title: Extended Long-Term Effects of Cervical Vagal Nerve Stimulation on Headache Intensity/Frequency and Affective/Cognitive Headache Perception in Drug Resistant Complex-Partial Seizure Patients.
abstract: OBJECTIVE
  Invasive vagal nerve stimulation (iVNS) is an established treatment option for drug-resistant focal seizures and has been assumed to diminish frequent co-incidental daily headache/migraine. However, long-term effects on cognitive/affective head pain perception, headache intensity/frequency are lacking. We therefore investigated potential iVNS-induced effects in patients with drug-resistant focal seizure and daily headache/migraine.
  
  
  METHODS
  A clinical database was used to select 325 patients with drug-resistant epilepsy treated by either iVNS plus best medical treatment (BMT) or BMT alone, compared to a healthy control group (HC). We assessed headache intensity (VAS), headache frequency, affective/cognitive pain perception (PASS; FSVA), migraine disability scores (MIDAS), sleep architecture (PSQI), depressive symptoms (BDI), and body weight (BMI).
  
  
  RESULTS
  Nineteen patients with daily headache/migraine composed the clinical groups (10 iVNS and 9 BMT; iVNS mean age 49 years, range 36-61 years; BMT mean age 45 years, range 23-63 years; equally distributed gender). Cervical iVNS was applied from 5-13 years (mean 8 years) with following stimulation patterns: 1.3 mA (0.5-2 mA), 20 Hz, 250 μsec, 30 sec on/1.9 min off (0.5-5 min). The iVNS group had significantly lower VAS scores (iVNS 5.4; BMT 7.8; p = 0.03) and PASS cognitive/anxiety subscores (iVNS 21; BMT 16; p = 0.02) compared to BMT and HC. Global PASS (p = 0.07), FSVA, PSQI, BDI, and BMI scores did not differ significantly between groups.
  
  
  CONCLUSIONS
  iVNS appears to have positive modulatory long-term effects on headache and affective/cognitive head pain perception in patients with drug-resistant focal epilepsy, thus deserving further attention.
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Pintea
authors.affiliation: Department of Epileptology, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hampel
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Boström
authors.affiliation: Department of Epileptology, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Surges
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.|Division of Functional Neurosurgery, Stereotaxy and Neuromodulation, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Ilana S
authors.initials: IS
authors.lastname: Lendvai
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.|Division of Functional Neurosurgery, Stereotaxy and Neuromodulation, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kinfe
mesh_terms: D000328:Adult; D003071:Cognition / Q000502:physiology*; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058748:Pain Perception / Q000502:physiology*; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods / Q000639:trends*; D055815:Young Adult
keywords: Affective/cognitive head pain perception; cervical vagal nerve stimulation; headache; seizure