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RNS® System

362 bytes added, 20:02, 6 December 2016
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[[File:Vns cyberonics.jpg|thumb|Vagus Nerve Stimulation (VNS)]]
VNS , manufactured for example by Cyberonics, Inc.<ref name="Medtronic Receives European CE Mark Approval">U.S. Food & Drug Administration. VNS Therapy System - P970003s050. U.S. Food & Drug Administration [online]. 2016. Available online at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P970003 (Retrieved 6.12.2016)</ref>, sends regular, mild pules of electrical energy to the brain via the vagus nerve. It is placed under the skin in the chest and in the neck.<ref name="VNS">SCHACHTER, S.C., SIRVEN, J.I. Vagus Nerve Stimulation (VNS). Epilepsy foundation [online]. 2013. Available online at: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns (Retrieved 2.12.2016)</ref> VNS began clinical investigation in 1988 and was approved by FDA (Premarket Approval) for the treatment of medically refractory epilepsy in 1997. VNS is intended to treat epilespy of partial-onset seizures. But recent studies have suggested to treat with VNS other epilepsy syndromes, such as idiopthic generalized epilespies and Lennox-Gestaut syndrome. Efficacy of VNS in the sizures reduction is ranging between 35 - 50%. It always depend on the particulary study. VNS has been associated with positive improvement of alertness and mood. The negative side effects are connected with acute phase after implantation (intermittent hoarseness (28%), cough (14%), voice alteration (13%), paresthesias (12%), headache (4.5%), and shortness of breath (3.2%)).<ref name="Neurostimulation for the Treatment of Epilepsy"/>
TNS is not yet been approven by FDA. It has been studied in animal and pilot clinical trials. But it has not yet been sufficiently corroborated, that TNS is effective to treat epilepsy, based on relativelly small scale of the trials.<ref name="Trigeminal Nerve Stimulation May Not Be Effective">PACK, A.M. Trigeminal Nerve Stimulation May Not Be Effective for the Treatment of Refractory Partial Seizures. Epilepsy Currents. 2013, Vol. 13, No. 4, pp. 164–165.</ref>
DBS treatment is stimulation of the different areas of central nervous system. Most extensively has been studied the stimulation of the anterior nucleus of the thalamus. The DBS stimulation has been approved first by European Union (Conformité Européenne, CE) for company Medtronic in 2013 <ref name="Medtronic Receives European CE Mark Approval">Medtronic. Medtronic Receives European CE Mark Approval for Deep Brain Stimulation Therapy for Refractory Epilepsy. Medtronic, Inc. [online]. 2010. Available online at: http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=1773303 (Retrieved 5.12.2016)</ref> , and than by FDA in 2013 for treatment of epilepsy (under the FDAs Humanitarian Device Exception)<ref name="Deep Brain Stimulation: Expanding Applications">TEKRIWAL, A., BALTUCH, G. Deep Brain Stimulation: Expanding Applications. Neurol Med Chir, Tokyo, 2015, Vol. 55, No. 12, pp. 861–877.</ref>. The other areas of the stimulation are, for example the cerebellum or the hippocampus. Effectiveness of the stimulation in the anterior nucleus is estimated on 50% reduction seizures.<ref name="Neurostimulation for the Treatment of Epilepsy"/>
The RNS System is on the other hand based on closed-loop stimulation, which provide stimulation only if triggered by early seizure activity. However the above meantioned systems of stimulation provide stimulation constantly, regardless of neuronal activity. So the RNS System has less adverse effect than the rest.<ref name="Neurostimulation for the Treatment of Epilepsy"/>
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