Vagus nerve stimulation

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Vagus nerve stimulation or vagal nerve stimulation or VNS is a medical treatment that involves delivering electrical impulses to the vagus nerve via a device that is either implanted or wearable. This VNS device is referred to informally as a "pacemaker for the brain."[1]

The effects of VNS were first observed in the 1880s that massage and compression of the carotid artery in the neck could suppress seizures, an effect attributable to crude, early form of VNS.[2] Currently, VNS is most frequently used as an adjunctive treatment for certain types of intractable epilepsy[3] and treatment-resistant depression.[3][4]

Methods[edit | edit source]

VNS can be delivered via an implantable or wearable device. The non-surgical option is called transcutaneous vagus nerve stimulation or t-VNS and is delivered via an electrode clipped onto the ear and attached to a portable impulse-generating device.[1][5]

It is possible that paced breathing (e.g., via deep breathing exercise, yoga or aerobic exercise) can also influence brain electrical activity, mediated by VNS arising from the diaphragm.

Applications[edit | edit source]

While still experimental, researchers are trialing with vagus nerve stimulation as an adjunct therapy on a host of mental health, neurological, and inflammatory illnesses, including anxiety,[6] atrial fibrillation,[7]chronic pain,[8]Crohn's disease,[9]fibromyalgia,[10]heart failure,[11]migraines,[12] and many other conditions. Kevin J. Tracey, MD and his research group at The Feinstein Institute for Medical Research have shown that vagus nerve stimulation has decreased inflammation in methotrexate-resistant rheumatoid arthritis patients.[13]

Mechanisms[edit | edit source]

The vagus nerve can inhibit cytokine release, via release of the neurotransmitter acetylcholine[14] and thereby prevent tissue injury and death. In research studies, stimulation of the vagus nerve prevents the damaging effects of cytokine release in experimental sepsis, endotoxemia,[15] ischemia/reperfusion injury, hemorrhagic shock, arthritis, and other inflammatory syndromes.[16]

