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Saturday, June 30, 2012

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature.

2012 Mar;32(3):E12.

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature.


Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana 71130-3932, USA.



The authors conducted a study to evaluate the published results of vagal nerve stimulation (VNS) for medically refractory seizures according to evidence-based criteria.


The authors performed a review of available literature published between 1980 and 2010. Inclusion criteria for articles included more than 10 patients evaluated, average follow-up of 1 or more years, inclusion of medically refractory epilepsy, and consistent preoperative surgical evaluation. Articles were divided into 4 classes of evidence according to criteria established by the American Academy of Neurology.


A total of 70 publications were reviewed, of which 20 were selected for review based on inclusion and exclusion criteria. There were 2 articles that provided Class I evidence, 7 that met criteria for Class II evidence, and 11 that provided Class III evidence. The majority of evidence supports VNS usage in partial epilepsy with a seizure reduction of 50% or more in the majority of cases and freedom from seizure in 6%-27% of patients who responded to stimulation. High stimulation with a gradual increase in VNS stimulation over the first 6 weeks to 3 months postoperatively is well supported by Class I and II data. Predictors of positive response included absence of bilateral interictal epileptiform activity and cortical malformations.


Vagal nerve stimulation is a safe and effective alternative for adult and pediatric populations with epilepsy refractory to medical and other surgical management.
[PubMed - indexed for MEDLINE]

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Sunday, June 24, 2012

Fear mongering, hearsay and unsubstantiated opinions

Every now and then I’m drawn back to the VNS Message Board in hope of reading something new or any posting of any significant value.

What I tend to find is the same old fear mongering, hearsay and ranting as illustrated in the recent post I just came across.

If only one of their participants took the time to investigate how many individuals die of Epilepsy each year never having utilized VNS Therapy or how many individuals have died from the use of their medications or from the absence of any therapy intervention it would help place things in a more understandable perspective than the continuing hearsay.  Instead one reads the same old unsubstantiated ramblings.

In my opinion if individuals like these were all to have their way as it pertains to each and every therapy there would be no treatment options from which to choose and we’d be back to the Middle Ages in health care.

It is unfortunate, as it is with Depression patients, that Epilepsy patients also have no way of knowing in advance who would or would not respond favorably to any treatment and worse yet the potential for encountering serious side-effects.

What is important is not to give up hope and to be reasonably educated when undertaking any treatment option and then hoping for the best.

The fact that any therapy is a potential “god-send” at all when all else has failed is enough to keep one’s hopes alive.


Monday, June 4, 2012

Cranial Electrotherapy Stimulation Could Reduce The Risk Of Injury From Falling And Other Movement Related Accidents

Fisher Wallace Laboratories Announces Novel Therapy May Improve Gait and Balance of Parkinson's Patients

Cranial Electrotherapy Stimulation Could Reduce The Risk Of Injury From Falling And Other Movement Related Accidents

The Fisher Wallace Stimulator
The Fisher Wallace Stimulator
Quote start...the study found that gait velocity and stride length increased in Parkinson’s patients who received the therapy...Quote end
New York, NY (PRWEB) June 04, 2012

A pilot study published in Neurorehabilitation and Neural Repair indicates that the Fisher Wallace Stimulator, a low-risk and non-invasive therapy also known as Cranial Electrotherapy Stimulation (“CES”), may lead to improved gait and balance recovery in people with Parkinson’s disease.

Conducted by a team of researchers led by Gad Alon, PT, PhD at the Department of Physical Therapy & Rehabilitation at the University of Maryland School of Medicine, the study found that gait velocity and stride length increased in Parkinson’s patients who received the therapy, which may reduce the risk of injury from falling and other movement related accidents, and lead to an improved quality of life for patients with Parkinson’s disease.

Ten patients participated in the pilot study to ascertain the safety and ability of CES, also known as tPCS, to modify protective stepping and gait of individuals with Parkinson’s disease. The participants received three therapies: 1) one treatment of a CES delivered current for 20 minutes; 2) walking on treadmill for 20 minutes; and 3) a combination of CES and treadmill for 20 minutes. One CES session increased stride length and gait velocity significantly compared with treadmill alone, or CES and treadmill combined, suggesting that multiple treatments of CES might yield even better gains.

