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Use of vagal nerve stimulation as a treatment for refractory epilepsy in dogs

Karen R. MuñanaDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.

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 DVM, MS, DACVIM
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Susanne M. VitekDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.
Present address is Bayer Pharmaceutical, 1200 New Hope Rd, Raleigh, NC 27610.

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W. Brent TarverCyberonics Inc, 16511 Space Center Dr, Houston, TX, 77058.

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Miyoko SaitoDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.

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Todd M. SkeenDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.
Present address is Carolina Veterinary Specialists, 501 Nichols Rd, Greensboro, NC 27409.

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Nicholas J. H. SharpDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.
Present address is Animal Critical Care Group of Vancouver, 1410 Boundary Rd, Burnaby, BC, Canada V5K 4V3.

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Natasha J. OlbyDepartment of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606.

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Michael M. HaglundDepartment of Neurosurgery, Duke University Medical School, Duke University, Durham, NC, 27710.

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 MD, PhD

Abstract

Objective—To evaluate safety and efficacy of vagal nerve stimulation in dogs with refractory epilepsy.

Design—Placebo-controlled, double-masked, crossover study.

Animals—10 dogs with poorly controlled seizures.

Procedure—A programmable pacemaker-like device designed to deliver intermittent stimulation to the left cervical trunk of the vagus was surgically implanted in each dog. Dogs were assigned randomly to two 13- week test periods, 1 with nerve stimulation and 1 without nerve stimulation. Owners recorded data on seizure frequency, duration, and intensity, as well as adverse effects.

Results—No significant difference in seizure frequency, duration, or severity was detected between overall 13-week treatment and control periods. During the final 4 weeks of the treatment period, a significant decrease in mean seizure frequency (34.4%) was detected, compared with the control period. Complications included transient bradycardia, asystole, and apnea during intraoperative device testing, and seroma formation, subcutaneous migration of the generator, and transient Horner's syndrome during the 14-day period between surgery and suture removal. No adverse effects of stimulation were detected, and most owners were satisfied with the treatment.

Conclusions and Clinical Relevance—Vagal nerve stimulation is a potentially safe approach to seizure control that appears to be efficacious in certain dogs and should be considered a possible treatment option when antiepileptic medications are ineffective. (J Am Vet Med Assoc 2002;221:977–983)

Abstract

Objective—To evaluate safety and efficacy of vagal nerve stimulation in dogs with refractory epilepsy.

Design—Placebo-controlled, double-masked, crossover study.

Animals—10 dogs with poorly controlled seizures.

Procedure—A programmable pacemaker-like device designed to deliver intermittent stimulation to the left cervical trunk of the vagus was surgically implanted in each dog. Dogs were assigned randomly to two 13- week test periods, 1 with nerve stimulation and 1 without nerve stimulation. Owners recorded data on seizure frequency, duration, and intensity, as well as adverse effects.

Results—No significant difference in seizure frequency, duration, or severity was detected between overall 13-week treatment and control periods. During the final 4 weeks of the treatment period, a significant decrease in mean seizure frequency (34.4%) was detected, compared with the control period. Complications included transient bradycardia, asystole, and apnea during intraoperative device testing, and seroma formation, subcutaneous migration of the generator, and transient Horner's syndrome during the 14-day period between surgery and suture removal. No adverse effects of stimulation were detected, and most owners were satisfied with the treatment.

Conclusions and Clinical Relevance—Vagal nerve stimulation is a potentially safe approach to seizure control that appears to be efficacious in certain dogs and should be considered a possible treatment option when antiepileptic medications are ineffective. (J Am Vet Med Assoc 2002;221:977–983)