MedWorm: Vagus Nerve Stimulation Therapy

Renin-Angiotensin-Aldosterone System: The Forgotten Stress Hormone System: Relationship to Depression and Sleep

Pharmacopsychiatry — Mon, 30 Jan 2012 05:00:00 +0100

PharmacopsychiatryDOI: 10.1055/s-0031-1291346Neuroendocrine changes in depression have long been recognized, with a focus mainly on hypercortisolism. The other hormone of the hypothalamus-pituitary adrenocortical system, aldosterone, has been widely neglected.Here we summarize the involvement of the renin-angiotensin-aldosterone system (RAAS) and the regulation of aldosterone in health with a particular focus on sleep-related changes and its role in stress-related conditions, like major depression.We highlight its role in functional systems which could be relevant in the therapy for refractory depression, like inflammatory mechanisms, the monoaminergic and the glutamatergic systems. Furthermore, anatomic areas which specifically mediate the action of aldosterone have been identified. In pa...

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Paediatric vagus nerve stimulation saves costs in the USA

PharmacoEconomics and Outcomes News — Fri, 27 Jan 2012 15:13:30 +0100

(Source: PharmacoEconomics and Outcomes News)

Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy.

European Journal of Paediatric Neurology — Tue, 17 Jan 2012 05:00:00 +0100

CONCLUSIONS: VNS in pediatric patients is associated with decreased resource use and epilepsy-related events, cost savings, and QALY gain. PMID: 22261080 [PubMed - as supplied by publisher] (Source: European Journal of Paediatric Neurology)

Long-term results of vagus nerve stimulation in children and adolescents with drug-resistant epilepsy

Child's Nervous System — Thu, 05 Jan 2012 17:06:53 +0100

Conclusion Vagus nerve stimulation therapy is a safe and effective adjunctive treatment for children and adolescents of all ages with drug-resistant epilepsy. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00381-011-1670-zAuthors Beata Majkowska-Zwolińska, Epilepsy Diagnostic and Therapeutic Centre, Foundation of Epileptology, 122 Wiertnicza Str, 02-952 Warsaw, PolandPiotr Zwoliński, Neurosurgery Department, Memorial Child Institute, Warsaw, PolandMarcin Roszkowski, Neurosurgery Department, Memorial Child Institute, Warsaw, PolandKrzysztof Drabik, Neurosurgery Department, Memorial Child Institute, Warsaw, Poland Journal Child's Nervous SystemOnline ISSN 1433-0350Print ISSN 0256-7040 (Source: Child's Nervous System)

A systematic review and meta‐analysis of heart rate variability in epilepsy and antiepileptic drugs

Epilepsia — Thu, 05 Jan 2012 05:00:00 +0100

SummaryPurpose: Epilepsy is associated with near‐fatal and fatal arrhythmias, and sudden unexpected death in epilepsy (SUDEP) is partly related to cardiac events. Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, the results are still mixed regarding whether imbalance of sympathetic, vagal, or both systems is present in epilepsy, and also the importance of anticonvulsant treatment on the autonomic system. Therefore, we aimed to investigate epilepsy and its treatment impact on heart rate variability (HRV), assessed by sympathetic and parasympathetic activity expressed as low‐frequency (LF) and high‐frequency (HF) power spectrum, respectively.Method: We pe...

Effect of vagus nerve stimulation during transient focal cerebral ischemia on chronic outcome in rats

Journal of Neuroscience Research — Thu, 22 Dec 2011 05:00:00 +0100

AbstractThe aim of this study was to investigate the effect of vagus nerve stimulation (VNS) on infarct volume and neurological recovery up to 3 weeks following transient focal cerebral ischemia. Transient ischemia was produced by filament occlusion of the proximal middle cerebral artery (MCA) in rats. The right vagus nerve was stimulated starting 30 min after MCA occlusion and consisted of 30‐sec pulse trains (20 Hz) delivered to the animal's right vagus nerve every 5 min for a total period of 60 min (n = 10). All the procedures were duplicated, but no stimulus was delivered, in a control group (n = 10). Neurological evaluations were performed in all animals at 24 hr, 48 hr, 1 week, 2 weeks, and 3 weeks after MCA occlusion; animals were euthanized; and neuronal damage was evaluated in h...

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Long‐term follow‐up of febrile infection–related epilepsy syndrome

Epilepsia — Thu, 22 Dec 2011 05:00:00 +0100

SummaryPurpose: Febrile infection–related epilepsy syndrome (FIRES) is an increasingly recognized epileptic syndrome that presents with multifocal refractory status epilepticus in previously normal children and evolves into a chronic, refractory, focal epilepsy with associated cognitive and behavioral difficulties. Herein we describe the features of the chronic epilepsy and critically review evidence for the etiology of this syndrome.Methods: Seven patients with FIRES were studied. The duration of follow‐up in six survivors was 5–17 years. Clinical, electroencephalography (EEG), neuroimaging, and other investigative findings during the acute and chronic phases were reviewed.Key Findings: These previously normal children presented with a febrile illness and status epileptic...

EP News: Basic and Translational

Heart Rhythm — Mon, 05 Dec 2011 05:00:00 +0100

Rosas-Ballina et al (Science 2011;334:98, PMID 21921156) determined whether vagus nerve stimulation induces increased acetylcholine release in the spleen by measuring acetylcholine in perfusate samples collected by microdialysis. Acetylcholine levels were elevated within minutes after electrical vagus nerve stimulation and reached peak levels within 20 minutes. This indicates that action potentials originating in the vagus nerve can enhance acetylcholine release in the spleen. They also identified an acetylcholine-producing, memory phenotype T-cell population in mice that is integral to the inflammatory reflex. These acetylcholine-producing T cells are required for inhibition of cytokine production by vagus nerve stimulation. A major finding of this study is the surprising functional role ...

Systematic review and meta-analysis of vagus nerve stimulation in the treatment of depression: Variable results based on study designs.

European Psychiatry — Wed, 30 Nov 2011 05:00:00 +0100

CONCLUSION: Currently, insufficient data are available to describe VNS as effective in the treatment of depression. In addition, it cannot be ruled out that the positive results observed in the uncontrolled studies might have been mainly due to a placebo effect. PMID: 22137776 [PubMed - as supplied by publisher] (Source: European Psychiatry)

Pairing tone trains with vagus nerve stimulation induces temporal plasticity in auditory cortex.

Experimental Neurology — Fri, 04 Nov 2011 04:00:00 +0100

In this study, we tested whether pairing VNS with tone trains can change the temporal response properties of A1 neurons. In naïve rats, A1 neurons respond strongly to tones repeated at rates up to 10pulses per second (pps). Repeatedly pairing VNS with 15pps tone trains increased the temporal following capacity of A1 neurons and repeatedly pairing VNS with 5pps tone trains decreased the temporal following capacity of A1 neurons. Pairing VNS with tone trains did not alter the frequency selectivity or tonotopic organization of auditory cortex neurons. Since VNS is well tolerated by patients, VNS-tone train pairing represents a viable method to direct temporal plasticity in a variety of human conditions associated with temporal processing deficits. PMID: 22079155 [PubMed - as supplied by ...

Vagus nerve stimulation for epilepsy: the notre-dame hospital experience.

The Canadian Journal of Neurological Sciences — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion: VNS as practiced at Notre-Dame hospital is an efficacious and safe treatment for refractory epilepsy. Quotas allotted to epilepsy centers in the province of Quebec should be lifted or increased to allow more patients to benefit from this therapeutic device. PMID: 22030430 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

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Canadian experience with vagus nerve stimulation for epilepsy in adults.

The Canadian Journal of Neurological Sciences — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Tellez-Zenteno JF, McLachlan RS PMID: 22030414 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

Electrical vagus nerve stimulation for the treatment of chronic heart failure

Cleveland Clinic Journal of Medicine — Tue, 04 Oct 2011 04:00:00 +0100

Autonomic dysregulation is a feature of chronic heart failure (HF) and is characterized by a sustained increase of sympathetic drive and by withdrawal of parasympathetic activity. Both sympathetic overdrive and increased heart rate are predictors of poor long-term outcome in patients with HF. Pharmacologic agents that partially inhibit sympathetic activity, such as beta-adrenergic receptor blockers, effectively reduce mortality and morbidity in patients with chronic HF. In contrast, modulation of parasympathetic activation as a potential therapy for HF has received only limited attention because of its inherent complex cardiovascular effects. This review examines results of experimental animal studies that provide support for the possible use of electrical vagus nerve stimulation (VNS) as ...

Efficacy of Vagus Nerve Stimulation for Epilepsy by Patient Age, Epilepsy Duration, and Seizure Type

Neurosurgery Clinics of North America — Fri, 23 Sep 2011 20:50:53 +0100

Medically refractory epilepsy is a morbid condition, and many patients are poor candidates for surgical resection because of multifocal seizure origin or eloquence near epileptic foci. Vagus nerve stimulation (VNS) was approved in 1997 by the US Food and Drug Administration as an adjunctive treatment of intractable epilepsy for individuals aged 12 years and more with partial epilepsy. Controversy persists regarding the efficacy of VNS for epilepsy and about which patient populations respond best to therapy. In this article, the authors retrospectively studied a patient outcome registry and report the largest, to their knowledge, analysis of VNS outcomes in epilepsy. (Source: Neurosurgery Clinics of North America)

Neurostimulation: Vagus Nerve Stimulation and Beyond

Seminars in Pediatric Neurology — Thu, 01 Sep 2011 04:00:00 +0100

Patients with medically intractable epilepsy who are not candidates for epilepsy surgery could benefit from neurostimulation. At this time, vagus nerve stimulation (VNS) therapy is the only Food and Drug Administation–approved neurostimulation modality; it has been shown to be efficacious and just as well tolerated in children and adolescents as in adults. Notwithstanding the initial cost of the device and implantation, VNS therapy has been shown to be a cost-effective treatment, reducing direct medical costs and improving health-related quality of life measures. Deep brain stimulation of various brain regions, especially the anterior nucleus of the thalamus and responsive neurostimulation, also appear effective but are not yet approved for clinical use. Repetitive transcranial magnetic ...

Vagus nerve stimulation in the treatment of patients with pharmacoresistant epilepsy: our experiences.

Collegium Antropologicum — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Hajnsek S, Petelin Z, Poljaković Z, Mrak G, Paladino J, Desnica A Abstract Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients older than 12 years was approved in Europe in 1994 and in the United States in 1997. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Centre Zagreb. From 1997 to 2001 we have implanted VNS in 11 patients with pharmacoresistant epilepsy, who were magnetic resonance imaging (MRI) negative and from May 2007 to May 2009 in 11 patients with pharmacoresistant epilepsy, 9 of them were MRI positive, and were inoperable due to localisation of the pathomorphologic changes...

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Autonomic effects of refractory epilepsy on heart rate variability in children: influence of intermittent vagus nerve stimulation

Developmental Medicine and Child Neurology — Wed, 31 Aug 2011 23:00:00 +0100

Aim Vagus nerve stimulation (VNS) is a therapeutic option for individuals with refractory epilepsy. Individuals with refractory epilepsy are prone to dysfunction of the autonomic nervous system. Reduced heart rate variability is a marker of dysfunction of the autonomic nervous system. Our goal was to study heart rate variability in children with refractory epilepsy and the influence of VNS on this parameter.Methods In 17 children (13 male; four female; mean age 7y 6mo; age range 3–16y) with refractory epilepsy, electroencephalographic and electrocardiographic data were obtained before and after implantation of VNS during stage 2 and slow‐wave sleep. Time and frequency domain parameters were calculated and the results were compared with an age‐ and sex‐matched group of indiv...

Clinical and economic impact of vagus nerve stimulation therapy in patients with drug-resistant epilepsy.

