{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:55:55Z","timestamp":1793051755278,"version":"4.5.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of this study was to assess the safety and efficacy of combined active responsive neurostimulation (RNS) and vagus nerve stimulation (VNS) therapies in pediatric patients with drug-resistant epilepsy.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A single-center retrospective chart review was conducted on pediatric patients implanted with the RNS System with a concomitant active VNS System (VNS+RNS) between 2015 and 2021. Patients with at least 1 month of overlapping concomitant VNS and RNS treatment were included. Patients who had an RNS device implanted after 21 years of age, those who had responsive neurostimulators implanted after their VNS was inactivated, or those in whom the VNS battery died and was not replaced before RNS System implantation were excluded.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seven pediatric VNS+RNS patients were identified, and their courses of treatment were evaluated. All patients tolerated concurrent VNS and RNS treatment well, no device-device interactions were identified, and no major treatment-related adverse effects were noted. The median follow-up after RNS System implantation was 1.2 years. By electroclinical criteria, all 7 patients achieved 75%\u201399% reductions in the frequency of disabling seizures after RNS System implantation. By patient and caregiver report, 2 patients (28.6%) had 75%\u201399% reductions in the frequency of their disabling seizures, 2 patients (28.6%) achieved 50%\u201374% reductions, 2 patients achieved 1%\u201324% reduction in frequency of disabling seizures, and 1 patient (14.3%) experienced a 1%\u201324% increase in seizure frequency. The available VNS magnet swipe data identified 2 patients with 75%\u201399% reductions in seizure frequency as measured by magnet swipes, one with 25%\u201349% reductions and the other with 1%\u201324% increases in seizure frequency as measured by magnet swipes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study demonstrated that RNS and VNS therapies can safely be used simultaneously in pediatric patients. RNS may potentially augment the therapeutic effects of VNS treatment. Patients in whom a response to VNS has been suboptimal should still be considered for RNS therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.1.peds22486","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T18:19:29Z","timestamp":1679077169000},"page":"565-573","source":"Crossref","is-referenced-by-count":17,"title":["Safety of vagus nerve stimulation and responsive neurostimulation used in combination for multifocal and generalized onset epilepsy in pediatric patients"],"prefix":"10.3171","volume":"31","author":[{"given":"Cameron P.","family":"Beaudreault","sequence":"first","affiliation":[{"name":"New York Medical College, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eris","family":"Spirollari","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria F.","family":"Naftchi","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishad","family":"Sukul","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"},{"name":"Department of Neurosurgery, Westchester Medical Center, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankita","family":"Das","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sima","family":"Vazquez","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Wolf","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"},{"name":"Department of Pediatrics, Division of Pediatric Neurology, Maria Fareri Children\u2019s Hospital, Valhalla; and"},{"name":"Boston Children\u2019s Hospital Physicians, Hawthorne, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia E.","family":"McGoldrick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology, Maria Fareri Children\u2019s Hospital, Valhalla; and"},{"name":"Boston Children\u2019s Hospital Physicians, Hawthorne, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie R.","family":"Muh","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla;"},{"name":"Department of Neurosurgery, Westchester Medical Center, Valhalla;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Epilepsia","first-page":"1069","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies","volume":"51","author":"Kwan P","year":"2010","unstructured":"Kwan P, Arzimanoglou A, Berg AT,  Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069\u20131077."},{"key":"b2","series-title":"World Neurosurg","first-page":"e596","article-title":"Dual-device neuromodulation in epilepsy","volume":"161","author":"Freund B","year":"2022","unstructured":"Freund B, Grewal SS, Middlebrooks EH, Moniz-Garcia D, Feyissa AM, Tatum WO. Dual-device neuromodulation in epilepsy. World Neurosurg. 