Media coverage[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.01.1 "Vagus Nerve Stimulation (VNS)". Epilepsy Foundation. Retrieved Feb 25, 2020. 
  2. Lanska, DJ (February 2002). "J.L. Corning and vagal nerve stimulation for seizures in the 1880s". Neurology. 
  3. 3.03.1 Pisapia, Jared; Baltuch, Gordon (Jan 22, 2016), "Vagus nerve stimulation: Introduction and technical aspects", in Hamani, Clement; Holtzheimer, Paul; Lozano, Andres; Mayberg, Helen, Neuromodulation in Psychiatry, Chicester, UK: Wiley-Blackwell, doi:10.1002/9781118801086.ch17/, ISBN 978-1118801048 
  4. "Vagus nerve stimulation - Mayo Clinic". Retrieved Feb 25, 2020. 
  5. "Treating Depression With Non-Invasive Vagus Nerve Stimulation", Neuroscience News, Houston, Feb 4, 2016, retrieved Dec 12, 2016 
  6. Fanselow, Michael S. (Jun 1, 2013), "Fear and anxiety take a double hit from vagal nerve stimulation", Biological Psychiatry, 73 (11): 1043–1044, doi:10.1016/j.biopsych.2013.03.025, ISSN 1873-2402, PMID 23647735 
  7. Stavrakis, Stavros; Humphrey, Mary Beth; Scherlag, Benjamin J.; Hu, Yanqing; Jackman, Warren M.; Nakagawa, Hiroshi; Lockwood, Deborah; Lazzara, Ralph; Po, Sunny S. (Mar 10, 2015), "Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation", Journal of the American College of Cardiology, 65 (9): 867–875, doi:10.1016/j.jacc.2014.12.026, ISSN 1558-3597, PMID 25744003 
  8. Chakravarthy, Krishnan; Chaudhry, Hira; Williams, Kayode; Christo, Paul J. (December 2015), "Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management", Current Pain and Headache Reports, 19 (12): 54, doi:10.1007/s11916-015-0528-6, ISSN 1534-3081, PMID 26493698 
  9. Bonaz, B.; Sinniger, V.; Hoffmann, D.; Clarençon, D.; Mathieu, N.; Dantzer, C.; Vercueil, L.; Picq, C.; Trocmé, C.; Faure, P.; Cracowski, J.-L.; Pellissier, S. (June 2016), "Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study", Neurogastroenterology and Motility: The Official Journal of the European Gastrointestinal Motility Society, 28 (6): 948–953, doi:10.1111/nmo.12792, ISSN 1365-2982, PMID 26920654 
  10. Lange, Gudrun; Janal, Malvin N.; Maniker, Allen; Fitzgibbons, Jennifer; Fobler, Malusha; Cook, Dane; Natelson, Benjamin H. (September 2011), "Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase I/II proof of concept trial", Pain Medicine (Malden, Mass.), 12 (9): 1406–1413, doi:10.1111/j.1526-4637.2011.01203.x, ISSN 1526-4637, PMID 21812908 
  11. Hauptman, Paul J.; Schwartz, Peter J.; Gold, Michael R.; Borggrefe, Martin; Van Veldhuisen, Dirk J.; Starling, Randall C.; Mann, Douglas L. (June 2012), "Rationale and study design of the increase of vagal tone in heart failure study: INOVATE-HF", American Heart Journal, 163 (6): 954–962.e1, doi:10.1016/j.ahj.2012.03.021, ISSN 1097-6744, PMID 22709747 
  12. Silberstein, Stephen D.; Calhoun, Anne H.; Lipton, Richard B.; Grosberg, Brian M.; Cady, Roger K.; Dorlas, Stefanie; Simmons, Kristy A.; Mullin, Chris; Liebler, Eric J.; Goadsby, Peter J.; Saper, Joel R.; EVENT Study Group (Aug 2, 2016), "Chronic migraine headache prevention with noninvasive vagus nerve stimulation: The EVENT study", Neurology, 87 (5): 529–538, doi:10.1212/WNL.0000000000002918, ISSN 1526-632X, PMID 27412146 
  13. "Kevin J. Tracey, MD". Retrieved Feb 25, 2020. 
  14. Lund, D. D.; Oda, R. P.; Pardini, B. J.; Schmid, P. G. (March 1986), "Vagus nerve stimulation alters regional acetylcholine turnover in rat heart", Circulation Research, 58 (3): 372–377, ISSN 0009-7330, PMID 3719926 
  15. Borovikova, Lyudmila V.; Ivanova, Svetlana; Zhang, Minghuang; Yang, Huan; Botchkina, Galina I.; Watkins, Linda R.; Wang, Haichao; Abumrad, Naji; Eaton, John W.; Tracey, Kevin J. (May 25, 2000), "Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin", Nature, 405 (6785): 458–462, doi:10.1038/35013070, ISSN 0028-0836, retrieved Dec 12, 2016 
  16. Tracey, Kevin J. (Feb 1, 2007), "Physiology and immunology of the cholinergic antiinflammatory pathway", Journal of Clinical Investigation, 117 (2): 289–296, doi:10.1172/JCI30555, ISSN 0021-9738, PMID 17273548, retrieved Dec 12, 2016 
  17. Knapton, Sarah (Jul 7, 2016), "Electronic implant in 'Spock' nerve could reverse rheumatoid arthritis", The Telegraph, London, retrieved Dec 12, 2016 
  18. Johnson, Cort (Jan 11, 2016), "Vagus Nerve Stimulation, Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)", HealthRising, Henderson, NV, retrieved Dec 12, 2016 
  19. Behar, Michael (May 23, 2014), "Can the Nervous System Be Hacked?", The New York Times, retrieved Dec 12, 2016 

phase one - A drug trial involving only a small group of humans, often healthy volunteers, to assess drug safety and side effects. Typically 20-80 participants, often using a comparison group.

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