Epilepsy and Behaviour — Fri, 26 Aug 2011 23:00:00 +0100

Authors: Helmers SL, Duh MS, Guérin A, Sarda SP, Samuelson TM, Bunker MT, Olin BD, Jackson SD, Faught E Abstract We evaluated long-term medical and economic benefits of vagus nerve stimulation (VNS) therapy in drug-resistant epilepsy. A pre-post analysis was conducted using multistate Medicaid data (January 1997-June 2009). One thousand six hundred fifty-five patients with one or more neurologist visits with epilepsy diagnoses (ICD-9 345.xx, 780.3, or 780.39), one or more procedures for vagus nerve stimulator implantation, one or more antiepileptic drugs (AEDs), and 6 or more months of continuous Medicaid enrollment pre- and post-VNS were selected. The pre-VNS period was 6months. The post-VNS period extended from implantation to device removal, death, Medicaid disenrollment, or st...

Vagus Nerve Stimulation Shows Early Promise in FibromyalgiaVagus Nerve Stimulation Shows Early Promise in Fibromyalgia

Medscape Today Headlines — Fri, 26 Aug 2011 15:55:21 +0100

A pilot study finds stimulation of the vagus nerve is safe and effective in patients with treatment-resistant fibromyalgia. Medscape Medical News (Source: Medscape Today Headlines)

Obstructive Sleep Apnea and Respiratory Complications Associated with Vagus Nerve Stimulators

Journal of Clinical Sleep Medicine : JCSM — Tue, 16 Aug 2011 02:50:13 +0100

Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fibers 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 ...

Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response.

Journal of Neurosurgery — Thu, 11 Aug 2011 23:00:00 +0100

In conclusion, VNS is an effective and relatively safe adjunctive therapy in patients with medically refractory epilepsy not amenable to resection. However, it is important to recognize that complete seizure freedom is rarely achieved using VNS and that a quarter of patients do not receive any benefit from therapy. PMID: 21838505 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

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Severe new seizures after initiation of vagus nerve stimulation therapy.

Epilepsy and Behaviour — Wed, 03 Aug 2011 23:00:00 +0100

We describe the emergence of a new type of disabling, recurrent partial seizure immediately after initiation of vagus nerve stimulation in a 51-year-old man with a known history of refractory partial epilepsy. Discontinuation of vagus nerve stimulation therapy and multiple antiepileptic drug interventions were required to abort these unexpected new seizures. We conclude that vagus nerve stimulation may induce paradoxical seizures, similarly to some antiepileptic drugs. PMID: 21820359 [PubMed - as supplied by publisher] (Source: Epilepsy and Behaviour)

Safety and Efficacy of Vagus Nerve Stimulation in Fibromyalgia: A Phase I/II Proof of Concept Trial

Pain Medicine — Tue, 02 Aug 2011 23:00:00 +0100

Conclusions. Side effects and tolerability were similar to those found in disorders currently treated with VNS. Preliminary outcome measures suggested that VNS may be a useful adjunct treatment for FM patients resistant to conventional therapeutic management, but further research is required to better understand its actual role in the treatment of FM. (Source: Pain Medicine)

Therapeutic devices for epilepsy

Annals of Neurology — Sun, 31 Jul 2011 23:00:00 +0100

AbstractTherapeutic devices provide new options for treating drug‐resistant epilepsy. These devices act by a variety of mechanisms to modulate neuronal activity. Only vagus nerve stimulation, which continues to develop new technology, is approved for use in the United States. Deep brain stimulation (DBS) of anterior thalamus for partial epilepsy recently was approved in Europe and several other countries. Responsive neurostimulation, which delivers stimuli to one or two seizure foci in response to a detected seizure, recently completed a successful multicenter trial. Several other trials of brain stimulation are in planning or underway. Transcutaneous magnetic stimulation (TMS) may provide a noninvasive method to stimulate cortex. Controlled studies of TMS split on efficacy, and may depe...

The Application of Vagus Nerve Stimulation and Deep Brain Stimulation in Depression

Neuropsychobiology : Last 20 articles — Thu, 28 Jul 2011 23:00:00 +0100

Neuropsychobiology 2011;64:170–181 (DOI:10.1159/000325225) (Source: Neuropsychobiology : Last 20 articles)

Efferent vagal nerve stimulation attenuates acute lung injury following burn: The importance of the gut-lung axis

Surgery — Sun, 24 Jul 2011 23:00:00 +0100

Conclusion: Vagal nerve stimulation is an effective strategy to protect against acute lung injury following burn. Moreover, the protective effects of vagal nerve stimulation in the prevention of acute lung injury are eliminated by performing an abdominal vagotomy. These results establish the importance of the gut-lung axis after burn in the genesis of acute lung injury. (Source: Surgery)

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Vagus nerve stimulation protects against ventricular fibrillation independent of muscarinic receptor activation

Cardiovascular Research — Mon, 18 Jul 2011 23:00:00 +0100

Conclusions We show that the vagal anti-fibrillatory action in the rabbit ventricle occurs via post-ganglionic efferent nerve fibres, independent of muscarinic receptor activation, VIP, and the endothelium. Together with our previous publications, our data support the possibility of a novel ventricular nitrergic parasympathetic innervation and highlight potential for new therapeutic targets to treat ventricular dysrhythmias. (Source: Cardiovascular Research)

Seizure freedom with VNS monotherapy: A case report

Seizure: European Journal of Epilepsy — Mon, 18 Jul 2011 04:00:00 +0100

We report a case that a patient became seizure free for 5 years with VNS monotherapy. To our knowledge, a similar case has not been reported previously. (Source: Seizure: European Journal of Epilepsy)

Time Perception in Patients with Major Depressive Disorder during Vagus Nerve Stimulation

Pharmacopsychiatry — Mon, 11 Jul 2011 23:00:00 +0100

PharmacopsychiatryDOI: 10.1055/s-0031-1280815Abstract[...]Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Pharmacopsychiatry)

MF.06 Cognitive function during vagus nerve stimulation (VNS) for treatment-refractory epilepsy: a Pilot Study using the Critical Flicker Fusion (CFF) Test

Journal of Neurology, Neurosurgery and Psychiatry — Wed, 06 Jul 2011 23:00:00 +0100

Conclusions This prospective pilot study suggests that the CFF Test can be a useful and sensitive tool in detecting subtle cognitive enhancement in patients with refractory epilepsy successfully treated with VNS. (Source: Journal of Neurology, Neurosurgery and Psychiatry)

Depot Based Drug Delivery System for the Management of Depression - A Review.

Current Drug Delivery — Tue, 21 Jun 2011 23:00:00 +0100

Authors: Pilaniya U, Khatri K, Patil UK Depression is a common mental disorder discerns with depressed mood, loss of interest, the primary treatment methods are drug therapy, electroconvulsive therapy, psychotherapy, light therapy, vagus nerve stimulation, etc. A number of innovative delivery systems have been developed to address suboptimal therapy outcomes by enhancing drug delivery, assuring efficacy of treatment, reducing side effects, improving compliance and drug targeting specific locations resulting in a higher efficiency. Depot delivery offers the advantage of a very high loading, controlled release of drug for an extended period of time and reduces frequency of dosing. The increase in AUC and decrease in Cmax reflects that the depot formulations could reduce the toxic complic...

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Cerbomed: Promising Results For A Study Into Using Transcutaneous Vagus Nerve Stimulation For Hard To Treat Epilepsies

Health News from Medical News Today — Fri, 17 Jun 2011 16:00:00 +0100

The pilot study into treating therapy resistant epilepsies using NEMOS confirms the initial, positive, intermediate results from June 2010. NEMOS, from cerbomed GmbH, is the first device worldwide for transcutaneous Vagus Nerve Stimulation (t-VNS). The study produced positive indications for safety, tolerability and effectiveness, along with verifying the high user-friendliness of t-VNS. The prospective pilot study was carried out over 9 months at the epilepsy center of the University Hospital Erlangen, under the supervision of Professor Dr. Hermann Stefan... (Source: Health News from Medical News Today)

Cerbomed: Promising Results for a Study into Using Transcutaneous Vagus Nerve Stimulation for Hard to Treat Epilepsies

HSMN NewsFeed — Thu, 16 Jun 2011 13:17:32 +0100

ERLANGEN, Germany--(Healthcare Sales & Marketing Network)-- The pilot study into treating therapy resistant epilepsies using NEMOS confirms the initial, positive, intermediate results from June 2010. NEMOS, from cerbomed GmbH, is the first device worldwide... Devices, NeurologyCerbomed, NEMOS , Vagus Nerve Stimulation, t-VNS, epilepsy (Source: HSMN NewsFeed)

CerebralRx Enters Global Neuromodulation Market With The FitNeS™ System For Treating Epilepsy

Health News from Medical News Today — Wed, 15 Jun 2011 15:00:00 +0100

CerebralRx, a newly formed spin-off of implantable neuromodulation systems developer BioControl Medical, has announced market entry with the launch of its FitNeS vagus nerve stimulation system. Designed to treat epilepsy patients with partial onset seizures who do not achieve full seizure control with available prescription drugs (or those with "refractory epilepsy"), the FitNeS system has been successfully implanted in the first two patients at the Institute for Clinical Neurosciences at the Shalgrenska Academy in GÃ¶tenberg, Sweden... (Source: Health News from Medical News Today)

CerebralRx Enters Global Neuromodulation Market With the FitNeS System for Treating Epilepsy

HSMN NewsFeed — Tue, 14 Jun 2011 12:58:47 +0100

YEHUD, Israel--(Healthcare Sales & Marketing Network)-- CerebralRx, a newly formed spin-off of implantable neuromodulation systems developer BioControl Medical, has announced market entry with the launch of its FitNeS vagus nerve stimulation system. Design... Devices, NeurologyCerebralRx, neuromodulation, FitNeS, vagus nerve stimulation, epilepsy (Source: HSMN NewsFeed)

CerebralRx Enters Global Neuromodulation Market With the FitNeS(TM) System for Treating Epilepsy

HSMN NewsFeed — Tue, 14 Jun 2011 12:58:47 +0100

YEHUD, Israel--(Healthcare Sales & Marketing Network)-- CerebralRx, a newly formed spin-off of implantable neuromodulation systems developer BioControl Medical, has announced market entry with the launch of its FitNeS vagus nerve stimulation system. Design... Devices, NeurologyCerebralRx, neuromodulation, FitNeS , vagus nerve stimulation, epilepsy (Source: HSMN NewsFeed)

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Physical treatments for bipolar disorder: A review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques

Journal of Affective Disorders — Wed, 08 Jun 2011 14:21:51 +0100

Conclusions: ECT is an effective treatment for acute mania, bipolar depression and mixed affective states and has useful efficacy even in pharmacotherapy-resistant patients. Other brain stimulation techniques may have potential for the treatment of bipolar disorder and should be further researched. (Source: Journal of Affective Disorders)

Marked Response to VNS in a Post-Cingulotomy Patient: Implications for the Mechanism of Action of VNS in TRD.

CNS Spectrums — Tue, 31 May 2011 23:00:00 +0100

We describe the case of a woman, 53 years of age, with a long and sustained history of TRMD (33 years), which was unresponsive to numerous treatments (multiple pharmacotherapies, psychotherapy, electroconvulsive therapy [ECT]). Additionally, her TRMD failed to respond to a bilateral anterior cingulotomy. She underwent placement of a cervical vagus nerve stimulator and a brief course of ECT (3 unilateral treatments). Her depression improved markedly, and it has remained in sustained remission for 3.5 years. This case suggests a potential synergistic effect of VNS and ECT, as well as provides possible clues to the neural circuitry of VNS in TRMD. PMID: 21632014 [PubMed - as supplied by publisher] (Source: CNS Spectrums)

Role of the Cholinergic Antiinflammatory Pathway in Murine Autoimmune Myocarditis.

Circulation Research — Wed, 18 May 2011 23:00:00 +0100

Conclusions: We showed that activation of the cholinergic antiinflammatory pathway with nicotine reduces inflammation in autoimmune myocarditis. Our results may open new possibilities in the therapeutic management of autoimmune myocarditis. PMID: 21597011 [PubMed - as supplied by publisher] (Source: Circulation Research)

Alternative Surgical Approaches in Epilepsy

Current Neurology and Neuroscience Reports — Mon, 16 May 2011 08:42:29 +0100

Abstract The mainstay of epilepsy surgery is the resection of a presumed seizure focus or disruption of seizure propagation pathways. These approaches cannot be applied to all patients with medically refractory epilepsy (MRE). Since 1997, vagus nerve stimulation has been a palliative adjunct to the care of MRE patients. Deep brain stimulation (DBS) in select locations has been reported to reduce seizure frequency in small studies over the past three decades. Recently published results from the SANTE (Stimulation of the Anterior Nuclei of Thalamus for Epilepsy) trial—the first large-scale, randomized, double-blind trial of bilateral anterior thalamus DBS for MRE—demonstrate a significant reduction in seizure frequency with programmed stimulation. Another surgical altern...

