The chemical neuroanatomy of vagus nerve stimulation

Ruffoli, Riccardo; Giorgi, Filippo Sean; Pizzanelli, Chiara; Murri, Luigi; Paparelli, Antonio; Fornai, Francesco

doi:10.1016/j.jchemneu.2010.12.002

Cited by 166 publications

(157 citation statements)

References 67 publications

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“…The cervical level of the vagus nerve is comprised of myelinated A and B fibers, as well as unmyelinated C fibers [127,128]. There is considerabe diversity in morphological and functional parameters of the nerve from individual to individual, suggesting that optimal stimulation parameters may also vary [129,130].…”

Section: Optimizing Vns Parametersmentioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

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Section: Optimizing Vns Parametersmentioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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“…Brain imaging studies in human have shown that brain regions activated were greater at high (20 Hz) than low (5 Hz) frequency VNS (Lomarev et al, 2002). The widespread projections of the NTS, the target of vagal afferents, in the brain explain the efficacy of VNS in epilepsy and depression (Ruffoli et al, 2011). The locus coeruleus (LC), the principal brain noradrenergic nucleus, is believed to mediate many of the effects of VNS in the central nervous system.…”

Section: Vagus Nerve Stimulation In Epilepsy and Depressionmentioning

confidence: 99%

“…The locus coeruleus (LC), the principal brain noradrenergic nucleus, is believed to mediate many of the effects of VNS in the central nervous system. The LC receives excitatory input from the NTS via the nucleus paragigantocellularis (Ruffoli et al, 2011). Lesions of the LC block the anti-epileptic and anti-depressant effects of VNS (Krahl et al, 1998).…”

Section: Vagus Nerve Stimulation In Epilepsy and Depressionmentioning

confidence: 99%

“…Among the nervous system, the vagus nerve (VN), the principal component of the parasympathetic nervous system, appears as an interesting target for Bioelectronic Medicine due to its anatomical specificity at the interface of gut-brain interactions and its role in the neuro-endocrine-immune axis (Bonaz et al, 2017). VN stimulation (VNS) is presently used in the treatment of drug resistant epilepsy and depression (Milby et al, 2008) based on the widespread central projections of the VN (Ruffoli et al, 2011). More recently, VNS has been shown to improve experimental models of septic shock and colitis (Borovikova et al, 2000;Meregnani et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Is-there a place for vagus nerve stimulation in inflammatory bowel diseases?

Bonaz

2018

Bioelectron Med

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The vagus nerve (VN), the longest nerve of the organism that innervates the gastrointestinal tract, is a mixed nerve composed of 80% of afferent and 20% of efferent fibers. The VN has anti-inflammatory properties, in particular an anti-TNFα effect through the cholinergic anti-inflammatory pathway. The VN is a key component of the autonomic nervous system, i.e. the parasympathetic nervous system. An imbalance of the autonomic nervous system, as represented by a low vagal tone, is described in many diseases and has a pro-inflammatory role. Inflammatory bowel diseases (IBD) are chronic disorders of the gastro-intestinal tract where TNFα is a key cytokine. VN stimulation (VNS), classically used for the treatment of drug resistant epilepsy and depression, would be of interest in the treatment of IBD. We have recently reported in a 6 month follow-up pilot study that VNS improves active Crohn's disease. Preliminary data of another pilot study confirm this interest. Similarly, VNS has recently been reported to improve rheumatoid arthritis, another TNFα mediated disease. Bioelectronic Medicine, as represented by VNS, opens new therapeutic avenues in the treatment of such chronic inflammatory disorders. In the present manuscript, we will focus on the interest of VNS in IBD.

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“…The neurologist James Corning was one of the predecessors of this procedure and his technique consisted of stimulating the vagus nerve transcutaneously, in conjunction with carotid compression. This method was initially proposed by Parry in 1792, with the intent of reducing cardiac output and, consequently, cerebral blood flow 5 . Apart from side effects, Corning was motivated by the outcomes, but his successors did not share his enthusiasm and the technique was subsequently abandoned.…”

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The role of vagus nerve stimulation in refractory epilepsy

Oliveira

Francisco

Demartini

et al. 2017

Arq. Neuro-Psiquiatr.

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Vagus nerve stimulation is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or had poor results after surgical procedures. Its mechanism of action is not yet fully comprehended but it possibly involves modulation of the locus coeruleus, thalamus and limbic circuit through noradrenergic and serotonergic projections. There is sufficient evidence to support its use in patients with focal epilepsy and other seizure types. However, it should be recognized that improvement is not immediate and increases over time. The majority of adverse events is stimulation-related, temporary and decreases after adjustment of settings. Future perspectives to improve efficacy and reduce side effects, such as different approaches to increase battery life, transcutaneous stimulation and identification of prognostic factors, should be further investigated.Keywords: vagus nerve stimulation; epilepsy. RESUMOA estimulação vagal é uma terapia paliativa utilizada no tratamento de pacientes com epilepsia refratária que não são candidatos à cirurgia ressectiva ou naqueles com evolução insatisfatória após o procedimento cirúrgico. Seu mecanismo de ação ainda não foi completamente elucidado mas possivelmente envolve a modulação do locus coeruleus, tálamo e circuito límbico através de projeções noradrenérgicas e serotoninérgicas. Atualmente há evidência suficiente para corroborar o uso desta terapia em pacientes com epilepsia focal e outros tipos de crise, com resultados que, apesar de não imediatos, melhoram progressivamente no longo prazo. Os eventos adversos são, em sua maioria, relacionados à estimulação e auto-limitados. Perspectivas futuras para aumentar a eficácia e reduzir os efeitos colaterais como a utilização de baterias com maior durabilidade, estimulação transcutânea e identificação de fatores prognósticos devem ser investigadas. Palavras-chave: estimulação do nervo vago; epilepsia.Epilepsy is one of the most common chronic neurologic diseases and affects at least 50 million people worldwide 1 . Although much has been understood about its causes, epilepsy is still extremely stigmatizing and many patients are victims of prejudice and social exclusion. The quality of life of those affected by the disease is remarkably compromised due to seizures, antiepileptic drugs (AED), cognitive impairment and physical limitations.Those who do not achieve adequate seizure control, even with multiple AED trials, are considered refractory. Currently, medically resistant epilepsy is regarded as a worldwide health issue as it is endured by approximately one third of epileptic patients. The financial burden is substantial and, among all health costs of uncontrolled patients, nearly 50% are related to epilepsy care costs 2 . For these individuals, whose treatment is generally complex, epilepsy surgery may be indicated and can provide up to 80% seizure control, depending on distinct aspects such as time of follow-up and epileptic focus localization. Figure 1 illustrates the therapy ...

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The chemical neuroanatomy of vagus nerve stimulation

Cited by 166 publications

References 67 publications

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Is-there a place for vagus nerve stimulation in inflammatory bowel diseases?

The role of vagus nerve stimulation in refractory epilepsy

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