Latest VNS Therapy for Epilepsy [transcript] [audio]

Guest: Dr. Marie Collier

Presenter: Neal Howard

Guest Bio: Marie Collier, M.D., is a board-certified epileptologist and neurologist. As medical director of the epilepsy program at St. Mary’s Medical Center in Colorado, Dr. Collier often takes an integrative approach to managing epilepsy. As part of patients’ treatment plans, Dr. Collier commonly incorporates one or more non-medication options, such as dietary changes, stress reduction, sleep management and – when appropriate – VNS Therapy. Dr. Collier was one of the first physicians to prescribe the latest VNS Therapy System, which includes the new SenTiva™ device and next-generation programming system.

Segment Overview: Dr. Marie Collier discusses the latest VNS (Vagus Nerve Stimulation) Therapy System, which includes the new SenTivadevice and next-generation programming system. She also talks about her integrative approach to treating epilepsy.

Transcript

Neal Howard: Welcome to the program, I’m your host Neal Howard here on Health Professional Radio. Glad that you could join us today. Our guest is Dr. Marie Collier. She’s a board-certified epileptologist and neurologist and she’s also the Medical Director of the Epilepsy Program at St. Mary’s Medical Center in Colorado. She’s joining us today on the program to talk about VNS Therapy. Welcome to the program, Dr. Collier.

Dr. Marie Collier: Thank you Neal. Thank you for having me.

N: Glad that you could join us. Give us a bit of background about yourself.

C: Sure. Well I am as you said a board-certified epileptologist. I know that does roll off the tongue. It’s easier to say, seizure specialist. Basically, what that means is I did an internship and then after that a neurology residency and then followed by an epilepsy fellowship where we learn how to diagnose, treat epilepsy as there are many treatment options for epilepsy. So basically, I did my training at the University of Utah in Salt Lake City and I’ve been in Grand Junction for little over a year now. We have built NAEC, National Association of Epilepsy Centers, Level 3, certified epilepsy center here in on the Western slope, only one of its kind, where we offer comprehensive epilepsy care to patients with epilepsy.

N: Most of our listeners are healthcare providers and in some capacity or other, everybody is in the healthcare field. But for those who may not be as familiar with epilepsy as you are, what are some of the most important things that you’d like us to know.

C: Epilepsy is the fourth most common neurologic disorder. It’s actually more common in Parkinson’s disease or on multiple sclerosis. Most patients can treat their epilepsy with medications. However, approximately one-third of patients with epilepsy are not going to be seizure-free on that occasion alone. And so I do have to explore other options including epilepsy surgery for those that are surgery candidates but for those that are not surgery candidates, looking into neurostimulation devices such as the Vagus Nerve Stimulator is certainly, something that I am an expert in and take into consideration and again, that’s a little bit about myself. I’m also an integrative medicine doctor. I’m trained in integrative medicine. I’m in the integrative medicine fellowship and once I’m finished with my fellowship, I will actually be able to sit pretty in the integrative medicine board. So I’ll be board-certified in neurology, epilepsy and integrative medicine. The importance of integrative medicine in epilepsy is that by taking an integrative approach, you give your patients the chance to improve their chances of seizure-freedom. So I kind of wanted to think, I said to my patients that, if you have a brain, you can have the seizure. So all of us are walking around with a seizure threshold. So patients or people who find their seizure threshold, those are people with epilepsy. So we all have one and actually, after the age of 60, there is a 3% per decade chance of developing epilepsy. So I looked at integrative medicine as primary prevention for epilepsy much like one would look at primary prevention for heart disease or primary prevention for stroke. I look at that in epilepsy as well. I like to think of myself as an integrative epileptologist and almost like a preventative epileptologist if you will.

N: First of all, what is the “Vagus Nerve” that you just spoke of a moment ago and is VNS Therapy part of the traditional modality or the integrative modality or is it a combination of the two?

C: That’s a great question. So the Vagus Nerve is Cranial Nerve 10. Vagus is Latin for “vagabond”. It’s the wandering nerve. It wanders throughout the body and it does a number of things. So we don’t really fully understand the true mechanism of the action of why the Vagus Nerve Stimulator works. It has been FDA-approved for both depression and epilepsy, particularly for my patients who have comorbid depression which is common in patients with epilepsy. The Vagus Nerve Stimulator is great because it can address both comorbidities, both depression and epilepsy and to help improve quality of life. The Vagus Nerve Stimulator is actually considered more conventional therapy. I’s been around since 1997 in the United States when it was FDA approved. Approximately, 100,000 patients have been implanted since that time. So it’s consider to be more of the conventional root in terms of adjunctive therapy if you will. But I like to think of it as kind of another tool in my tool kit to help patients achieve seizure-freedom.

N: Now, this has been around for a while. Is it in the same form as it was when it was introduced or have there been improvement made upon these therapies? Talk about some of the latest in VNS.

