{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:03:04Z","timestamp":1770271384619,"version":"3.49.0"},"reference-count":283,"publisher":"Georg Thieme Verlag KG","issue":"S 01","license":[{"start":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T00:00:00Z","timestamp":1653264000000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Laryngorhinootologie"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Zahlreiche Studien belegen, dass die Vagusnervstimulation (VNS) eine effiziente indirekte neuromodulatorische Therapie mit intermittierend appliziertem elektrischen Strom darstellt fu\u0308r die medikamento\u0308s therapierefrakta\u0308re Epilepsie, die nicht epilepsiechirurgisch interveniert werden kann, und die medikamento\u0308s therapierefrakta\u0308re Depression. Bei der VNS handelt es sich um eine etablierte, Evidenz basierte und in der Langzeitbetrachtung kosteneffektive Therapie in einem interdisziplin\u00e4ren Gesamtkonzept.<\/jats:p><jats:p>Es existieren Langzeitdaten zu Sicherheit und Vertr\u00e4glichkeit der Methode trotz gro\u00dfer Heterogenit\u00e4t der Patientenkollektive. Stimulationsbedingte Nebenwirkungen wie Heiserkeit, Par\u00e4sthesien, Husten, Dyspnoe sind abh\u00e4ngig von der Stimulationsst\u00e4rke und h\u00e4ufig mit fortschreitender Therapiedauer in den Folgejahren r\u00fcckl\u00e4ufig. Stimulationsbezogene Nebenwirkungen der VNS sind durch Ver\u00e4nderung der Stimulationsparameter gut beeinflussbar. Insgesamt ist die invasive Vagusnervstimulation als sichere und gut vertr\u00e4gliche Therapieoption anzusehen.<\/jats:p><jats:p>F\u00fcr die invasive und transkutane Vagusnervstimulation sind die antiepileptischen und antidepressiven sowie positive kognitive Effekte belegt. Im Gegensatz zu den Medikamenten wirkt sich die VNS nicht negativ auf die Kognition aus. Eine verbesserte Lebensqualita\u0308t ist in vielen Fa\u0308llen m\u00f6glich.<\/jats:p><jats:p>Die iVNS-Therapie hat eine geringe Wahrscheinlichkeit der kompletten Anfallsfreiheit bei fokaler und genetisch generalisierter Epilepsie. Sie ist als palliative Therapie anzusehen, dass heisst, sie f\u00fchrt nicht zur Heilung und erfordert die Fortf\u00fchrung der spezifischen Medikation. Als Wirkprinzip wird eine allgemeine Reduktion neuronaler Exzitabilit\u00e4t betrachtet. Dieser Effekt stellt sich in einer langsamen Wirksamkeitssteigerung zum Teil \u00fcber Jahre ein. Als Responder z\u00e4hlen Patienten mit einer mindestens 50%igen Reduktion der Anfallsh\u00e4ufigkeit. In Studien zeigt sich zum Teil in 20% der F\u00e4lle eine Anfallsfreiheit. Derzeit ist es nicht mo\u0308glich, pr\u00e4therapeutisch\/pr\u00e4operativ zwischen potentiellen Respondern und Non- Respondern zu differenzieren.<\/jats:p><jats:p>Durch die aktuellen technischen Weiterentwicklungen der VNS zur responsiven VNS Therapy mit Herzraten-basierter-Anfalls-Erkennung (CBSD) reduziert sich neben der Epilepsie-Anfallsschwere auch das SUDEP-Risiko (sudden unexpected death in epilepsy patients).<\/jats:p><jats:p>Die iVNS kann ein Schlaf-Apnoe-Syndrom verschlechtern und kann neben der engen Zusammenarbeit mit den Schlafmedizinern gegebenfalls eine n\u00e4chtliche Therapiepause (z.\u2009B. Tag\/Nacht-Programmierung) erfordern.<\/jats:p><jats:p>In Auswertung der zahlreichen iVNS-Studien der letzten 2 Jahrzehnte zeigten sich vielf\u00e4ltige positive Effekte auf weitere immunologische, kardiologische und gastroenterologische Erkrankungen, so dass sich je nach zuk\u00fcnftigen Studienergebnissen zus\u00e4tzliche Therapieindikationen erwarten lassen. Aktuell ist die Vagusnervstimulation Gegenstand der Forschung in den Bereichen der Psychologie, Immunologie, Kardiologie, sowie Schmerz- oder Plastizita\u0308tsforschung mit erhofftem Potenzial zur zuk\u00fcnftigen medizinischen Anwendung.<\/jats:p><jats:p>Neben der invasiven Vagusnervstimulation wurden in den letzten Jahren Ger\u00e4te zur transdermalen und somit nicht invasiven Vagusnervstimulation entwickelt. Diese haben nach den derzeit zur Verf\u00fcgung stehenden Daten eine etwas geringere Wirksamkeit hinsichtlich der Verminderung von Anfallsschwere und Anfallsdauer bei der therapierefrakt\u00e4ren Epilepsie und eine etwas geringe Wirksamkeit bei der Verbesserung von Symptomen der Depression. Hierzu fehlen in vielen F\u00e4llen noch Studien, die eine hohe Evidenz der Wirksamkeit nachweisen. Gleiches gilt f\u00fcr die beschriebenen sonstigen Indikationen wie z.\u2009B. Tinnitus, Cephalgien, Magen-Darm-Beschwerden etc. Ein weiterer Nachteil der transkutanen Vagusnervstimulation liegt darin, dass die Stimulatoren vom Patienten aktiv angesetzt werden m\u00fcssen und somit nur intermittierend wirksam sind, was eine hohe Therapieadh\u00e4renz unsicher macht.<\/jats:p>","DOI":"10.1055\/a-1660-5591","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T18:43:39Z","timestamp":1653331419000},"page":"S114-S143","source":"Crossref","is-referenced-by-count":7,"special_numbering":"S","title":["Die Vagusnervstimulation bei konservativ therapierefrakt\u00e4rer Epilepsie und Depression"],"prefix":"10.1055","volume":"101","author":[{"given":"H","family":"M\u00f6bius","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr HNO-Heilkunde, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover"},{"name":"Abt. f\u00fcr HNO-Heilkunde, Kinderkrankenhaus auf der Bult, Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H J","family":"Welkoborsky","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr HNO-Heilkunde, Kopf- und Halschirurgie, KRH Klinikum Nordstadt, Hannover"},{"name":"Abt. f\u00fcr HNO-Heilkunde, Kinderkrankenhaus auf der Bult, Hannover"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,5,23]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S1474-4422(05)70020-X","article-title":"Epilepsy and social identity. 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