Tahry Riëm El, Dibué Maxine, Szmalec Arnaud, Patel Roshani, Verner Ryan, Boffini Massimiliano, Fahoum Firas, Tzadok Michal
Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Epilepsy Behav Rep. 2024 Dec 13;29:100734. doi: 10.1016/j.ebr.2024.100734. eCollection 2025 Mar.
For patients with drug-resistant epilepsy who are not candidates for epilepsy surgery, Vagus nerve stimulation (VNS) is the most widely available neuromodulation option and has been available in several countries for 30 years. Given its broad availability and extended history on the market, many healthcare providers (HCPs) have developed individualized practice habits regarding the titration and dosing of VNS. This study provides novel evidence to describe the extent to which VNS management differs among providers and discusses recent literature that indicates how unique programming approaches may impact patient outcomes. In this work, practice habits regarding the titration and dosing of VNS were explored through a survey of HCPs and an examination of ongoing study data collected as part of the CORE-VNS Study. The global survey revealed significant variability in dosing and titration habits. Providers reported a wide range of initial/maximum target doses and time-to-dose, even if the population averages approximated guidance from professional societies and the manufacturer's labeling. Variable dosing and titration were reflected in varied perception of how long it takes to realize the clinical benefits of VNS. In the CORE-VNS Study, this reported experience was represented in how different generator models were used, with users of SenTiva (and the Scheduled Programming feature) depicting faster time-to-dose than those using earlier models of VNS. Our results suggest VNS providers would benefit from continued training on the use of VNS and the use of the scheduled programming feature to enhance consistency of VNS management among providers.
对于不适合进行癫痫手术的耐药性癫痫患者，迷走神经刺激（VNS）是最广泛应用的神经调节方法，在多个国家已应用30年。鉴于其广泛的可用性和较长的市场历史，许多医疗保健提供者（HCP）在VNS的滴定和给药方面形成了个性化的实践习惯。本研究提供了新的证据，以描述不同提供者之间VNS管理的差异程度，并讨论了近期文献，这些文献表明独特的编程方法可能如何影响患者预后。在这项工作中，通过对HCP的调查以及对作为CORE-VNS研究一部分收集的正在进行的研究数据的检查，探索了VNS滴定和给药的实践习惯。全球调查显示，给药和滴定习惯存在显著差异。提供者报告了广泛的初始/最大目标剂量和达到目标剂量的时间，即使总体平均值接近专业协会和制造商标签的指导。可变的给药和滴定反映在对实现VNS临床益处所需时间的不同认知上。在CORE-VNS研究中，这种报告的经验体现在不同发生器型号的使用方式上，使用SenTiva（以及定时编程功能）的用户达到目标剂量的时间比使用早期VNS型号的用户更快。我们的结果表明，VNS提供者将受益于持续的培训，包括VNS的使用以及定时编程功能的使用，以提高提供者之间VNS管理的一致性。