The Fisher Wallace Stimulator, the CES device used in the study, has been FDA-cleared since 1991 to treat depression and anxiety—two common co-morbid symptoms in Parkinson's patients. The benefit of using one low-cost device to treat movement and mood disorders in Parkinson's patients is significant, and promising. The drugs currently used to treat Parkinson's patients come with serious side effects, and deep brain stimulation (DBS)-- the medical intervention of choice for improving motor control in Parkinson’s disease-- has such strict criteria surrounding its use that it excludes most Parkinson’s patients.

The University of Maryland study is among a growing body of evidence for the safe and effective use of non-pharmaceutical therapies like the Fisher Wallace Stimulator for treating a host of illnesses including post-traumatic stress, acute depression and chronic pain.

About Fisher Wallace Laboratories

Founded by Charles Avery Fisher, the son of stereo pioneer Avery Fisher, Fisher Wallace Laboratories manufactures the Fisher Wallace Stimulator, a cranial electrotherapy stimulation (CES) device cleared by the FDA for the treatment of depression, anxiety and insomnia. The device costs between $495 and $695 and may be purchased online after faxing or emailing written authorization from any licensed healthcare provider, such as a psychologist, nurse, acupuncturist, general practitioner or chiropractor. Fisher Wallace Laboratories continues groundbreaking research at Harvard Medical School, Columbia Medical School, Massachusetts General Hospital, NYU Medical Center and the University of Maryland. The company's devices are made in the USA.

Neuronetics, Inc. Receives CE Mark Approval for NeuroStar TMS Therapy

Neuronetics, Inc. Receives CE Mark Approval for NeuroStar TMS Therapy

Non-Invasive, Non-Drug Solution Offers Hope to Millions of Adults Living with Depression

Published: Monday, Jun. 4, 2012 - 6:11 am
/PRNewswire/ -- Neuronetics, Inc. announced today the receipt of CE Mark approval for its NeuroStar TMS Therapy® System for the treatment of Major Depressive Disorder (MDD) in adult patients who have failed to receive satisfactory improvement from antidepressant medications. The decision is based on data from five studies, collectively representing the largest clinical data set for a therapeutic use of TMS, that demonstrate the safety and efficacy of NeuroStar TMS Therapy in depressed patients across a broad range of antidepressant treatment resistance. One of the five studies has shown a sustained benefit through six months of follow-up in a majority of patients, with only eleven percent of patients experiencing a relapse of illness.

"There is a significant need to extend non-drug treatment options to patients with depression outside the U.S., as not all patients respond to drug therapy," said Dr. Mark Demitrack, Chief Medical Officer for Neuronetics, Inc. "The CE Mark for NeuroStar TMS Therapy is an important milestone for Neuronetics as it signifies that we have met the requirements of the European Union authorities with extensive clinical efficacy and safety evidence to support the role of TMS in treating depression, while demonstrating our commitment to advance treatment options for patients around the world."

NeuroStar TMS Therapy is a non-invasive, non-systemic therapeutic device that delivers magnetic resonance imaging (MRI)-strength, pulsed, magnetic fields to induce an electric current in a localized region of the cerebral cortex, the part of the brain that controls mood. NeuroStar is a highly- targeted therapy for adults living with MDD without the systemic side effects commonly associated with oral antidepressant medications.

Recent studies conducted using the NeuroStar TMS Therapy System, include a published, National Institute of Mental Health funded, and company-independent research study evaluating NeuroStar TMS Therapy in patients with major depression (George, et al 2010). This study replicated and extended the results reported in Neuronetics' multicenter, controlled trial and further validated TMS Therapy as an effective and safe treatment option without the systemic side effects of drug treatment.
In the recent Treatment Utilization and Outcomes Study conducted by Neuronetics, one out of two patients responded to NeuroStar TMS Therapy, defined as experiencing a decrease in symptoms by at least 50 percent. One out of three patients achieved remission, defined as experiencing the absence of any clinically meaningful illness symptoms. These results replicate the results of two prior open-label clinical trials of NeuroStar TMS Therapy and verify that these outcomes are achieved with the NeuroStar TMS Therapy System during general clinical practice (Neuronetics data on file, 2012).

