Vagus Nerve Stimulation

Schachter, Steven C.

doi:10.1002/9780470752463.ch73

Cited by 31 publications

(40 citation statements)

References 98 publications

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“…Studies in cats have demonstrated that high-intensity vagus nerve stimulation desynchronizes cortical EEGs but low-intensity stimulation at the same frequency synchronizes the EEG. 20 These studies show that VNS can desynchronize the interconnected cortical regions responsible for seizure activity. Additional studies in rats have demonstrated that VNS increases amino acid turnover and neuronal activity in certain areas of the brain, such as the locus ceruleus in the basolateral amygdala responsible for norepinephrine production.…”

Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 95%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

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Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fi bers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation. (VNS) to control refractory epilepsy in 1990. 1 Intermittent vagus nerve stimulation can reduce seizures by up to 50% in adult seizure patients and up to 90% in pediatric seizure patients. The FDA approved these devices for the treatment of refractory epilepsy in 1997 and for the treatment of refractory depression in 2005. VNS are currently under investigation for treatment of anxiety, obesity, bulimia, migraines, Alzheimer disease, chronic pain syndromes, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. 2 Vagus nerve stimulation can cause side effects involving the upper airway, lower respiratory tract, and upper gastrointestinal tract. These devices can decrease airfl ow, oxygen saturation, and respiratory amplitude during sleep. 3 Most patients with VNS have an increase in their apnea-hypopnea index (AHI) after implantation. 4 One-third of these patients develop mild obstructive sleep apnea post treatment, 4,5 and a minority of patients develop severe obstructive sleep apnea secondary to VNS therapy. 6 More than 50,000 patients have had VNS implants to date, and it is important for sleep medicine specialists to recognize the sleep disordered breathing and other respiratory complications related to VNS devices. We recently helped care for a patient who developed obstructive sleep apnea (OSA) after implantation of a VNS and then required discontinuation of the VNS. Our review of literature while attempting to answer some clinically relevant questions pertaining to this patient led to this review. This article focuses on six questions pertinent to the management of these patients and reviews the literature on sleep-related and respiratory complications associated with vagus nerve stimulators. mETHODSWe conducted a literature search with ...

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Section: Question 1: How Do Vagus Nerve Stimulators Work and What Armentioning

confidence: 95%

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Parhizgar

Nugent

Raj

2011

Journal of Clinical Sleep Medicine

111

View full text Add to dashboard Cite

show abstract

“…These intensity-specific effects led to the hypothesis that, with careful adjustment of stimulatory parameters, VNS may be able to disrupt epileptiform activity by desynchronizing interconnected cortical regions implicated in seizure activity. 31 Although human studies have not shown significant acute EEG changes with VNS, long-term effects of VNS include clustering and synchronization of epileptiform spike-spike and wave (SSW) activity with progressive prolongation of spike-free intervals. Paroxysms of SSW activity also decrease in duration and frequency with VNS, particularly in patients with prominent epileptiform activity.…”

Section: Rationale and Mechanism Of Action Of Vns In Epilepsy Controlmentioning

confidence: 99%

Vagus Nerve Stimulation for Epilepsy and Depression

2008

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Summary: Many patients with epilepsy suffer from persistent seizures despite maximal antiepileptic drug (AED) therapy. Chronic, intermittent vagus nerve stimulation (VNS) has proven to be a safe, effective option for patients suffering from refractory seizures who are not candidates for surgical resection. Although only a small minority of patients will be entirely seizure-free, VNS as an adjunct to medical therapy does appear to provide a significant amount of improvement in quality of life. Reports of antidepressant effects independent of seizure control, along with the use of multiple AEDs in the treatment of depression, has led to the investigation of VNS as a potential adjunctive treatment for major depressive disorder. Both the number of severely depressed patients refractory to available pharmacologic options and the need for repeated treatments and significant side effects associated with electroconvulsive therapy have heightened the interest in VNS for this patient population. Pilot studies of VNS for depression have shown impressive response rates; however, the effect appears to be gradual in onset, as demonstrated by the lack of a favorable response in a short-term, randomized controlled study. Investigation is thus needed to establish the potential role of VNS as an adjunctive treatment for severe depression.

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“…These have been most often described as a "buzzing," tingling, vibrating, or pain sensation in the neck or larynx concomitant with stimulation (2,4,5). Other reports of pain have described these symptoms as minor, transient, and self-limited over time and responsive to minor adjustments in stimulation parameters (1,3,6,7).…”

Section: Discussionmentioning

confidence: 99%

Tonsillar Pain Mimicking Glossopharyngeal Neuralgia as a Complication of Vagus Nerve Stimulation: Case Report

2000

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Summary:An adolescent girl presented with severe, lancinating tonsillar pain exacerbated by swallowing 6 weeks after initiation of left vagus nerve stimulation for intractable epilepsy. Her symptoms mimicked those seen in glossopharyngeal neuralgia and were relieved by temporary cessation of stimulation. Gradual reinstitution of therapy with alteration in stimuVagus nerve stimulation has become an increasingly used modality for the treatment of intractable epilepsy.This therapy has been reported to significantly improve seizure control in 30-70% of patients, and morbidity and mortality has been low (1-3). We report a case of delayed stimulation-related severe tonsillar pain, similar in quality to classic glossopharyngeal neuralgia, in a 16-year-old girl undergoing vagus nerve stimulation for intractable epilepsy. CASE REPORTThis left-handed girl was born with an occipital encephalocele that was repaired when she was 11 days old. She had essentially normal early psychomotor development, including walking at 14 months of age and appropriate language by 2 years. At 6 years of age, she had her first generalized tonic-clonic seizure, then remained seizure free until age 1 1, when she experienced simple and complex partial seizures characterized as behavioral arrest and visual blurring, with variable progression to unresponsiveness lasting up to 1 minute. MRI showed heterotopias surrounding the posterior horns of the lateral ventricle and partial dysgenesis of the corpus callosum.

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Vagus Nerve Stimulation

Cited by 31 publications

References 98 publications

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Vagus Nerve Stimulation for Epilepsy and Depression

Tonsillar Pain Mimicking Glossopharyngeal Neuralgia as a Complication of Vagus Nerve Stimulation: Case Report

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