2022;161:e596\u2013e601.35189423"},{"key":"b3","series-title":"Epilepsy Behav","first-page":"388","article-title":"Responsive neurostimulation: candidates and considerations","volume":"88","author":"Ma BB","year":"2018","unstructured":"Ma BB, Rao VR. Responsive neurostimulation: candidates and considerations. Epilepsy Behav. 2018;88:388\u2013395.30355456"},{"issue":"2","key":"b4","series-title":"Neurosurg Clin N Am","first-page":"231","article-title":"Responsive neurostimulation for the treatment of epilepsy","volume":"30","author":"Matias CM","year":"2019","unstructured":"Matias CM, Sharan A, Wu C. Responsive neurostimulation for the treatment of epilepsy. Neurosurg Clin N Am. 2019;30(2):231\u2013242.30898274"},{"key":"b5","series-title":"Epilepsy Res","first-page":"68","article-title":"Brain-responsive neurostimulation for epilepsy (RNS\u00ae System)","volume":"153","author":"Skarpaas TL","year":"2019","unstructured":"Skarpaas TL, Jarosiewicz B, Morrell MJ. Brain-responsive neurostimulation for epilepsy (RNS\u00ae System). Epilepsy Res. 2019;153:68\u201370.30850259"},{"issue":"4","key":"b6","series-title":"Aging Dis","first-page":"1070","article-title":"Neuromodulation in drug resistant epilepsy","volume":"12","author":"Rincon N","year":"2021","unstructured":"Rincon N, Barr D, Velez-Ruiz N. Neuromodulation in drug resistant epilepsy. Aging Dis. 2021;12(4):1070\u20131080.34221550"},{"key":"b7","series-title":"Epilepsy Behav","first-page":"108653","article-title":"Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy","volume":"129","author":"Brown MG","year":"2022","unstructured":"Brown MG, Sillau S, McDermott D,  Concurrent brain-responsive and vagus nerve stimulation for treatment of drug-resistant focal epilepsy. Epilepsy Behav. 2022;129:108653.35305525"},{"issue":"3","key":"b8","series-title":"Epilepsia","first-page":"432","article-title":"Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial","volume":"55","author":"Heck CN","year":"2014","unstructured":"Heck CN, King-Stephens D, Massey AD,  Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014;55(3):432\u2013441.24621228"},{"key":"b9","series-title":"Front Neurol","first-page":"610379","article-title":"Responsive vagus nerve stimulation for drug resistant epilepsy: a review of new features and practical guidance for advanced practice providers","volume":"11","author":"Fisher B","year":"2021","unstructured":"Fisher B, DesMarteau JA, Koontz EH, Wilks SJ, Melamed SE. Responsive vagus nerve stimulation for drug resistant epilepsy: a review of new features and practical guidance for advanced practice providers. Front Neurol. 2021;11:610379.33584511"},{"issue":"2","key":"b10","series-title":"J Clin Neurophysiol","first-page":"e5","article-title":"Combined VNS-RNS Neuromodulation for Epilepsy","volume":"39","author":"Khankhanian P","year":"2022","unstructured":"Khankhanian P, Lee AM, Drees CN, Decker BM, Becker DA. Combined VNS-RNS Neuromodulation for Epilepsy. J Clin Neurophysiol. 2022;39(2):e5\u2013e9.35130199"},{"issue":"3","key":"b11","series-title":"Epilepsia Open","first-page":"493","article-title":"Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study","volume":"4","author":"Jamy R","year":"2019","unstructured":"Jamy R, Kaur M, Pizarro D, Toth E, Pati S. Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study. Epilepsia Open. 2019;4(3):493\u2013497.31440731"},{"issue":"3","key":"b12","series-title":"Epilepsia Open","first-page":"345","article-title":"Application of RNS in refractory epilepsy: Targeting insula","volume":"2","author":"Chen H","year":"2017","unstructured":"Chen H, Dugan P, Chong DJ, Liu A, Doyle W, Friedman D. Application of RNS in refractory epilepsy: Targeting insula. Epilepsia Open. 2017;2(3):345\u2013349.29588964"},{"key":"b13","series-title":"Front Neurol","first-page":"656585","article-title":"Case report: responsive neurostimulation of the centromedian thalamic nucleus for the detection and treatment of seizures in pediatric primary generalized epilepsy","volume":"12","author":"Welch WP","year":"2021","unstructured":"Welch WP, Hect JL, Abel TJ. Case report: responsive neurostimulation of the centromedian thalamic nucleus for the detection and treatment of seizures in pediatric primary generalized epilepsy. 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Nat Rev Neurol. 2021;17(5):267\u2013284.33723459"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/31\/6\/article-p565.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/31\/6\/article-p565.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/31\/6\/article-p565.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:04:37Z","timestamp":1733490277000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/31\/6\/article-p565.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,1]]},"references-count":15,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2023.1.peds22486","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,1]]}}}