Modifications of sleep EEG induced by chronic vagus nerve stimulation in patients affected by refractory epilepsy

Rizzo, Pierpaolo; Beelke, Manolo; Carli, Fabrizio De; Canovaro, Paola; Nobili, Lino; Robert, Alice; Fornaro, Pantaleo; Tanganelli, Paolo; Regesta, Giovanni; Ferrillo, Franco

doi:10.1016/j.clinph.2003.10.026

Cited by 30 publications

(15 citation statements)

References 36 publications

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“…Further evidence implicates the role of vagus nerve in sleep regulation. For example, chronic vagus nerve stimulation increases EEG delta and theta power in NREMS in human subjects [25] and increases ponto-geniculate-occipital (PGO) wave density and the number of stages and total amount of REMS in the cat [26]. The influence of diet on sleep regulation, mediated through the vagal activation, may associate with increased sleep-promoting cytokines, particularly tumor necrosis factor (TNF) and interleukin (IL))6.…”

Section: Discussionmentioning

confidence: 98%

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Tsai

Chen

et al. 2006

J Biomed Sci

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The sedative-hypnotic medications, including benzodiazepines and non-benzodiazepines, are the most common treatments for insomnia. However, concerns regarding patterns of inappropriate use, dependence and adverse effects have led to caution in prescribing those sedative-hypnotic medications. On the other hand, a traditional Chinese herb remedy, suanzaorentang, has been efficiently and widely used in clinic for insomnia relief without severe side effects in Asia. Although suanzaorentang has been reported to improve sleep disruption in insomniac patients, its mechanism is still unclear. The present study was designed to elucidate the effects of oral administration of suanzaorentang on physiological sleep-wake architectures and its underlying mechanism in rats. We found that oral administration of suanzaorentang at the beginning of the dark onset dose-dependently increased non-rapid eye movement sleep (NREMS) during the dark period, but had no significant effect on rapid eye movement sleep (REMS). Our results also indicated that intracerebroventricular (ICV) administration of gamma-aminobutyric acid (GABA) receptor type A antagonist, bicuculline, significantly blocked suanzaorentang-induced enhancement in NREMS during the dark period, but GABA(B) receptor antagonist, 2-hydroxysaclofen had no effect. These results implicated that this traditional Chinese herb remedy, suanzaorentang increases spontaneous sleep activity and its effects may be mediated through the GABA(A) receptors, but not GABA(B) receptors.

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Section: Discussionmentioning

confidence: 98%

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Tsai

Chen

et al. 2006

J Biomed Sci

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“…VNS influences the interrelated network of respiration, epilepsy, and sleep. Sleep structure is modified by VNS (15,16) and by epilepsy (17,18). Modifications of sleep states are associated with changes in respiration (19), perhaps mediating some of the effects of VNS.…”

mentioning

confidence: 99%

Vagus Nerve Stimulation Induces Concomitant Respiratory Alterations and a Decrease in SaO₂ in Children