Since its U.S. FDA clearance in 2008, NeuroStar TMS Therapy has been administered to over 8,000 patients through more than 250,000 treatments at 400 centers in the U.S.

About Depression
Depression is a serious illness that affects about 121 million people worldwide, according to the World Health Organization. People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiety, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems.

About NeuroStar TMS Therapy®
NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly- focused MRI-strength magnetic field pulses. The treatment is typically administered daily for 4-6 weeks. NeuroStar TMS Therapy is available by prescription only. There is a rare risk of seizure associated with TMS (0.1% per acute treatment course). For full safety and prescribing information, visit

About Neuronetics
Neuronetics, Inc. is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses. Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation. Neuronetics was created as a spin-out of The Innovation Factory, a medical device incubator in Duluth, GA. For more information, please visit

NeuroStar®, NeuroStar TMS Therapy® and TMS Therapy® are registered trademarks of Neuronetics, Inc.
SOURCE Neuronetics, Inc.

Read more here:

Sunday, June 3, 2012

Treatment-resistant depression: therapeutic trends, challenges, and future directions.

Patient Prefer Adherence. 2012;6:369-88. Epub 2012 May 1.

Treatment-resistant depression: therapeutic trends, challenges, and future directions.


Medical College, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.



Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options.


In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review.


Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression.


Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.
[PubMed - in process]

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Friday, June 1, 2012

“Nerve Pacemaker” Helps Chronic Migraine Sufferers Acheive Freedom From Pain

“Nerve Pacemaker” Helps Chronic Migraine Sufferers Acheive Freedom From Pain

Dr. Brian Snyder of Neurological Surgery, P.C. Uses Occipital Nerve Stimulation When Medications Fail

Rockville Centre, NY (PRWEB) June 01, 2012
A relatively new treatment known as occipital nerve stimulation significantly decreases the severity and frequency of headaches in patients suffering from debilitating chronic migraines. The treatment is used by Brian J. Snyder, M.D., attending neurosurgeon with Neurological Surgery, P.C., when medical therapies fail to provide relief.

“Many suffer daily with severe migraines, without relief,” says Dr. Snyder. “Occipital nerve stimulation has been studied extensively, and can provide significant relief to patients whose migraines do not respond to medication.”

Occipital nerve stimulation involves delivering a small electrical charge over the region of the occipital nerves through an implanted device. The device resembles a cardiac pacemaker, except that it is used to stimulate nerves overlying the skull rather than the heart. It is implanted in the chest wall like a cardiac pacemaker and controlled via a remote control device. The doctor uses a programmer to set up the stimulation programs.

The device is first tried using temporary leads. Adjustments are then made, and if the device works well for the patient, permanent leads are implanted a week later. Recuperation time is brief.

There is one greater occipital nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. Although the pain relief mechanism is not entirely understood, occipital nerve stimulation may influence centers deep in the brain that are responsible for pain modulation.
One patient of Dr. Snyder’s who was recently helped by this device is E.W. of Long Island. E.W. suffered from daily migraines so debilitating they left her unable to work or care for her family. She was bedridden much of the time and required multiple hospitalizations, in which she received intravenous medications. Her migraines could last 10-15 days, and there was nothing that would stop them.

Just weeks after her second procedure, E.W. is now pain free. “Dr. Snyder was a lifesaver,” she says.
There are currently three large-scale randomized, placebo-controlled trials of occipital nerve stimulation, the largest being the Occipital Nerve Stimulation for the Treatment of Intractable Migraine (ONSTIM) study, sponsored by Medtronic. Preliminary findings from ONSTIM were published in 2010, showing significant migraine relief for severely debilitated patients who regularly experienced headaches for 15 days or more a month and were not responsive to medical therapies.
A number of nerve stimulators, known as “neurostimulation” or “neuromodulation” devices, are currently on the market. These devices are FDA approved for various neurostimulation uses, but are not yet cleared for occipital nerve stimulation. The government allows their use “off-label” if the physician feels it is in the patient’s best interest and they are approved for other uses. Occipital nerve stimulation has been in use since the 1990s, and has been studied extensively.

