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Vagus Nerve Stimulation Therapy in a Patient with Treatment-Resistant Depression: A Case Report of Long-Term Follow-up and Battery End-of-Service

Published online by Cambridge University Press:  07 November 2014

Abstract

This is the first case report of a patient who received long-term (69-month) adjunctive vagus nerve stimulation (VNS) therapy for treatment-resistant depression (TRD) and reached VNS battery end-of-service (EOS).The patient is a 41-year-old female with depression who entered a study of adjunctive VNS therapy for TRD. Her Hamilton Rating Scale for Depression (HAM-D) scores dropped from a mean of 33.5 (pre-implantation baseline period) to 16 at the end of the 12-week acute-phase treatment period, and then fluctuated from <7 (normal range) to scores in the moderately depressed range (∼20) during long-term follow-up. Three and one-half years after VNS implantation, the patient's HAM-D scores began to increase from a score of 18 to a peak score of 27 ∼ 16 months later (5-years post-implantation). The patient subsequently reported that she could no longer feel stimulation from the device and device interrogation 2 weeks later indicated battery EOS. The patient was hospitalized due to worsened depression, the pulse generator was replaced, and medication adjusted. HAM-D scores through the subsequent 9 months of followup returned to a pattern of fluctuations within the range noted during the long-term follow-up period prior to VNS battery EOS.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2006

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References

REFERENCES

1.Ben-Menachem, E, Manon-Espaillat, R, et al.Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35:616626.Google Scholar
2.Handforth, A, DeGiorgio, CM, Schachter, SC, et al.Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48S5.Google Scholar
3.Morris, GL, Mueller, WM, Vagus Nerve Stimulation Study Group (E01-E05). Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. Neurology. 1999;53:17311735.CrossRefGoogle Scholar
4.Harden, CL, Pulver, MC, Ravdin, LD, Nokolov, B, Halper, JP, Labar, DR. A pilot study of mood in epilepsy patients treated with vagus nerve stimulation. Epilepsy Behav. 2000;1:9399.Google Scholar
5.George, MS, Sackeim, HA, Rush, AJ, et al.Vagus nerve stimulation: a new tool for brain research and therapy. Biol Psychiatry. 2000;47:287295.Google Scholar
6.Henry, TR, Bakay, RA, Votaw, JR, et al.Brain blood flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: acute effects at high and low levels of stimulation. Epilepsia. 1998;39:983990.Google Scholar
7.Ben-Menachem, E, Hamberger, A, Hedner, T, et al.Effects of vagus nerve stimulation on amino acids and other metabolites in the CSF of patients with partial seizures. Epilepsy Res. 1995;20:221227.CrossRefGoogle ScholarPubMed
8.Krahl, SE, Clark, KB, Smith, DC, Browning, RA. Locus coeruleus lesions suppress the seizure attenuating effects of vagus nerve stimulation. Epilepsia. 1998;39:709714.CrossRefGoogle ScholarPubMed
9.Walker, BR, Easton, A, Gale, K. Regulation of limbic motor seizures by GABA and glutamate transmission in nucleus tractus solitarius. Epilepsia. 1999;40:10511057.Google Scholar
10.Sackeim, HA, Rush, AJ, George, MS, et al.Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology. 2001;25:713728.Google Scholar
11.Marangell, LB, Rush, AJ, George, MS, et al.Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biol Psychiatry. 2002;51:280287.CrossRefGoogle ScholarPubMed
12.Rush, AJ, Marangell, LB, Sackeim, HA, et al.Vagus nerve stimulation (VNS) for treatment-resistant depression: a randomized, controlled acute phase trial. Biol Psychiatry. 2005;58:347354.Google Scholar
13.Rush, AJ, Sackeim, HA, Marangell, LB, et al.Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005;58:355363.Google Scholar
14.George, MS, Rush, AJ, Marangell, LB, et al.A one-year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression. Biol Psychiatry. 2005;58:364373.Google Scholar
15.Tatum, WO 4th, Ferreira, JA, Benbadis, SR, et al.Vagus nerve stimulation for pharmacoresistant epilepsy: clinical symptoms with end of service. Epilepsy Behav. 2004;5:128132.Google Scholar
16.Vonck, K, Dedeurwaerdere, S, De Groote, L, et al.Generator replacement in epilepsy patients treated with vagus nerve stimulation. Seizure. 2005;14:8999.Google Scholar