Transcutaneous vagus nerve stimulation (t‐VNS) in pharmacoresistant epilepsies: A proof of concept trial

Stefan, Hermann; Kreiselmeyer, Gernot; Kerling, Frank; Kurzbuch, Katrin; Rauch, Christoph; Heers, Marcel; Kasper, Burkhard S.; Hammen, T.; Rzonsa, Martina; Pauli, E.; Ellrich, Jens; Graf, Wolfgang; Hopfengärtner, R.

doi:10.1111/j.1528-1167.2012.03492.x

Cited by 233 publications

(148 citation statements)

References 9 publications

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“…A biomarker for the efficacy of VNS could help neurologists to choose the optimal stimulation parameters in a more objective way. In combination with a noninvasive technique to deliver VNS, such as transcutaneous VNS (t-VNS) [56], responders could be identified prior to surgery. Hence, the biomarker could avoid unnecessary implantations of a VNS device in nonresponders and consequently improve the clinical efficacy of VNS.…”

Section: Discussionmentioning

confidence: 99%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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Currently, the mechanism of action of vagus nerve stimulation (VNS) is not fully understood, and it is unclear which factors determine a patient's response to treatment. Recent preclinical experiments indicate that activation of the locus coeruleus noradrenergic system is critical for the antiepileptic effect of VNS. This study aims to evaluate the effect of VNS on noradrenergic signaling in the human brain through a noninvasive marker of locus coeruleus noradrenergic activity: the P3 component of the event-related potential. We investigated whether VNS differentially modulates the P3 component in VNS responders versus VNS nonresponders. For this purpose, we recruited 20 patients with refractory epilepsy who had been treated with VNS for at least 18 months. Patients were divided into 2 groups with regard to their reduction in mean monthly seizure frequency: 10 responders (>50 %) and 10 nonresponders (≤50 %). Two stimulation conditions were compared: VNS OFF and VNS ON. In each condition, the P3 component was measured during an auditory oddball paradigm. VNS induced a significant increase of the P3 amplitude at the parietal midline electrode, in VNS responders only. In addition, logistic regression analysis showed that the increase of P3 amplitude can be used as a noninvasive indicator for VNS responders. These results support the hypothesis that activation of the locus coeruleus noradrenergic system is associated with the antiepileptic effect of VNS. Modulation of the P3 amplitude should be further investigated as a noninvasive biomarker for the therapeutic efficacy of VNS in patients with refractory epilepsy.

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Section: Discussionmentioning

confidence: 99%

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

et al. 2014

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“…They are usually mild to moderate and seldom require that the device be explanted (47). Recently, 2 types of noninvasive transcutaneous VNS (t-VNS) devices, safe and tolerable alternative treatments, were developed, and they are in clinical trials for epilepsy, depression, and migraine (48)(49)(50)(51). These noninvasive devices might be effective in disorders classically treated with VNS and could potentially be applied to inflammation-related disorders.…”

Section: Feasibility Of Vns As a Means Of Reducing Renal Injurymentioning

confidence: 99%

Vagus nerve stimulation mediates protection from kidney ischemia-reperfusion injury through α7nAChR+ splenocytes

Inoue¹,

Abe²,

Sung³

et al. 2016

Journal of Clinical Investigation

248

296

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) for measuring NE, the George F. O'Brien Center, University of Alabama (P30DK079337; principal investigator, Anupam Agarwal) for measuring plasma creatinine by LC-MS, the UVA Research Histology Core for their assistance in preparation of histology slides, and the UVA Flow Cytometry Facility for sample analysis using the Luminex 100 IS system and FACS sorting using BD Influx. We also thank Primetech Corp. (Tokyo, Japan) for supplying the iPRECIO microinfusion pump system.