Experience With Lacosamide in a Series of Children With Drug-Resistant Focal Epilepsy

Pediatric Neurology — Mon, 09 May 2011 14:38:29 +0100

We report our pediatric experience with lacosamide, a new antiepileptic drug, approved by the US Food and Drug Administration as adjunctive therapy in focal epilepsy in patients more than 17 years old. We retrospectively reviewed charts for lacosamide use and seizure frequency outcome in patients with focal epilepsy (Wilcoxon signed rank test). Sixteen patients (7 boys) were identified (median dose 275 mg daily, 4.7 mg/kg daily; mean age 14.9 years, range 8-21 years). Patients were receiving a median of 2 antiepileptic drugs (interquartile range [IQR] 1.7-3) in addition to having undergone previous epilepsy surgery (n = 3), vagus nerve stimulation (n = 9), and ketogenic diet (n = 3). Causes included structural (encephalomalacia and diffuse encephalitis, 1 each; stroke in 2) and genetic abn...

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Ictal and peri-ictal changes in cervical vagus nerve activity associated with cardiac effects

Medical and Biological Engineering and Computing — Thu, 05 May 2011 05:43:08 +0100

In this study, we characterize the association of ictal and peri-ictal VENG with cardiac parameters. The electrocorticogram (ECoG), electrocardiogram, and the VENG were recorded in anesthetized rats, which were intravenously infused with either a pentylenetetrazole (PTZ) solution (PTZ-lot, n = 11) or saline (control-lot, n = 6). Control animals were subsequently vagotomized and also infused with a PTZ solution (n = 5, V-PTZ-lot). Cardiac and VENG parameters were assessed during different ECoG stages of ictal activity. None of the parameters changed in the control-lot. PTZ infusion induced seizures in all rats. Cardiac-related VENG showed distinctive firing patterns for the left and right vagus nerves. Significant ictal and post-ictal changes were seen in b...

The role of locus coeruleus in the antiepileptic activity induced by vagus nerve stimulation

European Journal of Neuroscience — Sat, 30 Apr 2011 23:00:00 +0100

AbstractStimulation of the vagus nerve produces antiepileptic effects. This is used clinically to treat drug‐refractory epilepsies. The mechanisms responsible for these effects depend on the activation of vagal afferents reaching the nucleus of the solitary tract. This review focuses on the neuroanatomy of the nucleus of the solitary tract and its relation with the nucleus locus coeruleus as a preferential anatomical substrate in producing antiepileptic effects. In fact, following the transient or permanent inactivation of locus coeruleus neurons, some antiepileptic effects of vagus nerve stimulation are lost. The activation of locus coeruleus per se is known to limit the spread of a seizure and the duration of a variety of seizure types. This is due to the fine chemical neuroanatomy of ...

Animal models for vagus nerve stimulation in epilepsy.

Experimental Neurology — Fri, 29 Apr 2011 23:00:00 +0100

Authors: Aalbers M, Vles J, Klinkenberg S, Hoogland G, Majoie M, Rijkers K Vagus nerve stimulation (VNS) is a moderately effective adjunctive treatment for patients suffering from medically refractory epilepsy and is explored as a treatment option for several other disorders. The present review provides a critical appraisal of the studies on VNS in animal models of seizures and epilepsy. So far, these studies mostly applied short-term VNS in seizure models, demonstrating that VNS can suppress and prevent seizures and affect epileptogenesis. However, the mechanism of action is still largely unknown. Moreover, studies with a clinically more relevant setup where VNS is chronically applied in epilepsy models are scarce. Future directions for research and the application of this technology ...

Predicting success of vagus nerve stimulation (VNS) from interictal EEG

Seizure: European Journal of Epilepsy — Thu, 21 Apr 2011 23:00:00 +0100

Conclusion: In this study, quantifying EEG symmetry using the pdBSI shows promising results in predicting the reduction of seizure frequency after VNS treatment. (Source: Seizure: European Journal of Epilepsy)

Treatment Options in Juvenile Myoclonic Epilepsy

Current Treatment Options in Neurology — Thu, 14 Apr 2011 17:01:55 +0100

Opinion statement Juvenile myoclonic epilepsy (JME) is characterized by excellent response to treatment, if diagnosed correctly. Lifestyle advice is an integral part of the treatment of JME; it should include recommendations on avoidance of common triggers such as sleep deprivation and alcohol excess and emphasis on the importance of compliance with medication. The drug of first choice in the treatment of JME is sodium valproate, which has a response rate of up to 80%. Valproate should be avoided in women of childbearing age because of significantly increased risks of fetal malformations and neurodevelopmental delay. Levetiracetam or lamotrigine are alternative first-line options if valproate is contraindicated. With limited data from trials to support either of these drug...

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Treatment of Depression in Patients with Epilepsy

Current Treatment Options in Neurology — Wed, 06 Apr 2011 16:28:21 +0100

Opinion statement In this article, we review the current best evidence for the treatment of depression in patients with epilepsy. Depression is a common epilepsy comorbidity, but it is often unrecognized. The most important step in appropriately managing mood disorders in this population is making the diagnosis. Clinical vigilance and routine use of a validated screening tool can improve detection and quality of care. As is increasingly the case for the general population, persons with epilepsy are often interested in exploring alternative therapies for chronic conditions, including depression. Unfortunately, the benefit of complementary and alternative therapies for depression currently is largely unproven for persons with a seizure history, although an early study of exe...

A review of low-intensity focused ultrasound pulsation

Sun, 03 Apr 2011 23:00:00 +0100

This article reviews the background, rationale, and pilot studies to date, using a new brain stimulation method—low-intensity focused ultrasound pulsation (LIFUP). The ability of ultrasound to be focused noninvasively through the skull anywhere within the brain, together with concurrent imaging (ie, functional magnetic resonance imaging [fMRI]) techniques, may create a role for research and clinical use of LIFUP. This technique is still in preclinical testing and needs to be assessed thoroughly before being advanced to clinical trials. In this study, we review over 50 years of research data on the use of focused ultrasound (FUS) in neuronal tissue and live brain, and propose novel applications of this noninvasive neuromodulation method. (Source: BRAIN STIMULATION: Basic, Translational, a...

Chronic vagus nerve stimulation: a new and promising therapeutic approach for chronic heart failure

European Heart Journal — Thu, 31 Mar 2011 23:00:00 +0100

Conclusions This open-label study shows that chronic VNS in CHF patients with severe systolic dysfunction may be safe and tolerable and may improve quality of life and LV function. A controlled clinical trial appears warranted. (Source: European Heart Journal)

Vagus nerve stimulation reduces infarct size in rat focal cerebral ischemia: An unlikely role for cerebral blood flow.

Brain Research — Wed, 30 Mar 2011 23:00:00 +0100

Authors: Ay I, Sorensen AG, Ay H We sought to investigate the effect of cervical vagus nerve stimulation (VNS) on cerebral blood flow (CBF), infarct volume, and clinical outcome in a model of middle cerebral artery occlusion in rats. Electrical stimulation of the right and left vagus nerves was initiated 30min after the induction of the right-sided ischemia and lasted for 1h. Infarct size measurement revealed that the volume of ischemic damage was 41-45% smaller in animals receiving stimulation as compared with control animals. Both the right and left VNS caused subtle reduction in CBF during each 30-s stimulation period that quickly returned back to the baseline level at the end of each stimulation cycle. There was no significant effect of VNS on CBF during the entire 1-h stimulation ...

Chronic vagus nerve stimulation for treatment-resistant depression increases regional cerebral blood flow in the dorsolateral prefrontal cortex

Psychiatry Research: Neuroimaging — Wed, 16 Mar 2011 00:41:53 +0100

Abstract: The purpose of the present study was to assess the effects of vagus nerve stimulation (VNS) therapy on regional cerebral blood flow (rCBF) in depressed patients. Regional cerebral blood flow (rCBF) was assessed by [99mTc]-HMPAO-single photon emission computed tomography (SPECT) before and after 10weeks of VNS in patients participating in an open, uncontrolled European multi-center study investigating efficacy and safety of VNS. Patients suffered from major depression, with a baseline score of≥20 on the 24-item Hamilton Depression Rating Scale (HDRS) and had been unsuccessfully treated with at least two adequately prescribed antidepressant drugs. Data of 15 patients could be analyzed using SPM 2. After 10weeks of VNS (20Hz, 500μs pulse width, stimulation during 30s every 5min a...

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Management of seizures in lennox-gastaut syndrome.

Paediatric Drugs — Mon, 07 Mar 2011 03:45:35 +0100

Authors: Crumrine PK Lennox-Gastaut syndrome is an epilepsy syndrome that begins in childhood (between 1 and 8 years of age), worsens during latency and persists frequently into adulthood, is refractory to antiepileptic medications, and results in cognitive decline and behavioral problems in affected individuals. Seizure types consist primarily of axial tonic, atonic, and atypical absence; nocturnal tonic seizures are the most common seizure pattern in this population, but often are not one of the initial seizure patterns. Some patients also have myoclonic seizures; this seizure pattern is less frequent than the three preceding types. Although there are some cases that are cryptogenic, most are symptomatic, arising during prenatal and perinatal periods from intrauterine infections, and...

The effect of right vagus nerve stimulation on focal cerebral ischemia: an experimental study in the rat

Wed, 23 Feb 2011 05:00:00 +0100

Conclusions: VNS offers neuroprotection against stroke in both temporary and permanent ischemia. Although the precise mechanism of this effect remains to be determined, alterations in cerebral blood flow do not appear to play a role. VNS could readily be translated to clinical practice. (Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation)

In brief

Nature Reviews Neuroscience — Fri, 18 Feb 2011 00:00:00 +0100

Nature Reviews Neuroscience 12, 122 (2011). doi:10.1038/nrn3003 RepairReversing pathological neural activity using targeted plasticityEngineer, N. D.et al. Nature470, 101–104 (2011)Tinnitus is associated with plastic changes in the auditory cortex. By pairing vagus nerve stimulation with sensory inputs (multiple tone (Source: Nature Reviews Neuroscience)

Increased hippocampal noradrenaline is a biomarker for efficacy of vagus nerve stimulation (VNS) in a limbic seizure model

Journal of Neurochemistry — Wed, 16 Feb 2011 00:00:00 +0100

Conclusion: VNS induces increases in extracellular hippocampal noradrenaline, which are at least partly responsible for its seizure‐suppressing effect in a model for limbic seizures, and constitute a potential biomarker for the efficacy of VNS in temporal lobe epilepsy. (Source: Journal of Neurochemistry)

Increased hippocampal noradrenaline is a biomarker for efficacy of vagus nerve stimulation in a limbic seizure model

Journal of Neurochemistry — Wed, 16 Feb 2011 00:00:00 +0100

In this study, we measured VNS‐induced changes in hippocampal neurotransmitter levels and determined their potential involvement in the anticonvulsive action of VNS, to elucidate the mechanism of action responsible for the seizure suppressing effect of VNS in an animal model for limbic seizures. We used in vivo intracerebral microdialysis to measure VNS‐induced changes in hippocampal extracellular concentrations of noradrenaline, dopamine, serotonin and GABA in freely moving, male Wistar rats. During the same experiment, the effect of VNS on pilocarpine‐induced limbic seizures was assessed using video‐EEG monitoring. The involvement of VNS‐induced increases in hippocampal noradrenaline in the mechanims of action of VNS was evaluated by blocking hippocampal α2‐receptors. VNS pr...

