Intraoperative human vagus nerve compound action potentials

Evans, Marilyn; Verma-Ahuja, Suneeta; Naritoku, Dean K.; Espinosa, José Antonio Camacho

doi:10.1111/j.1600-0404.2004.00309.x

Cited by 63 publications

(49 citation statements)

References 14 publications

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“…In other species (cats and rabbits) also under anesthesia, similar physiological responses that were graded with stimulus strength were observed [R McAllen, Unpublished Observations]. Although it remains to be tested directly how applicable the method is in the absence of anesthesia and whether similar thresholding can be applied to humans, there is no reason to doubt that the same fiber groups would be recruited in the same sequence with increasing stimulus strength [14][15][16].…”

Section: Discussionmentioning

confidence: 78%

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

et al. 2017

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Vagal nerve stimulation is widely used therapeutically but the fiber groups activated are often unknown. Aim: To establish a simple protocol to define stimulus thresholds for vagal A, B and C fibers. Methods:The intact left or right cervical vagus was stimulated with 0.1 ms pulses in spontaneously breathing anesthetized rats. Heart and respiratory rate responses to vagal stimulation were recorded. The vagus was subsequently cut distally, and mass action potentials to the same stimuli were recorded. Results: Stimulating at either 50 Hz for 2 s or 2 Hz for 10 s at experimentally determined strengths revealed A, B and C fiber thresholds that were related to respiratory and heart rate changes. Conclusion: Our simple protocol discriminates vagal A, B and C fiber thresholds in vivo.

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Section: Discussionmentioning

confidence: 78%

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

et al. 2017

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“…The cervical level of the vagus nerve is comprised of myelinated A and B fibers, as well as unmyelinated C fibers [127,128]. There is considerabe diversity in morphological and functional parameters of the nerve from individual to individual, suggesting that optimal stimulation parameters may also vary [129,130]. Moreover, higher VNS intensities recruit more vagal fibers and trigger greater release of neuromodulators, which may improve efficacy [19,131,132].…”

Section: Optimizing Vns Parametersmentioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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

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“…77,78 Unilateral stimulation influences both cerebral hemispheres, as shown in several functional imaging studies. 79,80 Crucial brainstem and intracranial structures have been identified; these include the locus coeruleus, the nucleus of the solitary tract, the thalamus, and limbic structures.…”

Section: Mechanism Of Actionmentioning

confidence: 93%

Electrical Stimulation for the Treatment of Epilepsy

et al. 2009

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Summary: Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.

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Intraoperative human vagus nerve compound action potentials

Cited by 63 publications

References 14 publications

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Electrical Stimulation for the Treatment of Epilepsy

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