C: Yes. When I was a resident, I got to see the, usually about the 102, 103, 104 and 105, those are the generations of the Vagus Nerve Stimulator that have been around that I’ve had experienced with and I’ve had patients implanted. And then in 2015, along came of game-changer with was the Aspire 106. That was the first closed loop system where it could actually sense changes and heart rate. Actually while I was in my fellowship, I was able to participate in the studies of that particular model where we would actually turn off everything what we call “Autostimulation”. Autostimulation is where it could spin the changes in heart rate when someone was having a seizure in series because in series, algorithm goes that when you’re having a seizure, your heart rate spikes as opposed to when you’re exercising or running up stairs which is what I had just done before I started talking to you. If you’re exercising, your heart rate is going to go up gradually. It’s not going to be a spike. And so in series, the sooner it can detect the seizure and actually send a pulses therapy to the vagus nerve, the better chance you have of actually intercepting that seizure and stop in the seizure. And in clinical trial that was actually shown to do just that which is incredibly exciting particularly for patients who have nocturnal seizures or who can’t since they’re having a seizure to do an auto swipe. So the Vagus Nerve Stimulator prior to the Aspire 106, it has a magnet and the magnet therapy can be swiped and it will actually give an extra pulses therapy. So the vagus nerve is adjusted inside and there’s a number of settings on it. And one of the adjustments is to go on for certain period of time and offer certain period of time and that’s called the Duty Cycle. So it’s going on and it’s going off. And those of us who practice before the 106, we did what we call Rapid Cycling, where we had the Duty Cycle going off fairly frequently in series to try and capture a seizure. After the 106, we didn’t have to rapid cycle as much because the 106 would actually spin when the patient was having a seizure and send an extra pulses therapy like an internal magnet and it gives patients a sense of freedom. It gives patients a sense of confidence. I’ve seen it. I mean to be quite honest, for me as an epileptologist, it’s been a game-changer. And now, the people at LivaNova and I’ve met the people in research and development and I admire them because there’s very few people dedicating research to epilepsy relatively speaking. There are people out there and I genuinely appreciate them but when you look at Alzheimer’s or Parkinson’s, comparatively epilepsy is not as well-studied or as well-funded. So it’s exciting that our company is taking the initiative to continue to research and make breakthroughs in a disease like epilepsy especially since it’s so common. So the new device is called the SenTiva. And again, it’s another game-changer. It has auto up-titration, so patients don’t have to come to the clinic as frequently and myself living in a rural area, that is a huge benefit especially when patients are having to drive overpasses and the snow to come and see me because their Vagus Nerve Stimulator adjusted. It has auto up-titration, so I can set it, so that it does at their home and they don’t have to come in as frequently. The other thing that’s wonderful is it has daytime settings and nighttime settings. So for those active patients who are having seizures during the day and who only have nocturnal seizures for instance, to me, I just felt like it was Christmas I mean I’m not kidding. It was just like this was amazing and it’s so cool that we even have that technology.

N: How does SenTiva or VNS Therapy in general work for children? You’ve mentioned being an adult, 60 years old and having an increased susceptibility to seizures. What about children?

C: That’s an awesome question. And fortunately, the FDA has now recently approved the Vagus Nerve Stimulator for children as young as 4 years old. I would like to put it in the disclaimer here that I am, an adult epileptologist but I do see children on a case by case basis. And I actually have worked with some of my colleagues to Primary Children’s Hospital in Salt Lake City. They will get the device implanted there and then they come here and I’ll do the programming for them. So I do have a lot of experience with working with the pediatric population but I do like to kind of at least let people know that I am an adult epileptologist that does see children on a case to case basis. But the fact that it has been approved for children as young as 4 is phenomenal and I can at least state in my experience when I’ve implanted the Vagus Nerve Stimulator in children or had it implanted rather because it is implanted by either an ENT surgeon or a neurosurgeon. So it’s implanted by a surgeon and I’m a neurologist. When I’ve had the VNS implanted in children, I have had parents come back to me and say things like, “My child is starting to learn again.”. So you’re looking at some tremendous benefits especially when these informative years, these important years prior to the approval in children and some people be used as off-label. But now that we’ve gotten the “green light” to be able to use it in children as young as 4, I think it is again going to be another game-changer.

N: Now where can we go and learn more about VNS therapy?

C: So if you go to the LivaNova website, is one good website and there’s also a website called, it’s a physician website, vnstherapy.com/healthcare-professionals. That would be the place to look and there’s also case manager hotline, 1-888-867-7846. And then one of the things that I let my patients know is on the LivaNova website, there are amazing resources. They have real patients with real stories and actually on the first Tuesday of every month, patients are able to call in and actually speak with Vagus Nerve Stimulator ambassadors as well as physicians to get more information.

N: Great. It’s been a pleasure. Thank you so much for coming in today Dr. Collier.

C: Thank you so much for having me Neal. It’s been fun.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard in studio with Dr. Marie Collier. Transcripts and audio of the program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to the podcast on iTunes, listen in and download at SoundCloud and visit our affiliates page at hpr.fm.

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