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Seizures: Diagnosis and Management in the Outpatient Setting

Seminars in Neurology — Mon, 14 Feb 2011 00:00:00 +0100

Semin Neurol 2011; 31: 054-064DOI: 10.1055/s-0031-1271310ABSTRACTEpilepsy and seizures are common, and can significantly affect quality of life. A careful history and guided evaluation is necessary to avoid misdiagnosis, to establish causation, and to determine prognosis. Medical therapy is effective in controlling seizures in two thirds of people with epilepsy. In choosing which antiepileptic drug to use, it is important to consider epilepsy type, side effect profile, and cost. Even when seizures are controlled, dose-related side effects from antiepileptic medication, such as fatigue and imbalance, can negatively impact health-related quality of life. Teratogenic side effects are also of concern for women of childbearing age. Monotherapy is generally preferred, and with dose titration, a ...

Efficacy of vagus nerve stimulation over time: Review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS >10years.

Epilepsy and Behaviour — Sat, 05 Feb 2011 00:00:00 +0100

CONCLUSION: Following a "ramp-up" and accommodation period throughout the initial 24months after VNS implantation, seizure control improved slightly over the subsequent years of therapy and eventually stabilized. Variation in seizure frequency, however, was common, and frequent changes in AED regimens or stimulation parameters were likely an important and possibly synergistic component of seizure control. PMID: 21296622 [PubMed - as supplied by publisher] (Source: Epilepsy and Behaviour)

Vagus Nerve Stimulation Cuts Depression in Everyday Practice

Medscape Psychiatry Headlines — Thu, 03 Feb 2011 21:42:32 +0100

Vagus nerve stimulation (VNS), shown to help reduce depression in controlled trials, is equally effective in clinical practice, researchers say. Reuters Health Information (Source: Medscape Psychiatry Headlines)

Cyberonics Announces FDA Approval of Aspire High Capacity Generator for VNS Therapy

HSMN NewsFeed — Tue, 01 Feb 2011 23:59:26 +0100

HOUSTON, Feb. 1, 2011 (HSMN NewsFeed) -- Cyberonics, Inc. (Nasdaq:CYBX ) today announced that the AspireHC (High Capacity) generator for use in vagus nerve stimulation (VNS) therapy was approved by the United States Food and Drug Administration (FDA) fo... Devices, FDACyberonics, AspireHC, vagus nerve stimulation, VNS Therapy (Source: HSMN NewsFeed)

Efficacy of vagus nerve stimulation for refractory epilepsy among patient subgroups: A re-analysis using the Engel classification

Seizure: European Journal of Epilepsy — Fri, 28 Jan 2011 00:00:00 +0100

Abstract: Optimal candidates for VNS as a treatment for refractory epilepsy have not been identified. In this retrospective two-center study, we used the Engel classification for evaluating seizure outcome, and tried to identify predictive factors for outcome by means of subgroup analysis. The medical records of patients who have been treated with VNS for at least one year at Dartmouth–Hitchcock Medical Center and Ghent University Hospital were evaluated. Seizure frequency outcome was assessed using the Engel classification for the study population as a whole, and for patient subgroups with regard to mental functioning, seizure type, predisposing factors for developing epilepsy, age at time of VNS implantation and epilepsy duration. 189 patients (102M/87F) were included in the study (mea...

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A New Study Proves The Painkilling Effect Of Transcutaneous Vagus Nerve Stimulation

Health News from Medical News Today — Wed, 26 Jan 2011 09:00:00 +0100

The medical device company cerbomed cooperated with the Clinic for Psychiatry and Psychotherapy of the University of Regensburg 2010 on a randomized, controlled study into somatosensory pain processing. The study, lead by Prof. Dr. Peter Eichhammer and Dr. Volker Busch, aimed to judge the pain-relieving effect of transcutaneous Vagus Nerve Stimulation (t-VNS). In the context of the study, 48 healthy subjects underwent quantitative sensory testing (QST) with and without t-VNS activated on different days... (Source: Health News from Medical News Today)

Can vagus nerve stimulation halt or ameliorate rheumatoid arthritis and lupus?

Lipids in Health and Disease — Mon, 24 Jan 2011 00:00:00 +0100

Acetylcholine, the principal vagus neurotransmitter, inhibits inflammation by suppressing the production of pro-inflammatory cytokines through a mechanism dependent on the alpha7 nicotinic acetylcholine receptor subunit (alpha7nAChR) that explains why vagus nerve stimulation is anti-inflammatory in nature. Strong expression of alpha7nAChR in the synovium of rheumatoid arthritis and psoriatic arthritis patients was detected. Peripheral macrophages and synovial fibroblasts respond in vitro to specific alpha7nAChR cholinergic stimulation with potent inhibition of proinflammatory cytokines. Fibroblasts balance inflammatory mechanisms and arthritis development through feedback cholinergic stimulation by nearby immune cells. Collagen induced arthritis in alpha7nAChR(-/-) mice was significantly s...

Reversing pathological neural activity using targeted plasticity

Nature AOP — Wed, 12 Jan 2011 00:00:00 +0100

Authors: Navzer D. Engineer, Jonathan R. Riley, Jonathan D. Seale, Will A. Vrana, Jai A. Shetake, Sindhu P. Sudanagunta, Michael S. Borland & Michael P. Kilgard Brain changes in response to nerve damage or cochlear trauma can generate pathological neural activity that is believed to be responsible for many types of chronic pain and tinnitus. Several studies have reported that the severity of chronic pain and tinnitus is correlated with the degree of map reorganization in somatosensory and auditory cortex, respectively. Direct electrical or transcranial magnetic stimulation of sensory cortex can temporarily disrupt these phantom sensations. However, there is as yet no direct evidence for a causal role of plasticity in the generation of pain or tinnitus. Here we report evidence that reve...

Vagus Nerve Stimulation Improves Seizure Control at 10 Years

Medscape Psychiatry Headlines — Wed, 05 Jan 2011 01:08:23 +0100

New data show vagus nerve stimulation is a viable long-term option for refractory epilepsy. Medscape Medical News (Source: Medscape Psychiatry Headlines)

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Long-term outcome of vagus nerve stimulation therapy after failed epilepsy surgery

Seizure: European Journal of Epilepsy — Mon, 03 Jan 2011 00:00:00 +0100

Conclusion: VNS therapy in patients who have failed medical and surgical therapies only provides marginal improvement in seizure control but has greater likelihood to improve subjective QoL issues. In addition, VNS has the potential to reduce AED burden without adversely impacting seizure management. Given the low surgical risk of VNS placement, vagus nerve stimulation as a therapeutic modality should be individualized to achieve best clinical response and fewest side effects. (Source: Seizure: European Journal of Epilepsy)

Mania following vagus nerve stimulation: A case report and review of the literature.

Epilepsy and Behaviour — Sat, 01 Jan 2011 00:00:00 +0100

Authors: Gerson R, Murray E, Price B, Frankel M, Douglass LM, Cunningham M Vagus nerve stimulation (VNS) is an increasingly used therapy for patients with treatment-refractory epilepsy and depression. Hypomanic and manic symptoms are a rare but recognized adverse effect of VNS treatment. Here we describe a case in which VNS treatment in a patient with epilepsy and unipolar depression was associated with the rapid development of manic symptoms. The patient's manic symptoms resolved with temporary discontinuation of the VNS current, and the patient was eventually able to resume VNS treatment with good effect and without further manic symptoms. Mania is a rare but serious side effect of VNS; however, in this case and in the majority of reported cases of VNS-associated mania, symptoms reso...

Magnetoencephalography in epilepsy patients carrying a vagus nerve stimulator

Epilepsy Research — Thu, 30 Dec 2010 02:16:09 +0100

This study evaluates (1) the feasibility of MEG in VNS patients and (2) the added value of MEG in their presurgical evaluation (PE).Ten VNS patients were studied by MEG using the spatiotemporal signal space separation (tSSS) method. Equivalent current dipoles (ECD) were classified “clustered”/“scattered”. It was evaluated whether MEG (1) confirmed localisation of the hypothesized epileptogenic zone (HEZ), (2) improved delineation of the HEZ, or (3) identified 1 out of multiple HEZs. Finally it was evaluated whether adding MEG to the PE improved patient management by changing or supporting the hypothesis.In 7/10 patients, tSSS allowed to obtain interpretable MEG data, with interictal epileptiform discharges in 6/7. ECD clustered within 1 lobe in 4/6; confirming the localisation of t...

Cost-Effectiveness Of Cyberonics' VNS Therapy® System For Epilepsy Reinforced By 1,600-Patient Emory University School Of Medicine Study

Health News from Medical News Today — Tue, 28 Dec 2010 09:00:00 +0100

Cyberonics, Inc. (Nasdaq: CYBX) announced that the VNS Therapy System, the only FDA-approved implantable medical device for the treatment of refractory epilepsy, was featured in 22 poster presentations and in the Plenary II session on neurostimulation at the annual American Epilepsy Society Meeting that took place recently in San Antonio, Texas. Of particular significance at the meeting, Sandra Helmers, M.D... (Source: Health News from Medical News Today)

Vagus nerve stimulation: A new approach to reduce heart failure.

Cardiology Journal — Thu, 23 Dec 2010 23:10:04 +0100

Authors: Klein HU, Ferrari GM Autonomic imbalance with increased adrenergic and reduced parasympathetic activity is involved in the development and progress of heart failure (HF). Experimental data have demonstrated that stimulation of the vagus nerve is able to reverse ventricular remodeling of the failing heart. There is also evidence that increasing parasympathetic activity may stimulate the production of nitric oxide, and reduce the devastating inflammatory process involved in HF. Vagus nerve stimulation (VNS) has been successfully applied for many years to treat drug resistant epilepsy. The first study of right vagus stimulation in patients with advance HF has proven the feasibility and safety of this new approach. Long term follow-up of increased vagal tone over 12 months with a ...

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Cost-Effectiveness Of Cyberonics' VNS Therapy® System For Epilepsy Reinforced By 1,600-Patient Emory University School Of Medicine Study

Medical Design Online News — Tue, 21 Dec 2010 08:46:00 +0100

Cyberonics, Inc. (Nasdaq: CYBX) announced today that the VNS Therapy System, the only FDA-approved implantable medical device for the treatment of refractory epilepsy, was featured in 22 poster presentations and in the Plenary II session on neurostimulation at the annual American Epilepsy Society Meeting that took place recently in San Antonio, Texas (Source: Medical Design Online News)

Using Vagus Nerve Stimulation Correctly

Medscape Today Headlines — Fri, 17 Dec 2010 23:13:56 +0100

Dr. Andrew Wilner reviews the latest evidence regarding the use of vagus nerve stimulation in treating epilepsy. Medscape Neurology & Neurosurgery (Source: Medscape Today Headlines)

Vagus nerve stimulation: from pre-clinical to clinical application: challenges and future directions

Heart Failure Reviews — Fri, 17 Dec 2010 06:52:39 +0100

Abstract Vagus nerve stimulation was performed experimentally for the first time more than 150 years ago. In the 1980s and 1990s, vagus nerve stimulation was shown, both in the anesthetized and in the conscious animal, to exert marked antiarrhythmic effects, particularly during acute myocardial ischemia. There is a strong rationale for a beneficial effect of augmented vagal activity in the setting of chronic heart failure. Studies in experimental models of heart failure showed that chronic vagus nerve stimulation exerts beneficial effects on left ventricular function and on survival. Vagus nerve stimulation is approved in man for refractory epilepsy and depression. The first-in-man study performed in 32 patients with chronic heart failure suggests that vagus nerve sti...

Changes in Gustatory Perceptions of Patients with Major Depression Treated with Vagus Nerve Stimulation (VNS)

Pharmacopsychiatry — Tue, 14 Dec 2010 00:00:00 +0100

PharmacopsychiatryDOI: 10.1055/s-0030-1268427AbstractBackground: Olfactory and gustatory functions were investigated before and during vagus nerve stimulation (VNS) in a group of 9 patients with therapy-resistant depression, implanted with a VNS system.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Pharmacopsychiatry)

Vagus nerve stimulation as a strategy to prevent and manage metabolic syndrome

Medical Hypotheses — Thu, 09 Dec 2010 00:00:00 +0100

Abstract: An increase in pro-inflammatory cytokines, decrease in endothelial nitric oxide (eNO) and adiponectin levels and an alteration in hypothalamic peptides and gastrointestinal hormones such as incretins and cholecystokinin that regulate satiety, hunger, and food intake occur in metabolic syndrome. Thus, metabolic syndrome is a low-grade systemic inflammatory condition and could be due to inappropriate cross-talk between the peripheral tissues and the hypothalamic centers implying that methods designed to restore these two abnormalities to normal could be of significant benefit in metabolic syndrome. Vagus nerve stimulation has been shown to suppress inflammation and acetylcholine, the principal vagal neurotransmitter, modulates the actions of several hypothalamic peptides and incret...