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“…There is a fast growing interest in the transcutaneous vagal nerve stimulation (t-VNS), first proposed by Ventureira, 1 which is a promising treatment of refractory epilepsy, pain, depression and other neuropsychiatric diseases [2][3][4][5] and special stimulating devices are constructed for its application. 6 This method represents a noninvasive, safer and cheaper alternative of the cervical vagal nerve stimulation, studies that started in 1938 with cat experiments of Bailey and Bremmer 7 and established the vagal nerve as an important route in the central nervous system, which can be used for brain neuromodulation by the nonspecific stimulation information carried by vagal afferents.…”

Section: Introductionmentioning

confidence: 99%

Effects of Acute Transcutaneous Vagal Stimulation on the EEG Power Maps, EEG Sources Distribution and Steadiness of Quiet and Sensory-conflicted Stance

Dimitrov¹,

Gatev²

2015

Posture, Balance and the Brain

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Transcutaneous vagal stimulation (t-VNS) is a prospective method as a cheap and noninvasive alternative of surgical cervical vagal stimulation widely used for treatment of refractory epilepsy, depression etc. Data on its application in healthy people are scarce. A lot of problems concerning the acting mechanisms and cortical representation are unsolved. We did acute t-VNS and studied the standing balance steadiness, EEG absolute power maps and sources distribution. We found improvement of the steadiness of standing with eyes open (EO), but no changes in the eyes closed (EC) series.In EO Delta and Theta power in the right frontal area increased and Beta and Gamma bands of EEG absolute power in the left and right parieto-occipital areas also increased, which sustained for 20 min after t-VNS. The distribution of maxima of EEG sources revealed by LORETA showed shifts to the right and occipital direction after t-VNS, while 20 min later the maxima were symmetrically located, but the occipital shift was preserved. Pre-treatment sources during EO were in multisensory fields: the inferior parietal lobule, superior temporal gyrus and precuneus, after t-VNS they were in the inferior parietal lobule, middle temporal gyrus, right posterior cingulate, precuneus, cuneus and right lingual gyrus. After 20 min the maxima of EEG sources were in the inferior parietal lobule, superior and middle temporal gyrus and left insula.In EC following t-VNS Delta power first decreased in the right frontal and occipital areas and in the central parietal area, 20 min later it was greater than in pre-treatment series in these areas. The results showed an increase of EEG absolute power in the Beta and Gamma ranges mainly in the occipital area and less expressed in the postero-parietal one. The increase was more expressed for Gamma than Beta band similarly to the EO series. However, this increase in Beta and Gamma EEG power in EC was mainly located in the left side of the cortex. After t-VNS we observed shifts of electrical sources locations to the occipital and top parts of the brain. Unlike, during the EO series we observed shift to the lower frequencies in the absolute power cortical maps. After 20 min a tendency to return to the pre-treatment coordinates occurred, the power, increased immediately after t-VNS, dropped much lower than its initial value. The locations of maxima of electrical sources during EC before t-VNS were in the middle and inferior frontal gyrus, right inferior parietal lobule, cingulate and precuneus. Immediately after t- Bozhidar Dimitrov and Plamen Gatev 46VNS these locations were in the superior temporal gyrus, middle temporal gyrus, precuneus, cuneus and left inferior parietal lobule. After 20 min the locations of the maxima of electrical sources were in the anterior cingulate cortex, medial frontal gyrus, precuneus, cuneus and lingual gyrus.Our results show that cortical processing of the t-VNS information and its effect on standing balance are quite different during standing with EO compared to standing with...

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Transcutaneous vagus nerve stimulation (t‐VNS) in pharmacoresistant epilepsies: A proof of concept trial

Cited by 233 publications

References 9 publications

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

The P3 Event-Related Potential is a Biomarker for the Efficacy of Vagus Nerve Stimulation in Patients with Epilepsy

Vagus nerve stimulation mediates protection from kidney ischemia-reperfusion injury through α7nAChR+ splenocytes

Effects of Acute Transcutaneous Vagal Stimulation on the EEG Power Maps, EEG Sources Distribution and Steadiness of Quiet and Sensory-conflicted Stance

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