Effects of vagal nerve stimulation on mood and quality of life in patients with epilepsy
Start date: 1st February 2019
Award: 1 fully funded 3 year IoPPN PhD studentship
Project:
Anxiety and depressive disorders are common psychiatric conditions in patients with epilepsy (Kohler et al. 1999). Unfortunately, they are under-diagnosed and therefore often untreated. Depression is important clinically as there is evidence that it is the most important variable influencing quality of life of patients with epilepsy, even more so than seizure frequency (Elger & Schmidt 2008). Depressed mood in epilepsy is potentially cause by interactions of numerous clinical factors, such as seizure frequency, seizure severity, epilepsy duration, age at onset as well as psychosocial factors including quality of life, employment and marital status. It is also possible that biological mechanisms involved in seizure generation and/or seizure control contribute to depression (Schmitz et al. 1999).
Vagus nerve stimulation (VNS) is an accepted treatment option for patients with refractory epilepsy. Randomized controlled trials have demonstrated considerable reduction in seizure frequency; with ≥50% reduction in 22–39% of the patients. Complete remission of seizures is obtained in a small number of patients.
Previous studies have reported additional effects of VNS on mood and quality of life (QOL), although sample sizes were small. Mood improvements after treatment with VNS have been reported (Elger et al. 2000; Harden et al. 2000). However, no association between seizure reduction and mood improvement was found. It is possible that this is a result of specific and direct effects of VNS on mood, as has been demonstrated in clinical trial data for use of VNS in treatment of resistant depression, leading to FDA approval in 2005 (FDA, 2005). The effects of VNS on QOL are equivocal; some studies have reported increased health-related QOL (McLachlan et al. 2003) while others found no effect (McGlone et al. 2008).
The primary objective of this study is to assess the effects of VNS on mood, QOL and cognition in patients with refractory epilepsy for the first time using an adequately powered randomised controlled trial.
To provide context, the PhD project will start with a systematic review of effects of VNS on mood, QOL and cognition in patients with refractory epilepsy. They will also be instrumental in finalising the study design and obtaining regulatory approval.
The successful candidate for this project will be registered in and be part of the vibrant postgraduate research community in, the King’s College London Academic Neuropsychiatry Group and Centre for Affective Disorders in the Institute of Psychiatry, Psychology and Neuroscience.
References:
Elger, G. et al., 2000. Vagus nerve stimulation is associated with mood improvements in epilepsy patients. Epilepsy Research, 42(2-3), pp.203–210.
Elger, C.E. & Schmidt, D., 2008. Modern management of epilepsy: A practical approach. Epilepsy and Behavior, 12(4), pp.501–539.
FDA, 2005. VNS Therapy System for adjunctive long-term treatment of chronic or recurrent depression for patients 18 years of age or older. FDA Approvals.
Harden, C.L. et al., 2000. A Pilot Study of Mood in Epilepsy Patients Treated with Vagus Nerve Stimulation. Epilepsy and Behavior, 1(2), pp.93–99.
Kohler, C. et al., 1999. Depression in temporal lobe epilepsy before epilepsy surgery. Epilepsia, 40(3), pp.336–340.
McGlone, J. et al., 2008. Quality of life and memory after vagus nerve stimulator implantation for epilepsy. Canadian Journal of Neurological Sciences, 35(3), pp.287–296.
McLachlan, R.S. et al., 2003. Quality of life after vagus nerve stimulation for intractable epilepsy: Is seizure control the only contributing factor? European Neurology, 50(1), pp.16–19.
Deadline: 26th October 2018 (23.59 GMT)
Supervisors:
Professor Allan Young, Director, Centre for Affective Disorders allan.young@kcl.ac.uk. Institute of Psychiatry, Psychology and Neuroscience, PO72, De Crespigny Park, Denmark Hill, London SE5 8AF
Dr Paul Shotbolt paul.shotbolt@kcl.ac.uk 0207 188 0138. Academic Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, PO68, De Crespigny Park, Denmark Hill, London SE5 8AF
Entry requirements:
Applications are invited from candidates with an interest in multi-disciplinary research and have a 1st class or upper second degree in a relevant bioscience, biomedical science, physical science or health related discipline.
A master’s degree in a relevant area will be an advantage, as will experience of working with patients with epilepsy and/or neuropsychiatric conditions.
Candidates with lower second class degrees may be considered if they also have a relevant master’s degree classified at merit or above.
Award types and eligibility:
This studentship is funded by King’s College London and the Bergqvist Charitable Trust for 3 years. It includes a tax‑free stipend up to £20,000 per annum, full fees for Home/EU students, and an allowance for research consumables and conference travel.
International students are eligible to apply if they can pay the difference in fees. For information of fees please visit the prospectus page.
How to apply:
Applicants must complete and submit an online admissions application via the admissions portal by midnight (23:59 GMT) on 26th October 2018. On the choosing a programme page please select ‘Research degrees’ and enter the keyword Psychological Medicine Research MPhil/PhD (Full-time).
In your application you will be asked to include:
• Academic Transcripts – where applicable, academic transcripts must be submitted with the online admissions application
• Details of your qualifications (you will need to attach copies)
• Details of previous employment
• A personal statement describing your interests and why you wish to apply for this project. Please include this as an attachment rather than using the text box.
• Academic References – all admissions applications require two supporting references. If the applicant is relying on his/her referees to submit references directly to the College after he/she has submitted his/her admissions application, then the applicant must ensure that their chosen referees are made aware of the funding deadline.
In the Funding section, please tick box 5 and include the following reference: VNS-IoPPN-2018
Please note there is no need to complete the Research Proposal section in your application as the project has already been set.
You are welcome to email Dr Paul Shotbolt (supervisor) for more information regarding the project and studentship.
If you have any queries regarding the application process, please contact Lauren Soules, Postgraduate Research Administrative Assistant.
References must be received by the deadline for the applicant to be eligible.
Only shortlisted applicants will be contacted.
Interviews: 22nd and 23rd November 2018
Futher information:
About the IoPPN ( http://www.kcl.ac.uk/ioppn/about/index.aspx)
Studying at the IoPPN ( http://www.kcl.ac.uk/ioppn/study/index.aspx)
Research degrees at the IoPPN (http://www.kcl.ac.uk/ioppn/study/prospective-students/programmes-of-study/pgr/welcome.aspx)
KCL Researcher Development Programme http://www.kcl.ac.uk/study/pg/school/RDP/training-and-development/Researcher-Development-Programme-2014-15.pdf)