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Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: Long-term outcomes and predictors of response.

Epilepsy and Behaviour — Mon, 06 Dec 2010 00:00:00 +0100

CONCLUSION: Vagus nerve stimulation is a safe and effective palliative treatment option for focal and generalized TRE in adults and children. When used in conjunction with a multidisciplinary and multimodality treatment regimen including aggressive antiepileptic drug regimens and epilepsy surgery when appropriate, more than 60% of patients with TRE experienced at least a 50% reduction in seizure burden. Good results were seen in patients with non-U.S. Food and Drug Administration-approved indications. Prospective, randomized trials are needed for patients with generalized epilepsies and for younger children to potentially expand the number of patients who may benefit from this palliative treatment. PMID: 21144802 [PubMed - as supplied by publisher] (Source: Epilepsy and Behaviour)

Vagus nerve stimulation in experimental heart failure

Heart Failure Reviews — Thu, 02 Dec 2010 18:14:34 +0100

Abstract Chronic heart failure (HF) is associated with autonomic dysregulation characterized by a sustained increase in sympathetic drive and by withdrawal of parasympathetic activity. Sympathetic overdrive and increased heart rate are predictors of poor long-term outcome in patients with HF. Considerable evidence exists that supports the use of pharmacologic agents that partially inhibit sympathetic activity as effective long-term therapy for patients with HF; the classic example is the wide use of selective and non-selective beta-adrenergic receptor blockers. In contrast, modulation of parasympathetic activation as potential therapy for HF has received only limited attention over the years given its complex cardiovascular effects. In this article, we review the results o...

Vagus nerve stimulator treatment in adult-onset Rasmussen's encephalitis.

Epilepsy and Behaviour — Wed, 01 Dec 2010 00:00:00 +0100

We describe a patient with adult-onset Rasmussen's encephalitis (RE) responsive to vagus nerve stimulation. This previously healthy woman developed RE in the right hemisphere at the age of 27. Despite antiepileptic drug polytherapy, she continued to experience subcontinuous, simple-partial left-sided motor seizures and slowly progressive cognitive impairment. Resective surgery was not considered owing to the preservation of left motor skills. She was implanted with a vagus nerve stimulator at the age of 41; after 6months she experienced a greater than 50% reduction in seizure frequency, which persisted over 2years together with improvement of her neurological and cognitive status. PMID: 21130042 [PubMed - as supplied by publisher] (Source: Epilepsy and Behaviour)

[Perioperative anaesthetic management of an epileptic patient treated with a vagus nerve stimulation.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 26 Nov 2010 00:00:00 +0100

We report the perioperative management of an epileptic patient with this indwelling device. This observation summarizes the physiologic implications and the specific anaesthetic considerations for procedures with this pre-existing device. PMID: 21112732 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

A novel implantable vagus nerve stimulation system (ADNS-300) for combined stimulation and recording of the vagus nerve: Pilot trial at Ghent University Hospital

Epilepsy Research — Wed, 24 Nov 2010 06:52:09 +0100

Conclusion: This feasibility study demonstrates that the ADNS-300 system can be used for combined therapeutic stimulation (in 3/3 patients) and recording of CAPs in response to VNS (in 2/3 patients) up to three weeks after surgery. Implantation in a larger number of patients will lead to a better understanding of the electrophysiology of the vagus nerve, which in turn could result in more adequate and individualized VNS parameter choice. (Source: Epilepsy Research)

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Cardiovascular modulation during vagus nerve stimulation therapy in patients with refractory epilepsy

Epilepsy Research — Wed, 24 Nov 2010 06:52:06 +0100

Summary: To evaluate the effects of permanent vagal stimulation on cardiovascular system, 10 patients, affected by drug-resistant epilepsy with no primitive cardiovascular pathologies, were assessed prior to VNS surgery. A complete echocardiographic study [conventional and tissue Doppler imaging (TDI)], 24-h blood pressure (BP) monitoring and HRV evaluation were performed. The above mentioned parameters were investigated without any substantial changes to drug treatment during a check-up subsequent to VNS activation [mean: 7.7 months]. The results obtained show that while the anthropometrical data and both conventional and TDI echocardiography were unvaried compared to baseline, BP showed a significant increase of both systodiastolic values. Moreover, a close scrutiny of the most affected ...

Anti-inflammatory effect of vagus nerve stimulation in a rat model of inflammatory bowel disease

Autonomic Neuroscience: Basic and Clinical — Fri, 12 Nov 2010 00:00:00 +0100

Abstract: Vagus nerve stimulation of afferents is used as an adjunctive treatment for drug-resistant epilepsy and depression. In addition, anti-inflammatory properties of vagus nerve stimulation have been reported in various experimental models of inflammation but not in colitis. These effects are thought to be mediated via peripheral release of acetylcholine from the vagus and subsequent activation of macrophages. Our aim was to evaluate in rats the anti-inflammatory effects of chronic vagus nerve stimulation on colonic inflammation. Colitis was induced by intracolonic instillation of trinitrobenzene sulfonic acid. Vagus nerve stimulation (left cervical) was performed in freely moving animals 3h per day for five consecutive days. Assessment of colonic inflammation was obtained using physi...

Anti-inflammatory effect of vagus nerve stimulation in a rat model of inflammatory bowel disease.

Autonomic Neuroscience — Wed, 10 Nov 2010 00:00:00 +0100

Authors: Meregnani J, Clarençon D, Vivier M, Peinnequin A, Mouret C, Sinniger V, Picq C, Job A, Canini F, Jacquier-Sarlin M, Bonaz B Vagus nerve stimulation of afferents is used as an adjunctive treatment for drug-resistant epilepsy and depression. In addition, anti-inflammatory properties of vagus nerve stimulation have been reported in various experimental models of inflammation but not in colitis. These effects are thought to be mediated via peripheral release of acetylcholine from the vagus and subsequent activation of macrophages. Our aim was to evaluate in rats the anti-inflammatory effects of chronic vagus nerve stimulation on colonic inflammation. Colitis was induced by intracolonic instillation of trinitrobenzene sulfonic acid. Vagus nerve stimulation (left cervical) was perf...

Cyberonics Confirms Safety and Efficacy of VNS Therapy(R)

HSMN NewsFeed — Fri, 05 Nov 2010 19:04:23 +0100

HOUSTON, Nov. 5, 2010 (HSMN NewsFeed) -- To correct and clarify assertions and implications included in some recent media reports, Cyberonics, Inc. (Nasdaq:CYBX ) today confirmed the safety and efficacy of its vagus nerve stimulation (VNS) Therapy by emp... Devices, NeurologyCyberonics, vagus nerve stimulation, VNS Therapy, epilepsy (Source: HSMN NewsFeed)

Efficacy and tolerability of long-term treatment with vagus nerve stimulation in adolescents and adults with refractory epilepsy and learning disabilities

Seizure: European Journal of Epilepsy — Mon, 01 Nov 2010 00:00:00 +0100

Abstract: The long-term effects of vagus nerve stimulation (VNS) on seizure frequency were studied in 50 patients with epilepsy and learning disabilities. Mean observation time was 4.6 years. At follow-up, none of the patients was seizure-free, 25% had more than 50% seizure reduction, and 46% had some seizure reduction, but less than 50%. The discontinuation rate was 18%. Our results indicate that, like antiepileptic drugs, VNS does not have such a good seizure-reducing effect in patients with epilepsy and learning disabilities compared with the general epilepsy population. (Source: Seizure: European Journal of Epilepsy)

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Vagus nerve stimulation: effectiveness and tolerability in patients with epileptic encephalopathies

Child's Nervous System — Sun, 31 Oct 2010 05:46:07 +0100

Conclusion VNS is an effective and well-tolerated treatment for patients with epileptic encephalopathies EEs, improving QOL and neuropsychological performance. Content Type Journal ArticleDOI 10.1007/s00381-010-1314-8Authors Ricardo O. Cersósimo, Neurology Department, Hospital de Niños “Prof. Dr. Juan P Garrahan”, Combate de los Pozos 1881, Buenos Aires, CP 1245 ArgentinaMarcelo Bartuluchi, Neurosurgery Department, Hospital de Niños “Prof. Dr. Juan P Garrahan”, Combate de los Pozos 1881, Buenos Aires, CP 1245 ArgentinaCecilia De Los Santos, Neurology Department, Hospital de Niños “Prof. Dr. Juan P Garrahan”, Combate de los Pozos 1881, Buenos Aires, CP 1245 ArgentinaIrene Bonvehi, Neurology Department, Hospital de Niños “Prof. Dr. Juan P Garrahan”...

[Therapeutic neuromodulation in primary headaches.]

Der Nervenarzt — Sat, 23 Oct 2010 23:00:00 +0100

Authors: May A, Jürgens TP Neuromodulatory techniques have developed rapidly in the therapeutic management of refractory headaches. Invasive procedures comprise peripheral nerve stimulation (particularly occipital nerve stimulation), vagus nerve stimulation, cervical spinal cord stimulation and hypothalamic deep brain stimulation. Transcutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive variants. Based on current neuroimaging, neurophysiological and clinical studies occipital nerve stimulation and hypothalamic deep brain stimulation are recommended for patients with chronic cluster headache. Less convincing evidence can be found for their use in other refractory headaches such as chronic migra...

Clinical course of young patients with Dravet syndrome after vagal nerve stimulation.

European Journal of Paediatric Neurology — Thu, 21 Oct 2010 23:00:00 +0100

Authors: Zamponi N, Passamonti C, Cappanera S, Petrelli C Medical treatment of Dravet syndrome is disappointing. Ketogenic Diet and neurostimulation procedures as Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation are in ongoing evaluation. In the present study, the long-term effectiveness of VNS on seizures, cognition and behavior was retrospectively evaluated in eight young patients with DS and medically refractory epilepsy (mean age at VNS implant: 10.28 years, range: 5-25). The average duration of treatment was 54 months (range: 12-120). Compared to baseline (mean: 55; standard deviation: 83, range: 4-200), the mean number of monthly seizures after VNS implantation was 39 ± 67 at 3 months, 42 ± 67 at 6 months and 38 ± 69 at twelve months (not significant comparisons)...

Vagus nerve stimulation for epilepsy

Neurological Conditions Specialist Library — Wed, 20 Oct 2010 11:55:08 +0100

This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. (Source: Neurological Conditions Specialist Library)

Antireflux Action of Nissen Fundoplication and Stretch-Sensitive Mechanism of Lower Esophageal Sphincter Relaxation

Gastroenterology — Mon, 18 Oct 2010 00:00:00 +0100

Conclusions: Fundoplication reduces LES relaxation by interfering with axial stretch on the LES. Based on this mechanism of the antireflux actions of fundoplication, it might be possible to design new surgical strategies to treat reflux disease and reduce complications of fundoplication surgery. (Source: Gastroenterology)

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Acute Relapse After Successful Vagus Nerve Stimulation Therapy: A Case Report of Last-Resort ECT Treatment.

Primary Care Companion to the Journal of Clinical Psychiatry — Sat, 16 Oct 2010 11:40:05 +0100

Authors: Santermans L, Vanderbruggen N, Baeken C PMID: 20944785 [PubMed - in process] (Source: Primary Care Companion to the Journal of Clinical Psychiatry)

Early seizure detection in rats based on vagus nerve activity

Medical and Biological Engineering and Computing — Sat, 02 Oct 2010 05:56:12 +0100

This study investigates the possibility of early seizure detection based on the cervical vagus electroneurogram (VENG). Fourteen anesthetized rats received an intravenous infusion (IV) of either saline (control, n = 6) or pentylenetetrazol (PTZ) diluted in saline (PTZ-treated, n = 8). A cardiac-related VENG profile (CrVENG) was derived by using R-peak triggered averaging of the VENG energy. Following, changes in this profile were evaluated as a seizure predictor. Using left nerve VENG, seizures were detected in all PTZ-treated rats 103 ± 51 s (mean ± SD) before they developed tonic seizures. Control rats did not develop seizures and our method did also not detected seizures in these rats. Seizures can be early detecting based on left nerve...

