Vagus Nerve Stimulation for Epilepsy and Depression

Conway, Charles R.; Colijn, Mark A.; Schachter, Steven C.

doi:10.1002/9781118568323.ch17

Cited by 9 publications

(8 citation statements)

References 186 publications

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“…These newer non-invasive VNS delivery systems do not require surgery, and permit patient-administered stimulation on demand; therefore, they improve the safety and tolerability of VNS, making it more accessible and facilitating further investigations across a wider range of uses [55]. VNS has now obtained approval by the US Food and Drug Administration and EU regulatory agencies for [56], and treatment-resistant depression [57]. In particular, non-invasive VNS has gained popularity for its ease of use, broad spectrum of efficacy and tolerability in extremes of age and mental capacity [58].…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Bari

Marchi

Maria

et al. 2016

Phil. Trans. R. Soc. A.

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Cardiovascular and cerebrovascular regulatory systems are vital control mechanisms responsible for guaranteeing homeostasis and are affected by respiration. This work proposes the investigation of cardiovascular and cerebrovascular control systems and the nonlinear influences of respiration on both regulations through joint symbolic analysis (JSA), conditioned or unconditioned on respiration. Interactions between cardiovascular and cerebrovascular regulatory systems were evaluated as well by performing correlation analysis between JSA indexes describing the two control systems. Heart period, systolic and mean arterial pressure, mean cerebral blood flow velocity and respiration were acquired on a beat-to-beat basis in 13 subjects experiencing recurrent syncope episodes (SYNC) and 13 healthy individuals (non-SYNC) in supine resting condition and during head-up tilt test at 60° (TILT). Results showed that JSA distinguished conditions and groups, whereas time domain parameters detected only the effect of TILT. Respiration affected cardiovascular and cerebrovascular regulatory systems in a nonlinear way and was able to modulate the interactions between the two control systems with different outcome in non-SYNC and SYNC groups, thus suggesting that the analysis of the impact of respiration on cardiovascular and cerebrovascular regulatory systems might improve our understanding of the mechanisms underpinning the development of postural-related syncope.

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Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Bari

Marchi

Maria

et al. 2016

Phil. Trans. R. Soc. A.

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“…Vagus nerve stimulation (VNS) has assumed an increasingly important role in the nonpharmacologic management of medically refractory seizures . The VNS system used in this study has been employed to treat >65,000 patients with epilepsy worldwide …”

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confidence: 99%

Vagus nerve stimulation reduces cardiac electrical instability assessed by quantitative T‐wave alternans analysis in patients with drug‐resistant focal epilepsy

et al. 2014

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SUMMARYObjective: The cardiac component of risk for sudden unexpected death in epilepsy (SUDEP) and alterations in cardiac risk by vagus nerve stimulation (VNS) are not well understood. We determined changes in T-wave alternans (TWA), a proven noninvasive marker of risk for sudden cardiac death in patients with cardiovascular disease, and heart rate variability (HRV), an indicator of autonomic function, in association with VNS in patients with drug-resistant focal epilepsy. Methods: Ambulatory 24-h electrocardiograms (N = 9: ages 29-63, six males) were analyzed. Results: Mean TWA during the interictal period was 37 AE 3.1 lV (mean AE SEM) in lead V 1 for nine patients monitored following implantation of the VNS system (n = 7) or battery change (n = 2). Of these, six patients also monitored prior to implantation (n = 5) or battery change (n = 1) showed abnormally high TWA levels pre-VNS (60.0 AE 4.3 lV), which were significantly reduced by 24.3 lV (to 35.7 AE 4.8 lV, p = 0.02) after VNS settings were adjusted for desired clinical response. TWA in four (67%) of the six patients was reduced in association with VNS to levels below the 47-lV cut point of abnormality. The decrease in TWA was correlated with VNS intensity (r = 0.88, p < 0.02). In addition, low-frequency HRV was reduced by 60% (805.61 AE 253.96 to 323.49 AE 102.74 msec 2 , p = 0.05) and low-to high-frequency HRV ratio by 32% (3.34 AE 0.57 to 2.26 AE 0.31, p = 0.025), indicating a change in autonomic balance in favor of parasympathetic dominance. Significance: This is the first report that elevated levels of TWA in patients with drugrefractory partial-onset seizures were reduced in association with VNS, potentially by improving sympathetic/parasympathetic balance. VNS may have a cardioprotective role at stimulation settings typically used for seizure control. These findings indicate the utility of TWA for tracking improvement in cardiac status in this population. KEY WORDS: Vagus nerve stimulation, T-wave alternans, Heart rate variability, Sudden unexpected death in epilepsy.

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“…These newer non-invasive VNS delivery systems do not require surgery, and permit patient-administered stimulation on demand; therefore, they improve the safety and tolerability of VNS, making it more accessible and facilitating further investigations across a wider range of uses [55]. VNS has now obtained approval by the US Food and Drug Administration and EU regulatory agencies for treatment-resistant partial onset seizure disorder [56], and treatment-resistant depression [57]. In particular, non-invasive VNS has gained popularity for its ease of use, broad spectrum of efficacy and tolerability in extremes of age and mental capacity [58].…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

The heart side of brain neuromodulation

Rossi

Santarnecchi

Valenza

et al. 2016

Phil. Trans. R. Soc. A.

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Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.

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Vagus Nerve Stimulation for Epilepsy and Depression

Cited by 9 publications

References 186 publications

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Nonlinear effects of respiration on the crosstalk between cardiovascular and cerebrovascular control systems

Vagus nerve stimulation reduces cardiac electrical instability assessed by quantitative T‐wave alternans analysis in patients with drug‐resistant focal epilepsy

The heart side of brain neuromodulation

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