Cerebral Activation during Vagus Nerve Stimulation: A Functional MR Study

Narayanan, Jaishree; Watts, Richard; Haddad, Naim; Labar, Douglas; Li, P. Mark; Filippi, Christopher G.

doi:10.1046/j.1528-1157.2002.16102.x

Cited by 142 publications

(91 citation statements)

References 26 publications

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“…CSF studies have shown a significant increase in gamma-aminobutyric acid (GABA) after 3-4 months of VNS treatment, but no significant decrease in glutamate, aspartate or 5-hydroxyindoleacetic acid (5-HIAA) levels after 3 to 9 months of VNS treatment. Non-responders had the greatest effect on neurotransmitter levels 15 . Long-term VNS had no effect on interictal EEG background or epileptiform activity, and no effect on visual or auditory evoked potentials.…”

Section: Vagus Nerve Stimulationmentioning

confidence: 95%

Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Amorim

Silvado²,

Oliveira

et al. 2013

Arq. Neuro-Psiquiatr.

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Epilepsy comprises a set of neurologic and systemic disorders characterized by recurrent spontaneous seizures, and is the most frequent chronic neurologic disorder. In patients with medically refractory epilepsy, therapeutic options are limited to ablative brain surgery, trials of experimental antiepileptic drugs, or palliative surgery. Vagal nerve stimulation is an available palliative procedure of which the mechanism of action is not understood, but with established efficacy for medically refractory epilepsy and low incidence of side-effects. In this paper we discuss the recommendations for VNS use as suggested by the Brazilian League of Epilepsy and the Scientific Department of Epilepsy of the Brazilian Academy of Neurology Committee of Neuromodulation.Keywords: epilepsy, palliative procedures, vagus nerve stimulation. ResuMOAs epilepsias compreendem uma família de doenças neurológicas e sistêmicas que se apresentam com crises espontâneas repetitivas, sendo a doença neurológica crônica mais frequente. Em pacientes com epilepsias refratárias ao tratamento medicamentoso, as opções terapêuticas são restritas a cirurgia ablativa, estudos experimentais com novas drogas antiepilépticas ou cirurgias paliativas. A estimulação do nervo vago (VNS) é um procedimento paliativo disponível, cujo mecanismo de ação é ainda desconhecido, mas com eficácia estabelecida em pacientes com epilepsias refratárias ao tratamento medicamentoso, apresentando baixos índices de efeitos colaterais. Neste artigo apresentamos o posicionamento do Comitê de Neuromodulação da Liga Brasileira de Epilepsia e do Departamento Científico de Epilepsia da Academia Brasileira de Neurologia sobre as indicações de uso do VNS Palavras-chave: epilepsia, procedimentos paliativos, estimulação do nervo vago.

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Section: Vagus Nerve Stimulationmentioning

confidence: 95%

Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Amorim

Silvado²,

Oliveira

et al. 2013

Arq. Neuro-Psiquiatr.

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“…MRIs have been performed with the stimulator turned on to evaluate the impact of the stimulation. [88][89][90][91][92][93][94] In one study, the patient had a seizure on the table and diffusion weighted imaging demonstrated transient ischemia at the focus, which returned to normal at seizure completion. 95 …”

Section: Vns For Epilepsymentioning

confidence: 99%

Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial

Chen

Flanagan

Samadani

2013

Neurological Research

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Objectives-Traumatic brain injury has a high morbidity and mortality in both civilian and military populations. Blast and other mechanisms of traumatic brain injury damage the brain by causing neurons to disconnect and atrophy. Such traumatic axonal injury can lead to persistently vegetative and minimally conscious states, for which limited treatment options exist, including physical, occupational, speech and cognitive therapies.More than 60,000 patients have received vagus nerve stimulation for epilepsy and depression. In addition to decreased seizure frequency and severity, patients report enhanced mood, reduced daytime sleepiness independent of seizure control, increased slow wave sleep, and improved cognition, memory, and quality of life.Early stimulation of the vagus nerve accelerates the rate and extent of behavioral and cognitive recovery after fluid percussion brain injury in rats.Methods-We recently obtained FDA approval for a pilot prospective randomized crossover trial to demonstrate objective improvement in clinical outcome by placement of a vagus nerve stimulator in patients who are recovering from severe traumatic brain injury. Our hypothesis is that stimulation of the vagus nerve results in increased cerebral blood flow and metabolism in the forebrain, thalamus and reticular formation, which promotes arousal and improved consciousness, thereby improving outcome after traumatic brain injury resulting in minimally conscious or persistent vegetative states.Discussion-If this study demonstrates that vagus nerve stimulation can safely and positively impact outcome, then a larger randomized prospective crossover trial will be proposed.

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“…A number of functional imaging studies have demonstrated that VNS is associated with altered activity of the thalamus and hypothalamus, amygdala and related limbic structures, orbital cortex, basal ganglia, cerebellum, and medulla. 121,122 Although initial open trials suggested a substantial acute and long-term benefit in treatment-resistant depression, 123,124 a larger randomized controlled trial failed to show acute efficacy. 125 Evidence exists for modest efficacy at long-term (12 months) follow-up.…”

Section: Presumptive Mood Disorder Circuitsmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

136

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Summary:Major depressive disorder and bipolar disorder are severe mood disorders that affect the lives and functioning of millions each year. The majority of previous neurobiological research and standard pharmacotherapy regimens have approached these illnesses as purely neurochemical disorders, with particular focus on the monoaminergic neurotransmitter systems. Not altogether surprisingly, these treatments are inadequate for many individuals afflicted with these devastating illnesses. Recent advances in functional brain imaging have identified critical neural circuits involving the amygdala and other limbic structures, prefrontal cortical regions, thalamus, and basal ganglia that modulate emotional behavior and are disturbed in primary and secondary mood disorders. Growing evidence suggests that mechanisms of neural plasticity and cellular resilience, including impairments of neurotrophic signaling cascades as well as altered glutamatergic and glucocorticoid signaling, underlie the dysregulation in these circuits. The increasing ability to monitor and modulate activity in these circuits is beginning to yield greater insight into the neurobiological basis of mood disorders. Modulation of dysregulated activity in these affective circuits via pharmacological agents that enhance neuronal resilience and plasticity, and possibly via emerging nonpharmacologic, circuitry-based modalities (for example, deep brain stimulation, magnetic stimulation, or vagus nerve stimulation) offers promising targets for novel experimental therapeutics in the treatment of mood disorders.

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Cerebral Activation during Vagus Nerve Stimulation: A Functional MR Study

Cited by 142 publications

References 26 publications

Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Vagus nerve stimulator in patients with epilepsy: indications and recommendations for use

Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

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