Zaaimi

Heberlé²,

Berquin

et al. 2005

Epilepsia

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Summary:Purpose: To analyze respiratory alterations and effects on SaO 2 caused by vagus nerve stimulation (VNS) in children with epilepsy.Methods: Polysomnographic recordings, including electroencephalography, thoracoabdominal distention, nasal airflow, SaO 2 , and VNS artifact were evaluated in 10 children with pharmacoresistant epilepsy treated with VNS.Results: Each VNS caused a significant increase in respiratory frequency (p < 0.05) throughout the stimulation period and a decrease in thoracoabdominal-distention amplitude (p < 0.05), especially at the beginning of the stimulation. These respiratory alterations induced a decrease in SaO 2 from 1 to 5%. The effects of VNS on respiration differed significantly between rapid-eyemovement (REM) and non-REM (NREM) sleep states.Conclusions: VNS caused a pronounced change in respiration in children with epilepsy, and this induced a decrease in SaO 2 . It is possible that VNS has a neuroprotective effect, and this possibility calls for further investigation. Key Words: Epilepsy-Vagus nerve stimulation-RespirationNeuroprotection-SaO 2 .Vagus nerve stimulation (VNS), an adjunctive treatment for medication-resistant epilepsy, has been used in Europe since 1994. The antiepileptic effect of VNS was initially found in experiments with animal models (1,2) and has been confirmed in humans (3-5). An average seizure reduction of 44.7% after 6 months was reported (6) for 125 children who had a variety of seizure types. The vagus nerve carries most of the information from viscera to CNS, via various types of fibers (7). These afferents are engaged in physiologic regulation processes, such as those of the digestive and cardiorespiratory systems. An effect of VNS on respiration was first described by Breuer (8). Breuer demonstrated the role of the vagus nerve in shaping the different phases of respiration. Since then, numerous studies have been conducted in animals to elucidate the interaction between VNS afferents and brainstem and pontic respiratory neurons (9). In the Von Euler model, the vagus nerve afferents decrease the inspiratory-off-switch activation threshold, but little attention has been paid to respiratory/VNS interaction. The main discomfort reported by the patients receiving VNS is hoarseness and laryngeal irritation (10). Effects of VNS on respiration were expected, Accepted June 25, 2005. Address correspondence and reprint requests to Dr. B. Zaaimi at GRAMFC Laboratoire de genie biophysique, Laboratoire de neurophysiologie, Faculté de médecine, 3 rue des louvels, 80036 Amiens, France. E-mail : boubker.zaaimi@u-picardie.fr but no major respiratory change due to VNS was detected in one study (11). However, hypopneic-polypneic episodes and hypocapnia were observed in one child (12), and others showed apneas-hypopneas (4,13) or increases in respiratory frequency with hypocapnia (14). VNS influences the interrelated network of respiration, epilepsy, and sleep. Sleep structure is modified by VNS (15,16) and by epilepsy (17,18). Modifications of sleep states are associat...

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“…While several case reports of VNS-associated SDB have been described in the literature, there are currently no established criteria for its diagnosis. [1][2][3][4] In our case, the diagnosis of VNS-associated SDB was established by the onset of clinical symptoms following implantation, the use of surface electrodes with expanded filter settings to capture VNS activation artifact, time locking of apneic and hypopneic events with VNS ontime, and the resolution of symptoms when the VNS was turned off. VNS-associated SDB is a known, although poorly understood and often unrecognized, complication of VNS therapy.…”

Section: Discussionmentioning

confidence: 93%

Vagus Nerve Stimulator–Associated Sleep Disordered Breathing: Identification, Treatment, and Outcomes in a Pediatric Patient

Carosella

Sarber

et al. 2020

Journal of Pediatric Neurology

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Vagus nerve stimulator (VNS)-associated sleep disordered breathing (SDB) is a poorly understood side effect of VNS treatment. We present a patient with VNS-associated SDB who underwent sleep laboratory VNS titration, evaluation by drug-induced sleep endoscopy, and treatment including adenotonsillectomy and positive airway pressure therapy. This case is unique as it is the first to document, in real time, the inverse correlation of VNS current with airflow. This case offers unique insights into mechanisms and treatment of VNS-associated SDB, and a novel approach in its management. Most importantly, this case highlights the need for collaboration between physicians managing epilepsy with VNS and those managing sleep.

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Modifications of sleep EEG induced by chronic vagus nerve stimulation in patients affected by refractory epilepsy

Cited by 30 publications

References 36 publications

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Vagus Nerve Stimulation Induces Concomitant Respiratory Alterations and a Decrease in SaO₂ in Children

Vagus Nerve Stimulator–Associated Sleep Disordered Breathing: Identification, Treatment, and Outcomes in a Pediatric Patient

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Modifications of sleep EEG induced by chronic vagus nerve stimulation in patients affected by refractory epilepsy

Cited by 30 publications

References 36 publications

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration

Vagus Nerve Stimulation Induces Concomitant Respiratory Alterations and a Decrease in SaO2 in Children

Vagus Nerve Stimulator–Associated Sleep Disordered Breathing: Identification, Treatment, and Outcomes in a Pediatric Patient

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Vagus Nerve Stimulation Induces Concomitant Respiratory Alterations and a Decrease in SaO₂ in Children