Pregnancy Outcomes in Refractory Epilepsy Patients with Vagus Nerve Stimulation: Long-Term Single-Center Experience
Background and Study Aims Vagus nerve stimulation (VNS) has been employed worldwide as an adjunctive therapy in drug-resistant epilepsy patients. However, the mechanisms of VNS action potentially increase the risk of obstetric complications. The study presents the long-term single-center experience with pregnancies and childbirth in women with VNS for refractory epilepsy based on prospectively collected epileptologic data and a retrospective analysis of pregnancy, childbirth, and data about long-term child development.
Material and Methods From a group of patients with VNS implanted for refractory epilepsy between October 1999 and January 2018, all the women of childbearing age (younger than 40 years) were identified. After checking their hospital records for data about any pregnancies, the women with confirmed childbirth during active VNS stimulation and their general practitioners were interviewed based on a prepared questionnaire regarding their gynecologic history, the course of pregnancy and childbirth, gestational week, birth weight and length, any congenital anomalies of the child, and the child's psychomotor development, school performance, and somatic health problems.
Results From the group of 257 patients implanted with VNS for refractory epilepsy, 4 women (1.5%) became pregnant and gave birth (all on polypharmacotherapy). The mean interval from VNS implantation to birth was 44.3 months. Slight seizure worsening during the last trimester was reported in one woman. In one patient, acute caesarean section was required due to placental separation. Planned birth induction and caesarean section were used in the other two women because of their seizure disorder. No malfunction of the stimulation system was detected during pregnancy or after birth. No congenital malformations were observed. The two children who were of school age at the time of this study require special schooling.
Conclusions The study results confirmed a high rate of obstetric interventions in patients with VNS. Although no teratogenic effect of VNS has been proven, the higher incidence of children exposed to VNS needing special education requires attention.
Keywordsvagus nerve stimulation - epilepsy - pregnancy - obstetric interventions - psychomotor development
The work has not been previously published or presented.
Eingereicht: 29. Juni 2020
Angenommen: 16. Dezember 2020
Artikel online veröffentlicht:
08. September 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Ansari S, Chaudhri K, Al Moutaery KA. Vagus nerve stimulation: indications and limitations. Acta Neurochir Suppl (Wien) 2007; 97 (Pt 2): 281-286
- 2 Sabers A, Buchgreitz L, Neuhuber W. Does vagus nerve stimulation influence pregnancy outcomes?. Brain Stimul 2018; 11 (03) 618-619
- 3 Sato Y, Hotta H, Nakayama H, Suzuki H. Sympathetic and parasympathetic regulation of the uterine blood flow and contraction in the rat. J Auton Nerv Syst 1996; 59 (03) 151-158
- 4 Ortega-Villalobos M, García-Bazán M, Soláno-Flores LP, Ninomiya-Alarcón JG, Guevara-Guzmán R, Wayner MJ. Vagus nerve afferent and efferent innervation of the rat uterus: an electrophysiological and HRP study. Brain Res Bull 1990; 25 (03) 365-371
- 5 Christensen J, Vestergaard C, Hammer Bech B. Maternal death in women with epilepsy: Smaller scope studies. Neurology 2018; 91 (18) e1716-e1720
- 6 Sabers A, Battino D, Bonizzoni E. et al. Maternal and fetal outcomes associated with vagus nerve stimulation during pregnancy. Epilepsy Res 2017; 137: 159-162
- 7 Houser MV, Hennessy MD, Howard BC. Vagal nerve stimulator use during pregnancy for treatment of refractory seizure disorder. Obstet Gynecol 2010; 115 (2, Pt 2): 417-419
- 8 Suller Marti A, Mirsattari SM, Steven DA. et al. Experience on the use of Vagus Nerve Stimulation during pregnancy. Epilepsy Res 2019; 156: 106186
- 9 Rodríguez-Osorio X, López-González FJ, Garamendi Í. et al. VNS and pregnancy: a multicentric experience of four cases. Acta Neurol Scand 2017; 136 (04) 372-374
- 10 Husain MM, Stegman D, Trevino K. Pregnancy and delivery while receiving vagus nerve stimulation for the treatment of major depression: a case report. Ann Gen Psychiatry 2005; 4: 16
- 11 Salerno G, Passamonti C, Cecchi A, Zamponi N. Vagus nerve stimulation during pregnancy: an instructive case. Childs Nerv Syst 2016; 32 (01) 209-211
- 12 Battino D, Tomson T, Bonizzoni E. et al; EURAP Study Group. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia 2013; 54 (09) 1621-1627
- 13 Judkins A, Johnson RL, Murray ST, Yellon SM, Wilson CG. Vagus nerve stimulation in pregnant rats and effects on inflammatory markers in the brainstem of neonates. Pediatr Res 2018; 83 (02) 514-519
- 14 Tomson T, Battino D, Bonizzoni E. et al; EURAP study group. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol 2011; 10 (07) 609-617
- 15 Danielsson I, Lister L. A pilot study of the teratogenicity of vagus nerve stimulation in a rabbit model. Brain Stimul 2009; 2 (01) 41-49
- 16 Jazebi N, Moghimi N, Lall R, Osadebey E, Ortega-Barnett J, Masel T. Successful implantation and immediate activation of vagus nerve stimulation (VNS) during pregnancy in a patient with intractable epilepsy: a case illustration and review of the literature. J Clin Neurosci 2017; 42: 114-115