The role of the vagus nerve in stroke

Autonomic Neuroscience: Basic and Clinical — Tue, 28 Sep 2010 00:00:00 +0100

Abstract: The initiation and progression of ischemic and hemorrhagic stroke are the result of a complex cascade of processes that determine both the extent of the lesion and long-term outcome. Several of these processes, including peripheral inflammation, neuroinflammation, and neuroplasticity are influenced by the activity of the afferent as well as efferent pathways of the vagus nerve. It was shown that vagus nerve stimulation significantly reduces the extent of stroke-induced lesion of brain parenchyma. However, the mechanisms of beneficial effect of increased vagal activity on pathological processes related to stroke remains largely unclear. The aim of this article is to describe the role of afferent and efferent vagal pathways in the mechanisms that influence the initiation of stroke ...

The role of the vagus nerve in stroke.

Autonomic Neuroscience — Tue, 21 Sep 2010 23:00:00 +0100

Authors: Mravec B The initiation and progression of ischemic and hemorrhagic stroke are the result of a complex cascade of processes that determine both the extent of the lesion and long-term outcome. Several of these processes, including peripheral inflammation, neuroinflammation, and neuroplasticity are influenced by the activity of the afferent as well as efferent pathways of the vagus nerve. It was shown that vagus nerve stimulation significantly reduces the extent of stroke-induced lesion of brain parenchyma. However, the mechanisms of beneficial effect of increased vagal activity on pathological processes related to stroke remains largely unclear. The aim of this article is to describe the role of afferent and efferent vagal pathways in the mechanisms that influence the initiatio...

Excitation properties of the right cervical vagus nerve in adult dogs.

Experimental Neurology — Thu, 16 Sep 2010 23:00:00 +0100

Authors: Castoro MA, Yoo PB, Hincapie JG, Hamann JJ, Ruble SB, Wolf PD, Grill WM Vagus nerve stimulation (VNS) is an approved treatment for epilepsy and depression, and it is currently under investigation for applications in Alzheimer's disease, anxiety, heart failure, and obesity. However, the mechanism(s) by which VNS has its effects are not clear, and the stimulation parameters for obtaining therapeutic outcomes appear highly variable. The purpose of this study was to quantify the excitation properties of the right cervical vagus nerve in adult dogs anesthetized with propofol and fentanyl. Input-output curves of the right cervical vagus nerve compound action potential and laryngeal muscle electromyogram were measured in response to VNS across a range of stimulation parameters: ampli...

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Burn-Induced Organ Dysfunction: Vagus Nerve Stimulation Improves Cardiac Function

Medscape Cardiology Headlines — Tue, 07 Sep 2010 16:00:00 +0100

Can electrical vagus nerve stimulation help improve cardiac function in patients with burn injuries? ePlasty, Open Access Journal of Plastic Surgery (Source: Medscape Cardiology Headlines)

Time Course of Therapeutic Response, and Durability, of the Different Brain Stimulation Methods—From the Editor-in Chief’s Desk

Thu, 02 Sep 2010 23:00:00 +0100

One of the more fascinating aspects of the vast new Brain Stimulation frontier involves the widely differing time course of therapeutic effects. These vary profoundly with the various brain stimulation methods and different diseases. For example, high frequency (>100 Hz) deep brain stimulation (DBS) of the subthalamic nucleus (STN) causes a near immediate cessation of the tremor of Parkinson’s disease (PD). The tremor continues to be treated for many years as long as the device is in the brain and turned on. However, if a lead breaks or the battery depletes, the tremor returns almost instantaneously. That is, in general, there is no durability of the therapeutic effect of DBS for PD tremor beyond the instant of stimulation. In contrast, the same technology, DBS, applied in much the same ...

Newer Anticonvulsant Medications in Pediatric Neurology

Current Treatment Options in Neurology — Thu, 02 Sep 2010 08:26:09 +0100

This article focuses on studies and expert opinion consensus to guide the choice of AEDs. Content Type Journal ArticleDOI 10.1007/s11940-010-0094-5Authors Michael M. Quach, Texas Children’s Hospital, 6621 Fannin, CC1250, Houston, TX 77030, USAAbdul Mazin, Section of Pediatric Neurology, University of Chicago, 5721 South Maryland Avenue, MC 3055, Rm. C-391, Chicago, IL 60637, USAJames J. Riviello, Texas Children’s Hospital, 6621 Fannin, CC1250, Houston, TX 77030, USA Journal Current Treatment Options in NeurologyOnline ISSN 1534-3138Print ISSN 1092-8480 (Source: Current Treatment Options in Neurology)

Effects of the vagus nerve stimulation on amygdalohypothalamic and amygdalobulbular influences.

Doklady Biological Sciences — Tue, 31 Aug 2010 23:00:00 +0100

Authors: Lyubashina OA, Nozdrachev AD PMID: 20963652 [PubMed - in process] (Source: Doklady Biological Sciences)

Vagus nerve stimulation for drop attacks in a pediatric population.

Epilepsy and Behaviour — Tue, 24 Aug 2010 23:00:00 +0100

Authors: Abd-El-Barr MM, Joseph JR, Schultz R, Edmonds JL, Wilfong AA, Yoshor D A retrospective analysis of 43 patients with drop attack seizures who were treated with vagus nerve stimulation (VNS) was undertaken to determine the efficacy of VNS and to determine pre-implantation characteristics associated with VNS success. It was found that on last follow-up, 46% of patients had at least a 75% reduction in drops per day. Forty-six percent of patients had less than a 50% reduction in drops per day and were considered nonresponders. Univariate analysis failed to uncover significant associations between pre-implantation characteristics and VNS success. It was found that atonic head nods were more amenable to VNS treatment as compared with atonic or tonic drop attacks. In addition, patient...

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Vagus nerve stimulation and the postictal state.

Epilepsy and Behaviour — Mon, 16 Aug 2010 23:00:00 +0100

Authors: Vonck K, Raedt R, Boon P Vagus nerve stimulation (VNS) is an established neurostimulation therapy used to treat refractory epilepsy. The effect of acute or chronic VNS on the postictal state as a separate entity is seldom reported in clinical or experimental studies. Apart from its antiseizure effects, VNS has several other beneficial effects. These effects may be of particular benefit for patients with postictal neuropsychiatric symptoms. The hypothesized mechanisms underlying the initiation and sustainment of the postictal phase, to some extent, overlap with mechanisms involved in the seizure-suppressing effects of VNS as well as other neurological and psychotropic effects of VNS. Both the clinical symptoms and the basic research hypotheses of the postictal state show simila...

Evolution in VNS therapy for refractory epilepsy, experience with Demipulse devices at Ghent University Hospital

Seizure: European Journal of Epilepsy — Wed, 11 Aug 2010 23:00:00 +0100

Abstract: Rationale: Vagus nerve stimulation (VNS) is a frequently used treatment for patients with refractory epilepsy who are unsuitable candidates for epilepsy surgery. There has been a steady evolution in VNS technology, as generators’ volumes have become smaller and battery life expectancy longer. This pilot study is an open-label retrospective study that describes our experience with the latest commercially available generator, i.e. the VNS Therapy™ Demipulse Model 103. Treatment efficacy and side effects, as well as technical and practical enhancements useful for the patient and for the medical staff are discussed in this study.Methods: Twenty patients (11F/9M) with a mean age of 40 years (range 8–61), who were considered unsuitable candidates for resective surgery, were impla...

Cyberonics Board of Directors Nominates Jon T. Tremmel

HSMN NewsFeed — Mon, 09 Aug 2010 16:07:40 +0100

Founder Reese S. Terry, Jr. Retires HOUSTON, Aug. 9 (HSMN NewsFeed) -- Cyberonics, Inc. (Nasdaq:CYBX ) today announced that Jon T. Tremmel has been nominated to stand for election to its Board of Directors. Mr. Tremmel will replace Reese Terry, a di... Devices, Neurology, PersonnelCyberonics, VNS Therapy, neurostimulation (Source: HSMN NewsFeed)

APA Releases New Depression Treatment Guidelines

About.com Mental Health — Wed, 04 Aug 2010 23:00:00 +0100

The American Psychiatric Association (not to be confused with the American Psychological Association) has released new treatment guidelines for depression. According to Medscape Today, the guidelines include: A clinician- and/or patient-administered rating scale for psychiatric symptoms to help with treatment strategies; A recommendation for the use of electroconvulsive therapy (ECT or "shock therapy") to treat depression if many other treatments have been tried unsuccessfully, along with monoamine oxidase inhibitors (MAOIs), transcranial magnetic stimulation, and vagus nerve stimulation as other potential options; Aerobic exercise or resistance training to improve mood symptoms, especially in older adults with other physical or mental illness; and Consideration of long-term mai...

Vagus nerve stimulation for depression

MayoClinic.com Full Feed — Fri, 30 Jul 2010 05:00:00 +0100

Vagus nerve stimulation — Overview covers definition, risks, results of this procedure to treat depression. (Source: MayoClinic.com Full Feed)

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The effect of vagus nerve stimulation therapy on body mass index in children.

Epilepsy and Behaviour — Thu, 29 Jul 2010 23:00:00 +0100

Authors: Kansagra S, Ataya N, Lewis D, Gallentine W, Mikati MA The effects of vagus nerve stimulation on weight in individuals with epilepsy are not fully characterized. A retrospective review was performed of all pediatric patients who underwent placement of a vagus nerve stimulator at Duke University Medical Center. Baseline body mass index (BMI) percentile was compared with percentile on follow-up visits. We studied 23 patients who had undergone VNS placement during the period 2001-2009. Baseline BMI percentile was 61.7+/-34.3. We had a power of 81% to detect a difference of 20 in BMI percentile from baseline to last follow-up. At the 1-year follow-up (mean=345+/-112days) and last follow-up (mean 4.2+/-2.4years) the average BMI percentile was 61.6+/-31.88 and 56.09+/-30.83, respecti...

Inflammatory cytokines and nitric oxide in heart failure and potential modulation by vagus nerve stimulation

Heart Failure Reviews — Sat, 24 Jul 2010 20:05:58 +0100

Abstract In heart failure, an inflammatory response may occur. The relationship between inflammatory cytokines, NOS and heart failure progression remains uncertain. Parasympathetic activation can affect heart rate and AV conduction. In heart failure, a relationship between the vagus nerve and the inflammatory response has been proposed. Vagal nerve stimulation can modulate the inflammatory response and affect specific inflammatory mediators including nitric oxide that may be contributory to continued or progressive heart failure. Therefore, vagal nerve stimulation may have beneficial effects that are independent from heart rate or AV conduction in heart failure. Challenges remain regarding the relationship between specific inflammatory markers and heart failure and how to ...

Vagus Nerve Stimulation in Refractory Epilepsy: Effects on Pro- and Anti-Inflammatory Cytokines in Peripheral Blood

Neuroimmunomodulation — Fri, 16 Jul 2010 23:00:00 +0100

Neuroimmunomodulation 2011;18:52â56 (DOI:10.1159/000315530) (Source: Neuroimmunomodulation)

Electrical Stimulation in Epilepsy: Vagus Nerve and Brain Stimulation

Current Treatment Options in Neurology — Fri, 16 Jul 2010 07:49:32 +0100

Opinion statement Vagus nerve stimulation (VNS) for epilepsy is a well established and effective treatment for medically intractable epilepsy. VNS is indicated if resective epilepsy surgery is unsuccessful or is not an option. About 50% of patients with VNS have a seizure reduction greater than 50%, but less than 10% become seizure-free. VNS also has an alerting effect on patients and may allow a reduction in sedating medications. The major adverse event is hoarseness, but treatment is generally well tolerated. The therapeutic effect can be delayed: patients may improve several months after VNS implantation. Direct brain stimulation (DBS) is an emerging treatment for epilepsy. Scheduled stimulation is similar to brain stimulation in Parkinson’s disease. Only the anterior...

