LivaNova - Patients

Seizures that continue even after trying multiple prescribed medications are considered hard-to-treat or drug-resistant epilepsy. Studies have proven that adding more medications is not likely to control this kind of epilepsy. After trying two prescribed medications, there’s only a 5% chance adding more will make you seizure free.

Risks of drug-resistant epilepsy

Despite what we know about the risks of living with undertreated epilepsy, most people affected by this condition will continue to be prescribed additional medications instead of being evaluated for non-drug therapy options. Risks include:

• Seizure-related injury
• Increased risk of Sudden Unexpected Death in Epilepsy (SUDEP)
• Increased hospital and ER visits
• Depression, anxiety and developmental issues
• Changes with thinking and memory
• Issues with social interactions

Contact your physician to learn which treatment options are best for you.

More than 300 million people across all ages are living with depression worldwide.¹ Up to 35% of those living with major depressive disorder (MDD) experience resistance to treatment.² 

Not all depression is the same. When patients suffering from depression do not experience sustained improvement from two or more therapies they are considered to have Treatment Resistant Depression (TRD), also sometimes referred to as difficult to treat depression.  Every person living with depression is different, so each person requires a unique approach to overcoming this disease allowing them to live their best life.³

Although antidepressant medications help many people, some continue to experience depression in spite of treatment.

As many as one third of people diagnosed with depression experience long periods of depression without improvement.³ Many times an acute episode of depression will respond to treatment in the short-term, but for some patients depression comes back and persists despite treatment. Medications may relieve depression only partially, may not help, or may stop working after a while. If you have depression despite trying multiple therapies, you are not alone and there are options.
 
Physicians have discovered that there are many different causes of depression, instead of one single cause. Although some types of depression are more difficult to treat than others, physicians will continue to try different treatments until he or she finds the right one. When depression persists, physicians often try treatments that target different chemicals within the brain, either by changing the levels of naturally occurring brain chemicals, called neurotransmitters, or by improving the ability of nerves to process signals. Physicians are learning that many different neurotransmitters affect moods. Most antidepressant treatments may target or impact one or two potential causative factors of depression, but do not affect all the areas of the brain thought to affect mood. This may be one reason why depressive symptoms persist.⁴ Certain biologic factors can also contribute to treatment resistance, including genetics, changes within the brain over time or the body may change the way it handles a drug after a period of time.

People with depression may require a different type of ongoing treatment. Depression that persists despite several treatments may respond to other treatments. Depression can be a long-lasting condition that interferes with daily activities and compromises quality of life.^{3, 4} Therefore, a long-term solution is desired and there are options available with proven long term outcomes.⁴

Treatment Options

Lifestyle Modifications
Medications
Talk Therapy
Stimulation Therapy, including:
•    Vagus Nerve Stimulation (VNS) Therapy
•    Electroconvulsive Therapy
•    Transcranial Magnetic Stimulation (TMS)

To understand the benefits and side effects of each treatment option, speak with your physician.

 

Heart failure is a condition in which the heart cannot pump enough blood to meet your body’s needs. If you or a loved one have heart failure, you are not alone. Over 25 million people worldwide have this condition with several million new diagnoses per year. During heart failure, the heart attempts to compensate for lost pumping power, and the heart may change its shape and result in an uncoordinated and inefficient heartbeat.

Symptoms of Heart Failure
At first you might not experience any symptoms. However, over time you may experience some, or all, of the following symptoms:

• Chronic lack of energy
• Interrupted sleep at night due to breathing difficulties
• Confusion and/or impaired memory
• Increased urination at night
• Swelling of feet and legs
• Shortness of breath
• Abdominal swelling or tenderness with loss of appetite
• Cough with saliva/mucus

Treatment options
Treatment can help to relieve the symptoms of heart failure and may help you live longer. There are several ways that heart failure can be treated.

Lifestyle modifications
Certain lifestyle changes such as increasing physical activity, decreasing emotional stress, weight loss, stopping smoking and eating less salt/fat may reduce heart failure symptoms.
 
Medications
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications including beta-blockers, ACE inhibitors, angiotensin receptor blockers (ARBs), blood thinners and diuretics.
 
Medical devices or surgery
In some cases, doctors recommend interventions such as bypass or valve replacement surgery, implantation of a cardioverter-defibrillator or cardiac resynchronization device, or a heart transplantation.
 
Autonomic Regulation Therapy
A new form of therapy is being evaluated for patients with heart failure. It is called Autonomic Regulation Therapy (ART) delivered through Vagus Nerve Stimulation (VNS). ART applies mild electrical impulses to the vagus nerve to activate the body’s parasympathetic branch and restore balance. ART is investigational and being studied in a clinical trial called ANTHEM-HFrEF.
 
Speak with your physician about which treatment options are right for you.

Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea and is caused by a complete or partial obstruction of the upper airway. It is characterized by repetitive pauses or cessations in breathing during sleep, despite the effort to breathe, and is often associated with a reduction in blood oxygen saturation.
 
An individual with OSA is rarely aware of breathing difficulty, even upon awakening. It is commonly recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. OSA is commonly accompanied with snoring.


Symptoms of Obstructive Sleep Apnea
A person with Obstructive Sleep Apnea may suffer from the effects of a poor night’s sleep often waking up tired and may continue feeling drowsy or sleepy throughout the day. This may result in:
excessive daytime sleepiness; impaired memory, concentration and cognitive functions; morning headaches; hypertension; changes in mood; and sexual dysfunction.

Symptoms may be present for years or even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Sufferers who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of their symptoms.
 

Treatment Options:

CPAP
The current standard of care for OSA is continuous positive airway pressure (CPAP). 90% of patients diagnosed with OSA are prescribed CPAP therapy; however compliance to CPAP is poor with about 50% patient non-compliance.⁵
 
Implantable neurostimulation therapy
Neurostimulation is a proven, reliable and effective means of therapy in many medical conditions and can significantly reduce or eliminate obstructive sleep apnea.

Neurostimulation can consist of a minimally invasive, surgically implanted system for patients that suffer from moderate to severe obstructive sleep apnea. The procedure is performed by an ENT surgeon, usually as an outpatient procedure with quick recovery time.

By providing gentle stimulation to the hypoglossal nerve in the neck, neurostimulation restores the tone of key tongue muscles, increasing the opening in the upper airway and allowing patients to once again breathe normally during sleep.

Contact your physician to learn which treatment options are best suited for you.

1. World Health Organization (2018): http://www.who.int/news-room/fact-sheets/detail/depression, Accessed: 2018 August 26.
2. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, et al. (2006) Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 163: 1905-17.
3. Fava M, Rush AJ, Trivedi MH, et al. Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatr Clin North Am. 2003;26:457-494.
4. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. April 2000;157(suppl):1-45
5. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Canadian Respiratory Journal : Journal of the Canadian Thoracic Society. 2008;15(7):365-369.