Practical Considerations for the rapid titration of VNS
For patients with drug-resistant epilepsy who are not candidates for epilepsy surgery, Vagus nerve stimulation (VNS) is the most widely available neuromodulation option and has been available in several countries for 30 years. Given its broad availability and extended history on the market, many hea...
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Elsevier
2025-03-01
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| Series: | Epilepsy & Behavior Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589986424000911 |
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| author | Riëm El Tahry Maxine Dibué Arnaud Szmalec Roshani Patel Ryan Verner Massimiliano Boffini Firas Fahoum Michal Tzadok |
| author_facet | Riëm El Tahry Maxine Dibué Arnaud Szmalec Roshani Patel Ryan Verner Massimiliano Boffini Firas Fahoum Michal Tzadok |
| author_sort | Riëm El Tahry |
| collection | DOAJ |
| description | For patients with drug-resistant epilepsy who are not candidates for epilepsy surgery, Vagus nerve stimulation (VNS) is the most widely available neuromodulation option and has been available in several countries for 30 years. Given its broad availability and extended history on the market, many healthcare providers (HCPs) have developed individualized practice habits regarding the titration and dosing of VNS. This study provides novel evidence to describe the extent to which VNS management differs among providers and discusses recent literature that indicates how unique programming approaches may impact patient outcomes. In this work, practice habits regarding the titration and dosing of VNS were explored through a survey of HCPs and an examination of ongoing study data collected as part of the CORE-VNS Study. The global survey revealed significant variability in dosing and titration habits. Providers reported a wide range of initial/maximum target doses and time-to-dose, even if the population averages approximated guidance from professional societies and the manufacturer’s labeling. Variable dosing and titration were reflected in varied perception of how long it takes to realize the clinical benefits of VNS. In the CORE-VNS Study, this reported experience was represented in how different generator models were used, with users of SenTiva (and the Scheduled Programming feature) depicting faster time-to-dose than those using earlier models of VNS. Our results suggest VNS providers would benefit from continued training on the use of VNS and the use of the scheduled programming feature to enhance consistency of VNS management among providers. |
| format | Article |
| id | doaj-art-f2327f7e2fbd473d894ddd3cef9e078f |
| institution | OA Journals |
| issn | 2589-9864 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epilepsy & Behavior Reports |
| spelling | doaj-art-f2327f7e2fbd473d894ddd3cef9e078f2025-08-20T01:58:27ZengElsevierEpilepsy & Behavior Reports2589-98642025-03-012910073410.1016/j.ebr.2024.100734Practical Considerations for the rapid titration of VNSRiëm El Tahry0Maxine Dibué1Arnaud Szmalec2Roshani Patel3Ryan Verner4Massimiliano Boffini5Firas Fahoum6Michal Tzadok7Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium; Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Corresponding author at: Centre for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.Medical Affairs Neuromodulation, LivaNova PLC, London, United KingdomCenter for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Psychological Sciences Research Institute, Université Catholique de Louvain (UCLouvain), Louvain-la-Neuve, Belgium; Department of Experimental Psychology, Universiteit Gent (UGent), Gent, BelgiumMedical Affairs Neuromodulation, LivaNova PLC, London, United KingdomMedical Affairs Neuromodulation, LivaNova PLC, London, United KingdomMedical Affairs Neuromodulation, LivaNova PLC, London, United KingdomNeurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, IsraelFaculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, IsraelFor patients with drug-resistant epilepsy who are not candidates for epilepsy surgery, Vagus nerve stimulation (VNS) is the most widely available neuromodulation option and has been available in several countries for 30 years. Given its broad availability and extended history on the market, many healthcare providers (HCPs) have developed individualized practice habits regarding the titration and dosing of VNS. This study provides novel evidence to describe the extent to which VNS management differs among providers and discusses recent literature that indicates how unique programming approaches may impact patient outcomes. In this work, practice habits regarding the titration and dosing of VNS were explored through a survey of HCPs and an examination of ongoing study data collected as part of the CORE-VNS Study. The global survey revealed significant variability in dosing and titration habits. Providers reported a wide range of initial/maximum target doses and time-to-dose, even if the population averages approximated guidance from professional societies and the manufacturer’s labeling. Variable dosing and titration were reflected in varied perception of how long it takes to realize the clinical benefits of VNS. In the CORE-VNS Study, this reported experience was represented in how different generator models were used, with users of SenTiva (and the Scheduled Programming feature) depicting faster time-to-dose than those using earlier models of VNS. Our results suggest VNS providers would benefit from continued training on the use of VNS and the use of the scheduled programming feature to enhance consistency of VNS management among providers.http://www.sciencedirect.com/science/article/pii/S2589986424000911Vagus Nerve StimulationVNSPractice SurveyDosingTitration |
| spellingShingle | Riëm El Tahry Maxine Dibué Arnaud Szmalec Roshani Patel Ryan Verner Massimiliano Boffini Firas Fahoum Michal Tzadok Practical Considerations for the rapid titration of VNS Epilepsy & Behavior Reports Vagus Nerve Stimulation VNS Practice Survey Dosing Titration |
| title | Practical Considerations for the rapid titration of VNS |
| title_full | Practical Considerations for the rapid titration of VNS |
| title_fullStr | Practical Considerations for the rapid titration of VNS |
| title_full_unstemmed | Practical Considerations for the rapid titration of VNS |
| title_short | Practical Considerations for the rapid titration of VNS |
| title_sort | practical considerations for the rapid titration of vns |
| topic | Vagus Nerve Stimulation VNS Practice Survey Dosing Titration |
| url | http://www.sciencedirect.com/science/article/pii/S2589986424000911 |
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