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Antidepressant effect of vagal nerve stimulation in epilepsy patients: a systematic review

Neurological Sciences volume 41, pages 3075–3084 (2020)Cite this article

Abstract

Background

Vagal nerve stimulation (VNS) is an effective palliative therapy in drug-resistant epileptic patients and is also approved as a therapy for treatment-resistant depression. Depression is a frequent comorbidity in epilepsy and it affects the quality of life of patients more than the seizure frequency itself. The aim of this systematic review is to analyze the available literature about the VNS effect on depressive symptoms in epileptic patients.

Material and methods

A comprehensive search of PubMed, Medline, Scopus, and Google Scholar was performed, and results were included up to January 2020. All studies concerning depressive symptom assessment in epileptic patients treated with VNS were included.

Results

Nine studies were included because they fulfilled inclusion criteria. Six out of nine papers reported a positive effect of VNS on depressive symptoms. Eight out of nine studies did not find any correlation between seizure reduction and depressive symptom amelioration, as induced by VNS. Clinical scales for depression, drug regimens, and age of patients were broadly different among the examined studies.

Conclusions

Reviewed studies strongly suggest that VNS ameliorates depressive symptoms in drug-resistant epileptic patients and that the VNS effect on depression is uncorrelated to seizure response. However, more rigorous studies addressing this issue are encouraged.

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Author information

Affiliations

  1. Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy

    Giovanni Assenza, Mario Tombini, Jacopo Lanzone, Lorenzo Ricci & Vincenzo Di Lazzaro

  2. Epilepsy Surgery Center, IRCCS NEUROMED, Via Atinense 18, 86170, Pozzilli (IS), Italy

    Sara Casciato & Giancarlo Di Gennaro

  3. Epilepsy Unit, Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy

    Alessandra Morano, Anna Teresa Giallonardo & Carlo Di Bonaventura

  4. Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Ettore Beghi

  5. Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

    Edoardo Ferlazzo, Sara Gasparini, Umberto Aguglia & Vittoria Cianci

  6. Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy

    Loretta Giuliano

  7. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Francesco Pisani & Adriana Magaudda

  8. Department of Neurosciences, University of Torino, Torino, Italy

    Paolo Benna

  9. IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy

    Francesca Bisulli, Barbara Mostacci, Roberto Michelucci & Paolo Tinuper

  10. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Francesca Bisulli & Paolo Tinuper

  11. Neurology Unit, Ospedale del Mare, Via Enrico Russo, Naples, Italy

    Fabrizio A. De Falco

  12. Department of Neurophysiopathology, Fondazione Istituto Neurologico Carlo Besta, Milan, Italy

    Silvana Franceschetti & Giuliano Avanzini

  13. Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy

    Angela La Neve

  14. Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    Stefano Meletti

  15. Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana and Neuroscience Institute, CNR, Pisa, Italy

    Ferdinando Sartucci

  16. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy

    Pasquale Striano

  17. Pediatric Neurology and Muscular Diseases Unit, IRCCS ‘G. Gaslini’ Institute, Genoa, Italy

    Pasquale Striano

  18. Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Flavio Villani

  19. Child Neuropsychiatry Unit, Department of Mental Health, ASST-Lariana, Como, Italy

    Vincenzo Belcastro

  20. Division of Neurology, Hospital San Donato Arezzo, Arezzo, Italy

    Amedeo Bianchi

  21. Institute of Neurology, University Magna Graecia, Germaneto (CZ), Italy

    Angelo Labate

  22. Department of Behavioural Neurology and Laboratory of Cognitive Behavioural Psychology, Fondazione Istituto Neurologico Casimiro Mondino, Pavia, Italy

    Annapia Verri

  23. Regional Health Agency of Tuscany, Florence, Italy

    Gaetano Zaccara

  24. Neurophysiopatology Unit, S. Luca Hospital, Vallo della Lucania (SA), Italy

    Vincenzo Pizza

Authors
  1. Giovanni Assenza
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  2. Mario Tombini
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  3. Jacopo Lanzone
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  4. Lorenzo Ricci
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  5. Vincenzo Di Lazzaro
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  6. Sara Casciato
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  14. Francesco Pisani
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  15. Paolo Benna
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  17. Fabrizio A. De Falco
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  18. Silvana Franceschetti
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  19. Angela La Neve
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  20. Stefano Meletti
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  21. Barbara Mostacci
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  26. Giuliano Avanzini
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  27. Vincenzo Belcastro
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  28. Amedeo Bianchi
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  29. Vittoria Cianci
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  30. Angelo Labate
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  31. Adriana Magaudda
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  32. Roberto Michelucci
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  33. Annapia Verri
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  34. Gaetano Zaccara
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  35. Vincenzo Pizza
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  36. Paolo Tinuper
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  37. Giancarlo Di Gennaro
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Consortia

on behalf of the Epilepsy Study Group of the Italian Neurological Society

Corresponding author

Correspondence to Giancarlo Di Gennaro.

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Conflict of interest

Giovanni Assenza received a compensation for an educational symposium by LivaNova. Barbara Mostacci received travel support by LivaNova. Giancarlo Di Gennaro received speaker honoraria by LivaNova.

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Assenza, G., Tombini, M., Lanzone, J. et al. Antidepressant effect of vagal nerve stimulation in epilepsy patients: a systematic review. Neurol Sci 41, 3075–3084 (2020). https://doi.org/10.1007/s10072-020-04479-2

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  • DOI: https://doi.org/10.1007/s10072-020-04479-2

Keywords

  • Vagal nerve stimulation
  • Depression
  • Epilepsy
  • Drug-resistant epilepsy
  • Systematic review