“Many patients with chronic migraines and other types of pain who are not responsive to non-surgical treatment may benefit from neurostimulation devices,” says Dr. Snyder. “This is an important new treatment option.”

According to the American Migraine Foundation, 36 million Americans suffer from migraines. Migraines are three times more common in women than in men, and nearly a third of women experience migraine in their lifetimes. The World Health Organization places migraine as one of the top 20 disabling conditions on the planet, and chronic migraine is even more disabling. Chronic migraine, which affects 3.2 million Americans, is a severely debilitating headache that occurs 15 or more days a month for at least six consecutive months.

Brian J. Snyder, M.D. is a neurosurgeon who specializes in treating chronic pain, seizure disorders and epilepsy, as well as movement disorders such as Parkinson’s disease, tremor and dystonia. He is a leading practitioner of deep brain stimulation (DBS), having trained under Dr. Andres Lozano, perhaps the world’s foremost DBS authority. He also has extensive expertise in vagal nerve stimulation and procedures for mapping, recording and identifying seizure foci in the brain, and in the surgical resection of these foci. Dr. Snyder uses a number of types of neuromodulation techniques and devices for chronic pain, including spinal cord stimulation, peripheral nerve stimulation (including occipital nerve stimulation), deep brain stimulation and implantable drug pumps. He is certified in both Gamma Knife® and CyberKnife® radiosurgery.

About Neurological Surgery, P.C.
Neurological Surgery, P.C. is one of the New York City area’s premier neurosurgical groups, offering patients the most advanced treatments of brain and spine disorders. These include minimally invasive procedures such as stereotactic radiosurgery (Gamma Knife® and CyberKnife®), aneurysm coiling, neuro-endoscopy, spinal stimulators, carotid stents, interventional pain management, microdiscectomy, kyphoplasty, and X-STOP®. The practice’s physicians represent a range of surgical and nonsurgical specialties, combining compassionate care with highly specialized training. They are leaders in the region’s medical community, with appointments as chiefs of neurosurgery in some of Long Island’s best hospitals. NSPC offers nine convenient locations in Queens, Nassau and Suffolk Counties. For more information, call 1-800-775-7784 or visit

[Frequency of the Use of Vagus Nerve Stimulation for the Treatment of Intractable Epilepsy during the First Year of Public Health Insurance Coverage with in Kyushu Rosai Hospital and Other Areas in Japan].

Brain Nerve. 2012 Jun;64(6):681-7.

[Frequency of the Use of Vagus Nerve Stimulation for the Treatment of Intractable Epilepsy during the First Year of Public Health Insurance Coverage with in Kyushu Rosai Hospital and Other Areas in Japan].

[Article in Japanese]


Department of Neurosurgery, Kyushu Rosai Hospital.


Abstract Vagus nerve stimulation (VNS) is a palliative treatment for medically intractable epilepsy and has been covered by public health insurance in Japan since July 1, 2010. The frequency of the use of VNS during the first year of insurance coverage was determined by assessing the number of cases for which VNS was performed in Kyushu Rosai Hospital, the number of registered cases, and the questionnaire survey filled by 68 surgeons who are board certified as both epileptologists and neurosurgeons. VNS devices were placed in 98 patients from July 2010 to June 2011. These devices were placed in an average of 4.4 patients per month from July 2010 to November 2010 and in an average of 10.9 patients from December 2010 to June 2011. However, we did not observe an increasing trend. Almost all of the surgeries were performed in the Kanto (56 patients in 8 institutes) and Tokai (24 patients in 2 institutes) areas. VNS was not performed in many institutes primarily because VNS was not indicated for any of the patients. The questionnaire survey indicated that the use of VNS was likely to increase with an increase in the number of neurologists who decide on performing VNS preoperatively and regulate the conditions of the vagus nerve stimulator postoperatively. In conclusion, VNS is currently being applied in a limited number of institutes in the Kanto and Tokai areas, and a close association between the epileptologists and neurologists during preoperative and postoperative periods will increase the use of VNS. (Received: August 17, 2011, Accepted: December 19, 2011).
[PubMed - in process]

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