Lack of effects of vagus nerve stimulation on drug-resistant epilepsy in eight pediatric patients with autism spectrum disorders: A prospective 2-year follow-up study

ArticleinEpilepsy & Behavior 12(2):298-304 · March 2008with9 Reads
DOI: 10.1016/j.yebeh.2007.10.007 · Source: PubMed
Abstract
Vagus nerve stimulation (VNS) therapy has been reported to reduce seizure frequency in some children with drug-resistant epilepsy who are not suitable candidates for epilepsy surgery. It has been suggested that there may be positive cognitive and/or behavioral effects independent of seizure control. We describe the effects of VNS with respect to seizure frequency, cognition, and autistic symptoms and behavior in eight children and adolescents with medically intractable epilepsy and autism. In comparison to baseline, seizure frequency had not decreased in anyone in our series at the 2-year follow-up. In three cases, minor improvements in general functioning were noted, but there were no positive cognitive effects. This open prospective pilot study highlights the need for more prospective studies to prevent false expectations of improvement in this severely disabled group.
    • "In general, in individuals with an autistic spectrum disorder, vagus nerve stimulation has been found to benefit behavior, whether in individual cases [30, 33, 48], or in larger series [2, 27, 29, 34], and cognitive improvements have also been observed [2, 29, 34] . Only one report has been overwhelmingly consistent in showing little or no benefit on behavior and development in this patient population [12]. Thus, the current report would appear to add to a growing body of literature suggesting that the effects of vagus nerve stimulation on behavior in autistic spectrum disorders, when evident, are generally positive, if modest in breadth and depth, and that similarly sized effects on cognition may be observed. "
    [Show abstract] [Hide abstract] ABSTRACT: In individuals with a comorbid autistic spectrum disorder and medically refractory epilepsy, vagus nerve stimulation may offer the potential of seizure control and a positive behavioral side effect profile. We aimed to examine the behavioral side effect profile using longitudinal and quantitative data and review the potential mechanisms behind behavioral changes. We present a case report of a 10-year-old boy with autistic spectrum disorder and epilepsy, who underwent vagus nerve stimulation subsequent to unsuccessful treatment with antiepileptic medication. Following vagus nerve stimulation implantation, initial, if temporary, improvement was observed in seizure control. Modest improvements were also observed in behavior and development, improvements which were observed independent of seizure control. Vagus nerve stimulation in autistic spectrum disorder is associated with modest behavioral improvement, with unidentified etiology, although several candidates for this improvement are evident.
    Full-text · Article · Apr 2015
    • "" Striking improvements " were reported in four subjects with severe autistic behaviors after VNS for seizure control [154]. Another study examined behavior of eight children with ASDs and seizures two years after initiation of VNS; just three had improvement in general function, and none had positive cognitive effects [155]. Examination of a larger ASD cohort twelve months after VNS placement suggested improved neurocognitive performance, particularly alertness [156]. "
    [Show abstract] [Hide abstract] ABSTRACT: Electrophysiological findings implicate site-specific impairment of the nucleus tractus solitarius (NTS) in autism. This invites hypothetical consideration of a large role for this small brainstem structure as the basis for seemingly disjointed behavioral and somatic features of autism. The NTS is the brain's point of entry for visceral afference, its relay for vagal reflexes, and its integration center for autonomic control of circulatory, immunological, gastrointestinal, and laryngeal function. The NTS facilitates normal cerebrovascular perfusion, and is the seminal point for an ascending noradrenergic system that modulates many complex behaviors. Microvascular configuration predisposes the NTS to focal hypoxia. A subregion-the "pNTS"-permits exposure to all blood-borne neurotoxins, including those that do not readily transit the blood-brain barrier. Impairment of acetylcholinesterase (mercury and cadmium cations, nitrates/nitrites, organophosphates, monosodium glutamate), competition for hemoglobin (carbon monoxide, nitrates/nitrites), and higher blood viscosity (net systemic oxidative stress) are suggested to potentiate microcirculatory insufficiency of the NTS, and thus autism.
    Full-text · Article · Dec 2013
    • "Usually, medications are used in combina tion to treat accompanying symptoms including anxiety, obsessions, hyperactivity, impulsivity, irritability and aggressive behaviours. The most frequently prescribed medications for patients with ASDs include anti psychotics, antidepressants , anticonvulsants, mood stabilizers, and cholinesterase inhibitors [7,8,10111213151617. However, the efficacy of most of these medications among patients with ASDs has been uncertain. "
    [Show abstract] [Hide abstract] ABSTRACT: Pharmacogenomics investigates variations in the human genome and the ways in which genetic diversity might influence individual response to drug treatment. Autism is a complex genetic disorder, which awaits a pharmacogenomic approach to better its treatment. This article describes recent developments of genetics and pharmacogenomics in the field of autism, and highlights the prospective of pharmacogenomics in developing novel and more effective therapies, and personalizing treatment strategies for autism.
    Full-text · Article · Jan 2012 · International Journal of Environmental Research and Public Health
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