularities of the central control of the autonomic cardiovascular function. MATERIALS AND METHODS: Using Biopac Acquisition System, we analysed HRV parameters in resting condition and during sympathetic and parasympathetic activation tests in five patients with drug-resistant epilepsy, who underwent VNS procedure. RESULTS: During the sympathetic and vagal activation tests, all five patients presented normal responses of cardiac autonomic activity, reflected in RMSSD, HFnu and LF/HF dynamics in both HRV evaluations. No bradycardia, cardiac arrhythmia or orthostatic hypotension was registered during the two evaluations. CONCLUSIONS: Our results indicate that VNS appears not to alter the cardiac autonomic function after three months of neurostimulation. HRV analysis is a useful tool for evaluating cardiac autonomic modulation in epilepsy patients during VNS therapy. CLINICAL IMPLICATIONS: Patients with decreased HRV should be periodically monitored. Cardiac changes in patients with epilepsy are important because of the additional risk of arrhythmias mediated through the autonomic dysfunction.
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Constantinescu et al. (2020) conducted an observational in Drug-resistant epilepsy (n=5). Vagus nerve stimulation vs. Baseline (before VNS procedure) was evaluated on Cardiac autonomic modulation (heart rate variability parameters in resting condition and during sympathetic and parasympathetic activation tests). Vagus nerve stimulation did not alter cardiac autonomic function after three months of neurostimulation, with all patients presenting normal responses to sympathetic and vagal activation tests.
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