Vagus nerve stimulation for the management of seizures in children: an 8-year experience

Journal of Pediatric Surgery — Wed, 30 Jun 2010 23:00:00 +0100

Conclusions: Although the effectiveness of VNS is variable and unpredictable, safety is high even in young children. Because of the potential benefit for these complex patients, the implantation of this nerve stimulation device should be included in the armamentarium of pediatric surgeons. (Source: Journal of Pediatric Surgery)

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Refractory central supratentorial hiccup partially relieved with vagus nerve stimulation

Journal of Neurology, Neurosurgery and Psychiatry — Fri, 25 Jun 2010 09:19:31 +0100

(Source: Journal of Neurology, Neurosurgery and Psychiatry)

Effect of chronic vagal nerve stimulation on interictal epileptiform discharges

Seizure: European Journal of Epilepsy — Thu, 24 Jun 2010 23:00:00 +0100

Abstract: We evaluated the effect of vagus nerve stimulation (VNS) on interictal epileptiform discharges (IEDs) in 32 epileptic patients (18 females; 14 males) with an average age of 42.2±11.4 years, all of whom had been suffering from epilepsy for an average of 29.2±14.5 years. All of the patients had received VNS for 5 years. The first EEG was performed prior to the initiation of stimulation; the second EEG was performed at the 5-year follow-up visit. The duration of each EEG was 30min. We compared these two EEGs in terms of the number of IEDs present in each patient and correlated them to other variables.The average total number of IEDs during EEG and the total number of seconds in which IEDs were present decreased significantly after 5 years of stimulation from 97.3±106.9 resp. 80.6...

Chronic vagus nerve stimulation decreased weight gain, food consumption and sweet craving in adult obese minipigs.

Appetite — Fri, 18 Jun 2010 23:00:00 +0100

Authors: Val-Laillet D, Biraben A, Randuineau G, Malbert CH Chronic vagus nerve stimulation (VNS) is known to influence food intake and body weight in animals and humans. The aim of our work was to evaluate the effects of long-term VNS in adult obese minipigs. Eight minipigs were fed ad libitum a western diet to cause obesity, after which half of the animals were implanted with bilateral vagal electrodes connected to constant current stimulators (2mA, 30Hz, 500-mus-pulse, ON 30s, OFF 5min). The other animals were implanted with sham devices. Animals were weighed weekly and their daily consumption was measured. Still 14 weeks after surgery, VNS animals (70.3+/-3.3kg, P > 0.10) did not significantly gain weight compared to sham animals (80.6+/-8.0kg, P < 0.05). Furthermore, food co...

Arrhythmias and vagus nerve stimulation

Heart Failure Reviews — Fri, 18 Jun 2010 10:37:28 +0100

Abstract Enhancing vagal tone by delivering electrical stimulation to the vagal nerves (VNS) is emerging as a promising novel therapy in heart failure. In addition, VNS is already an FDA-approved therapy for refractory epilepsy and depression. Besides its well-known negative chronotropic, inotropic, and dromotropic effects, VNS has profound effects on cardiac electrophysiology and arrhythmogenesis. This review summarizes current knowledge about the complex relationship between VNS and cardiac arrhythmias. Specifically, the focus is on VNS capability to become a therapeutic strategy along with important electrophysiological alterations that may constitute a potential arrhythmogenic substrate and become a clinical concern. Content Type Journal ArticleDOI 10.1007/s10741-0...

The relation between epilepsy and obstructive sleep apnea syndrome: review

Journal of Epilepsy and Clinical Neurophysiology — Fri, 18 Jun 2010 06:12:10 +0100

CONCLUSION: The OSA is underreported in the pharmacoresistent epilepsy population and in daily excessive sleepiness patients (that can be consequence of the OSA) such as in that who will be submitted to the vagus nerve stimulation (may enhance OSA in patients with preexisting OSA) with the aim of seizure control. The data of this review raises the hypothesis that there is a important relationship between OSA and seizure, because some studies suggest the mutual relationship between the two factors in spite of not being statistically significant. In other hand, in a case report was hypothesized that the pathophysiology of OSA in patients with epilepsy may be impacted by frequent,extensive interictal epileptiform discharges or seizures altering upper airway control during sleep. This review a...

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cerbomed Reports Positive Intermediate Results From Epilepsy Pilot Study

Health News from Medical News Today — Thu, 10 Jun 2010 03:00:00 +0100

An evaluation has revealed positive intermediate results for the first three months of data from the clinical trials for the treatment of therapy resistant epilepsies with the world's first device using transcutaneous vagus nerve stimulation (t-VNS®), from cerbomed gmbh. t-VNS® proves its good safety profile and scores high on user-friendliness, and there are also preliminary indications of its effectiveness, for the patients in the cMPsE01 pilot study... (Source: Health News from Medical News Today)

Vagus Nerve Stimulation for Refractory Epilepsy in Tuberous Sclerosis

Pediatric Neurology — Tue, 08 Jun 2010 13:43:47 +0100

The goal of the study was to assess the long-term seizure and neuropsychologic outcomes of patients with tuberous sclerosis and refractory epilepsy who received vagus nerve stimulator implantation. Eleven patients with a follow-up period of at least 12 months were studied retrospectively. The mean age at the time of implantation was 14 years (range, 2-35). Seizure outcome was rated as class I (>80% seizure frequency reduction) in 1 (9%), class II (50-79% reduction) in 7 (63%), and class III ( (Source: Pediatric Neurology)

Treatment of refractory epilepsy in adult patients with right-sided vagus nerve stimulation

Epilepsy Research — Mon, 31 May 2010 23:00:00 +0100

We present two adult patients who underwent R-VNS. One of the patients improved dramatically after L-VNS, but the device had to be removed because of mechanical malfunction. This patient was thought to be at high risk for nerve injury if L-VNS reimplantation was done, thus R-VNS was chosen. In the other patient, L-VNS was first attempted, but the operation had to be stopped due to significant bleeding caused by the accidental tearing of an ectopic vein. Both patients had a marked reduction in their seizure activity and none of them had cardiac side effects from therapeutic R-VNS.We conclude that R-VNS therapy is an alternative, promising therapy for reducing seizure activity in those patients who cannot undergo L-VNS implantation. Close follow-up and frequent ECG monitoring is required to ...

Neuromodulation for refractory headaches

Neurological Sciences — Thu, 13 May 2010 07:43:40 +0100

Abstract Drug refractory headaches constitute an important cause of social life disability; when a lack of responsiveness to conservative treatments is ascertained for these pathological conditions, surgical options are considered. Several lines of evidence exist to assert that the neuromodulation procedures available so far are safe and effective in a large amount of patients for the treatment of different types of severe primary and secondary headaches. Central (deep-brain stimulation, DBS) and peripheral [vagus nerve stimulation (VNS), occipital nerve stimulation (ONS), subcutaneous trigeminal stimulation] neuromodulation procedures are here reviewed as reported in literature along with the experience of our Institute. Content Type Journal ArticleCategory Neuromodul...

Intraoperative and perioperative complications with a vagus nerve stimulation device

Journal of Clinical Anesthesia — Wed, 21 Apr 2010 12:42:11 +0100

Abstract: Vagus nerve stimulation (VNS) for medically refractory seizures has been an approved therapy by the Food and Drug Administration since 1997, with additional approval as an adjunct therapy for major depression granted in 2005. Potential applications for VNS therapy in obesity, neuropsychiatric disorders, and chronic pain syndromes are under investigation. Bradyarrhythmias, including asystole, may occur during VNS device placement or as a delayed complication. A peritracheal hematoma may develop following VNS device placement, necessitating emergent management. Other respiratory complications may include vocal cord movement abnormalities with potential for aspiration. Vagus nerve stimulation results in sleep-related breathing pattern changes, with an associated increase in the numb...

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DTB review: Vagus nerve stimulation for epilepsy

NeLM - Disease Focused Reviews — Wed, 14 Apr 2010 23:00:00 +0100

Source: Drug and Therapeutics Bulletin Area: Evidence > Disease Focused Reviews The article in the Drug and Therapeutics Bulletin (DTB) examines the place of vagus nerve stimulation therapy in the management of epilepsy. The following topics are covered: . About vagus nerve stimulation . Mode of action . Treatment parameters . Clinical efficacy . Quality of life . Unwanted effects . Precautions and contraindications . Health economic data . Who should have stimulation? . Guidelines The review concludes "based on current evidence, no conclusions can be drawn as to relative benefits of vagus nerve stimulation therapy in different epilepsy syndromes, and it has not been compared with resective brain sur...

VNS in drug resistant epilepsy: preliminary report on a small group of patients

Italian Journal of Pediatrics — Tue, 13 Apr 2010 23:00:00 +0100

Conclusions Our small experience seems to confirm the efficacy and safety of VNS in drug resistant partial and generalized epilepsy in developing age groups. (Source: Italian Journal of Pediatrics)

Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels

Epilepsy Research — Tue, 13 Apr 2010 13:48:39 +0100

Conclusions: VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness. (Source: Epilepsy Research)

Vagus nerve stimulation: Outcome and predictors of seizure freedom in long-term follow-up

Seizure: European Journal of Epilepsy — Thu, 01 Apr 2010 23:00:00 +0100

Conclusion: VNS implantation may render patients with some forms of cortical dysgenesis (parietooccipital polymicrogyria, macrogyria) seizure-free. Patients with unilateral IEDs and earlier implantation achieved the most benefit from VNS. (Source: Seizure: European Journal of Epilepsy)

Epilepsy secondary to tuberous sclerosis: lessons learned and current challenges

Child's Nervous System — Wed, 31 Mar 2010 16:59:40 +0100

Discussion The majority of patients (>60%) who are candidates for surgery remain seizure-free after tuberectomy. During the recent years technical advances in the localization of the epileptogenic zone during the recent years have lead to a 63% of Engel class I status after surgery compared with a previous 52%. In medically refractory patients not suitable for surgery, vagus nerve stimulation has proved efficacy in significantly reducing seizure frequency in more than 50% of cases. New evidence suggests that mTOR inhibitors may be helpful in the management of intractable epilepsy for individuals with TSC. Content Type Journal ArticleCategory Review PaperDOI 10.1007/s00381-010-1128-8Authors Romina Moavero, “Tor Vergata” University of Rome Department of Neuro...

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Electrical Vagus Nerve Stimulation and Nicotine Effects in Peritonitis-Induced Acute Lung Injury in Rats

Inflammation — Wed, 24 Mar 2010 17:57:36 +0100

Abstract The cholinergic anti-inflammatory pathway has been identified as playing a key role in the communication between the central nervous system and the immune system during inflammation. The potential beneficial role of vagus nerve stimulation (VNS) remains to be clarified in established sepsis. We hypothesized that VNS or nicotine administration would reduce lung injury and mortality in established sepsis. We conducted a prospective, randomized experimental study. Four hours after peritonitis induction by cecal ligation and puncture (CLP), rats were randomized into three groups of seven animals according to the intervention: control group, VNS group (15 V, 2 ms, 5 Hz during 20 min), and nicotine group (400 µg/kg intraperitoneal). Survival was...

Dramatic First Words Spoken in 2 Children After Vagus Nerve Stimulation

Seminars in Pediatric Neurology — Mon, 01 Mar 2010 00:00:00 +0100

We present two children (aged 8 and 9 years) who were non-verbal and spoke their first words shortly after vagus nerve stimulators were implanted. The mechanism is unclear although vagus nerve stimulation has been clearly shown to induce neuronal, chemical and perfusion changes in both subcortical and cortical regions of the brain. There is likely a combined effect on primary speech areas as well subcortical and mamillothalamic tracts, and possibly even stimulation and changes at the local vocal cord level contributing to this phenomenon. Our observation has important implications in encephalopathic patients both with and without epilepsy. (Source: Seminars in Pediatric Neurology)

Editorial Comment: Can VNS Therapy Influence Language and Other Cognitive Functions?

