People with epilepsy often have other comorbidities (such as depression, stroke, obesity, migraine, autism spectrum disorder, anxiety, bipolar disorder, attention deficit hyperactivity disorder, etc.). Approximately 50% of adults with active epilepsy have at least one Comorbidities of epilepsy. Epilepsy comorbidities are often associated with worse quality of life and prognosis. Vagus nerve stimulation (VNS) is a neuromodulation technique that relies on electrical stimulation and was approved by the Food and Drug Administration (FDA) in 1997 for the treatment of epilepsy. In the process of exploring the efficacy and mechanism of VNS in the treatment of epilepsy, an additional benefit was unexpectedly found, that is, VNS can meliorate symptoms of a variety of comorbidities. Since the FDA approved VNS for the treatment of depression in 2005, VNS has shown increasingly bright prospects in the treatment of comorbidities. In addition to the approved indications, including depression, stroke, obesity and migraine, VNS in other neuropsychiatric comorbidities have shown great potential. From invasive implantable VNS (iVNS) to non-invasive transcutaneous VNS (tVNS), studies on the benefits of VNS in the treatment of epilepsy and its Comorbidities are also evolving. This article reviews the progress of clinical treatment and mechanism of VNS in the treatment of epilepsy comorbidities in recent years, with the aim to provide the best treatment strategy for epilepsy patients and research basis for scientific researchers. At the same time, the parameter Settings of previous and latest clinical trials of VNS for the treatment of epilepsy comorbidity were summarized and analyzed to provide more references for the clinical application of VNS.
Objective To assess efficacy of mepivacaine on local anesthesia in dentistry and oral surgery and its safety. Methods Parallel group, stratified randomization, double blinded, muti-center clinical trial was designed. Two percent lidocaine with adrenaline in same cartridge was as control. Healthy patients with deep decay, pulpitis needed operative dentistry, or indication for extraction of the teeth, which located in the maxilla or front part of the mandible were included. Results Except 17 cases, 127 patients fulfilled inclusion criteria: 66 in treatment group and 61 in control group, dental filling for 60 and extraction for 67 cases, male 55 and female 72, average at 38.84 + 12.06 years. Submucous infiltration of 1.5 ml mepivacaine at labial or buccal side of the alveolar process produced onset of anesthesia in the median of 60 seconds which was same as that of lidocaine, anesthesia duration for 146.7 minutes with the median of 125 minutes, permitting painless filling or extractions. In the treatment group 81.82% freed of pain, while 15.15% had slight pain but received no extra local anesthetic for implementation of the treatment procedures, making the successful rate of 96.97%. In the mepivacaine group, 13.64% of the cases had transient elevation of the systolic pressure to the level of 145-162 mmHg, 8.33% diastolic pressure to the level of 91-93 mmHg. Only one case had transient palpitation in half minute after one minute injection of the drug with no medical care needed. All the cardiovascular reactions might result from adrenaline containing in the injections. Conclusion Mepivacaine is an effective, safe and reliable anesthetic agent for dentistry and oral surgery.