Seminars in Pediatric Neurology — Mon, 01 Mar 2010 00:00:00 +0100

Grill and Ng (see page 54) describe 2 previously nonverbal children, 8 and 9 years old, who began to speak within months of being implanted with the vagus nerve stimulator for the management of symptomatic generalized and cryptogenic partial epilepsy. Improvements in alertness, behavior, social interactions, and quality of life measures after vagus nerve stimulation (VNS) therapy have been pointed out by many authors. Over 70% of the 195 children in the Cyberonics Patient Outcome Registry who received VNS therapy with topiramate showed improved alertness at 12 months. Park examined a subset of 59 autistic and 6 Landau-Kleffner syndrome patients from the same registry and noted improvements in quality of life measures across the board, which were most pronounced with respect to alertness. (...

Safety of vagus nerve stimulation in a patient with bipolar disorder and an implanted cardioverter-defibrillator

Acta Neurologica Scandinavica — Thu, 18 Feb 2010 00:00:00 +0100

(Source: Acta Neurologica Scandinavica)

Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: A review

Mon, 15 Feb 2010 00:00:00 +0100

Electroconvulsive therapy (ECT) and ablative neurosurgical procedures are established interventions for treatment-resistant depression (TRD), but their use may be limited in part by neuropsychological adverse effects. Additional neuromodulation strategies are being developed that aim to match or exceed the efficacy of ECT/ablative surgery with a better neurocognitive side effect profile. In this review, we briefly discuss the neurocognitive effects of ECT and ablative neurosurgical procedures, then synthesize the available neurocognitive information for emerging neuromodulation therapies, including repetitive transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, vagus nerve stimulation, and deep brain stimulation. The available evidence sugge...

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Neurostimulatory and ablative treatment options in major depressive disorder: a systematic review

Acta Neurochirurgica — Tue, 26 Jan 2010 07:03:14 +0100

Discussion We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s00701-009-0589-6Authors Pablo Andrade, Maastricht University Department of Neuroscience, Faculty of Health, Medicine and Life Sciences Universiteitssingel 50 Box 38 6200 MD Maastricht The NetherlandsLieke H. M. Noblesse, Maastricht University Medical Center Department of Neurosurgery Maastricht The NetherlandsYasin Temel, Maastricht University Department of Neuroscience, Faculty of Health, Medicine and Life Sciences Universiteitssingel 50 Box 38 6200 MD Maastricht The NetherlandsLinda Ackermans, Maastricht University M...

3 tesla MRI of patients with a vagus nerve stimulator: Initial experience using a T/R head coil under controlled conditions

Journal of Magnetic Resonance Imaging — Sat, 23 Jan 2010 00:00:00 +0100

To assess safety of clinical MRI of the head in patients with implanted model 100, 102, and 103 vagus nerve stimulation (VNS) Therapy Systems (Cyberonics, Inc., Houston, TX) in 3.0 Tesla MRI (GE Healthcare, Milwaukee, WI).The distributions of the radiofrequency B1+-field produced by the clinically used transmit/receive (T/R) head coil (Advanced Imaging Research Incorporated, Cleveland, OH) and body coil were measured in a head and shoulders phantom. These measurements were supplemented by temperature measurements on the lead tips and the implantable pulse generator (IPG) of the VNS devices in a head and torso phantom with the same two coils. Clinical 3T MRI head scans were then acquired under highly controlled conditions in a series of 17 patients implanted with VNS.Phantom studies showed ...

Cyberonics' VNS Therapy(TM) System Receives Regulatory Approval in Japan

HSMN NewsFeed — Wed, 20 Jan 2010 02:20:51 +0100

HOUSTON, Jan. 19 (HSMN NewsFeed) -- Cyberonics, Inc. (Nasdaq: CYBX) today announced that the Japanese Ministry of Health, Labor and Welfare (MHLW) has granted the company final regulatory approval to market and sell its VNS Therapy System for the epilep... Devices, Neurology, RegulatoryCyberonics, VNS Therapy, epilepsy (Source: HSMN NewsFeed)

Cyberonics receives Japanese approval for VNS Therapy Solutions

bizjournals.com Health Care:Biotechnology headlines — Tue, 19 Jan 2010 17:36:38 +0100

Cyberonics Inc. has received a green light from the Japanese government to market its VNS Therapy Systems in Japan. (CYBX) (Source: bizjournals.com Health Care:Biotechnology headlines)

Acute seizure-suppressing effect of vagus nerve stimulation in the amygdala kindled rat.

Brain Research — Tue, 12 Jan 2010 00:00:00 +0100

CONCLUSION: The VNS-treated kindled rat is a clinically relevant animal model because it is a chronic epilepsy model that responds to VNS with effects that are comparable to the effects of VNS in epilepsy patients. In addition, this study demonstrates that VNS-treated kindled rats can be used to study the mode of action of VNS using immunohistochemical techniques. PMID: 20079342 [PubMed - as supplied by publisher] (Source: Brain Research)

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Modulation of Brain Dead Induced Inflammation by Vagus Nerve Stimulation

American Journal of Transplantation — Tue, 05 Jan 2010 00:00:00 +0100

Because the vagus nerve is implicated in control of inflammation, we investigated if brain death (BD) causes impairment of the parasympathetic nervous system, thereby contributing to inflammation. BD was induced in rats. Anaesthetised ventilated rats (NBD) served as control. Heart rate variability (HRV) was assessed by ECG. The vagus nerve was electrically stimulated (BD + STIM) during BD. Intestine, kidney, heart and liver were recovered after 6 hours. Affymetrix chip-analysis was performed on intestinal RNA. Quantitative PCR was performed on all organs. Serum was collected to assess TNF[alpha] concentrations. Renal transplantations were performed to address the influence of vagus nerve stimulation on graft outcome. HRV was significantly lower in BD animals. Vagus nerve stimulation inhibi...

Brain Stimulation Therapies for Clinicians – Free eBook From Psychiatry Online

What's New on JEFFLINE — Mon, 04 Jan 2010 21:11:27 +0100

Every month, Psychiatry Online offers free access to one of the texts from the APPI bookstore. For January, you may download Brain Stimulation Therapies for Clinicians (a $70 value). Follow JEFFLINE’s Quick Link to Psychiatry Online, and scroll down to the Book of the Month – the book will be free for you to download until January 31st. From the publisher’s blurb: Edmund S. Higgins, M.D., and Mark S. George, M.D. With foreword by Michael Trimble, M.D., F.R.C.P., F.R.C.Psych. Brain stimulation—focally applying electricity to the brain—is a field with a rapidly expanding and promising array of techniques, which already have proven efficacy in treating conditions ranging from Parkinson’s disease to chronic and acute pain to depression. Comprehensively surve...

Management of epilepsy in drug-resistant patients.

CNS Spectrums — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Smith BJ, Cole AJ Epilepsy affects > 2 million people in the United States, making it one of the most common neurobiological conditions. Typically, epilepsy is treated with one of several available antiepileptic drugs and patients are able to experience freedom from seizures with minimal side effects. However, there are some patients who do not respond to treatment and require the use of multiple drug combinations or surgical intervention. Although there are few studies supporting its use, multi-drug regimens have been known to be helpful for patients, although clinicians should monitor patients for adverse side effects. Vagus nerve stimulation is the only US Food and Drug Administration-approved surgical neurostimulation therapy for epilepsy, and patients' conditions often...

Vagus Nerve Stimulation

Medscape Neurology & Neurosurgery Headlines — Tue, 29 Dec 2009 17:00:00 +0100

This article reviews the history of vagus nerve stimulation, and recent advances of this technology, for treating medically refractory epilepsy. Neurosurgical Focus (Source: Medscape Neurology & Neurosurgery Headlines)

Effect of vagus nerve stimulation on thermal injury in rats

Burns : Journal of the International Society for Burn Injuries — Wed, 23 Dec 2009 13:55:11 +0100

Conclusions: Direct electrical stimulation of the vagus nerve might produce therapeutic effect on thermal injury. The effect may be realised by limiting the inflammatory response via nicotinic acetylcholine receptors in rats. (Source: Burns : Journal of the International Society for Burn Injuries)

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Focal Neuromodulation for the Treatment of Depression

Biological Psychiatry — Mon, 14 Dec 2009 16:24:22 +0100

Treatment-resistant depression (TRD) is a major public health problem with few evidence-based therapies. Driven by a need for better treatments, and supported by the refinement of neuroanatomically based disease models, increasing attention has focused on electrical brain stimulation, or focal neuromodulation therapies, for TRD. These interventions—including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, vagus nerve stimulation, direct subdural or epidural cortical stimulation, and deep brain stimulation (DBS) among others—are based in a framework that assumes abnormal mood regulation results from dysfunction within a distributed network of brain regions. A derivative presumption is that multiple targets for neuromodulation exist, similar ...

Cardiac Effects of Vagus Nerve Stimulation in Patients with Major Depression

Pharmacopsychiatry — Thu, 10 Dec 2009 16:16:42 +0100

PharmacopsychiatryDOI: 10.1055/s-0029-1237374Abstract Changes in the heart rate variability are well known among patients with depression. Amongst others, a modulation of the autonomic nervous system is discussed. An investigation of heart rate variability during terms of stimulation could give some insight in the central nervous effect of vagus nerve stimulation (VNS) and possible cardiac side effects.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: Pharmacopsychiatry)

Modulation of seizure threshold by vagus nerve stimulation in an animal model for motor seizures

Acta Neurologica Scandinavica — Thu, 10 Dec 2009 00:00:00 +0100

Conclusions [ndash] VNS significantly increases the MST in a cortical stimulation model for motor seizures. These data indicate that VNS is capable of modulating cortical excitability. (Source: Acta Neurologica Scandinavica)

NYU Langone Medical Center Study Shows VNS Therapy Is A Safe And Effective Treatment For Refractory Epilepsy

Health News from Medical News Today — Sat, 05 Dec 2009 09:00:00 +0100

AES Annual Meeting, Booth #901-- Cyberonics, Inc. (Nasdaq: CYBX) announced that Vagus Nerve Stimulation (VNS) Therapy, the only FDA-approved implantable medical device for the treatment of refractory epilepsy, will be featured in 14 presentations at the American Epilepsy Society's (AES) Annual Meeting, taking place December 4-8 at the Hynes Convention Center in Boston, Massachusetts. Robert Elliott, M.D... (Source: Health News from Medical News Today)

Treatment of vns-induced laryngospasm with botulinum toxin

Neurology — Mon, 23 Nov 2009 21:01:51 +0100

(Source: Neurology)

Effects of auricular electrical stimulation on vagal activity in healthy men: Evidence from a three-armed randomized trial

Clinical Science — Mon, 09 Nov 2009 00:00:00 +0100

The activity of the vagus nerve is negatively associated with risk factors such as stress and smoking, morbidity, and mortality. In contrast it is also a target of therapeutic intervention. Vagus nerve stimulation is used in depression and epilepsy. Due to its high invasivity and exclusive application to therapy-resistant patients, there is interest in less invasive methods affecting the vagus nerve. Several studies examining acupuncture report beneficial effects on vagal activity. However, findings are inconsistent and applied methods are heterogeneous resulting in difficulties in interpretation. The purpose of the present study was evaluation of the effects of acupuncture on vagal activity in a three-armed randomized trial while controlling several disturbing factors. Fourteen healthy me...

Vagus nerve stimulation-induced bradyarrhythmias in rats

Autonomic Neuroscience: Basic and Clinical — Mon, 02 Nov 2009 16:41:19 +0100

Abstract: The autonomic consequences of seizures can be severe. Death can follow from autonomic overactivity that causes a parasympathetically mediated bradyarrhythmia. We studied the cardiovascular consequences of unilateral and bilateral stimulation of the distal segments of transected vagus nerve in rats anesthetized with urethane. The range of stimulation rates tested is comparable to the firing rates observed in vagus nerve during seizures. There was a consistent inverse relation between stimulus rate and heart rate with nodal block appearing at 5–10Hz and minimum HR levels (cardiac standstill) occurring at 50Hz. Cardiac standstill could last many seconds. Blood pressure during VNS was maintained during lower frequency VNS, but collapsed at frequencies ≥20Hz to dramatically impair...

MedWorm: Vagus Nerve Stimulation Therapy

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In brief

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[Perioperative anaesthetic management of an epileptic patient treated with a vagus nerve stimulation.]

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