You can also turn it off using a special magnet. Research into the effects of VNS on people with treatment-resistant depression has generally been positive. A study in Biological Psychiatry in compared people that received usual treatment to people that received usual treatment plus VNS. After one year of treatment, the combination treatment group showed more improvement than the usual treatment group.
VNS is not a rapid treatment for depression. Studies show that, on average, it may take up to 9 months for a treatment response to occur. Possible side effects from VNS include temporary hoarseness, cough , and shortness of breath. Most of these side effects only occur during the 30 seconds that the stimulator is on. Like any operation, the implantation procedure poses some risks, including infection.
As with pacemakers, eventually, you will need surgery to replace the battery when it wears out. In addition, though rare, damage to the device or the leads could require additional surgery prior to replacing the battery. Since the VNS device can interfere with mammograms, special positioning may be required to get the best possible image. Certain medical procedures, such as defibrillation for the heart or ultrasound , can also damage the VNS device.
In addition, special precautions may need to be taken before having an MRI scan, so be sure your doctor knows. Chronic or severe depression affects up to 1. Depression is often difficult to treat because patients experiencing recurrent depressive episodes treated with conventional pharmaceuticals often experience relapses or do not experience full remission. A study conducted by Nahas et al showed patients with chronic or recurrent major depressive disorder receiving VNS may have beneficial long-term outcomes.
Both Bajbouj et al and Nahas et al use the same criteria for clinically significant remission, defined as the absence of clinically significant depressive symptoms. These regions comprise neurons that release neurotransmitters such as serotonin and norepinephrine which have both anticonvulsive and antidepressant effects. Although depression also affects many adolescents, treatment options for pediatric patients are limited.
Twelve of the 15 children examined had improvement in their quality of life. An exciting new application of VNS is as an anti-inflammatory treatment. Preliminary preclinical evidence suggests that VNS may attenuate the inflammatory response through activation of the cholinergic anti-inflammatory pathway CAP — a long loop from the vagus afferents, through the autonomic brain stem and forebrain cortical structures, and then back through the descending vagus efferents Figure 2.
In recent years, Tracey et al have devoted significant efforts to quantifying the role that VNS plays as an anti-inflammatory regulator primarily through altered regulation of acetylcholine. Other studies are focused on how VNS affects brain trauma and stroke. Because these are ongoing studies, the efficacy of VNS treatment for these disorders is currently unknown. Many of the inflammatory disorders that VNS may potentially treat also affect the pediatric and neonatal population.
Since VNS has been shown to be effective for adult and pediatric populations for epilepsy and depression, it stands to reason that VNS treatment may be beneficial to younger patients for a variety of disorders; however, there is limited data on pediatric applications. We summarize the results of studies related to these disorders below; however, these preliminary data provide a strong rationale for expanding research on the applications of VNS as an anti-inflammatory treatment across a range of different inflammatory diseases.
Sepsis is a multibillion dollar health care burden typically due to systemic bacterial infection and chronic activation of the pro-inflammatory cytokine cascade. Limiting inflammation in pediatric patients without the use of pharmaceuticals is important because neonates, particularly preterm infants, are more susceptible to developing sepsis due to their underdeveloped immune systems and susceptibility to perinatal infection chorioamnionitis, etc.
Since VNS seems to regulate inflammation by modulating the cytokine cascade, our laboratory is looking at the effect of VNS on the early pro-inflammatory cytokines, interleukin-6 IL-6 , TNFa, and IL-1b, in respiratory control regions of the brain stem. We looked at the NTS and hypoglossal motor nucleus XII , which are regions of critical importance for the control of breathing and implicated in breathing problems in neonatal rats as a model for preterm infants. Two major concerns in extending VNS to neonatal practice are the length of time that VNS takes to be effective and the invasive nature of the implantation procedure.
Although VNS as currently used for epilepsy and depression can take months to show dramatic effect, short-term stimulation has been used to reduce inflammation quickly, and our experiments have shown that a single bout of high-frequency stimulation 30 minutes can be effective as an anti-inflammatory treatment. Preliminary work performed by the Wilson laboratory and others suggests that this may be possible and useful for implementation of VNS treatment in neonates.
Vagus Nerve Stimulation Dramatically Reduces Inflammation | Psychology Today
The applications of VNS also extend to widespread inflammatory disorders associated with chronic or intermittent bouts of pain such as fibromyalgia and migraines. Another chronic pain ailment that VNS shows promise in treating is migraine headaches.
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In a study conducted by Barbanti et al, 50 patients with migraine were given VNS treatment applied externally at the neck in two second intervals with 3 minutes in-between. Although VNS would not likely be recommended as a first-line defense against obesity, research on the effects of VNS on diet and weight have been performed to evaluate VNS for its use as an adjunct treatment in controlling obesity. The implications of these studies are compelling, but the mechanism by which VNS influences weight loss is still unknown.
Some hypotheses include changes in metabolism, decreases in fat stores, or changes in satiety signaling. A study performed by Ikramuddin et al showed the effect of VNS on morbid obesity. Since bariatric surgery presents some major risks, investigators are looking for alternative, less-invasive methods of controlling obesity. Their trial showed that weight loss was higher by a statistically significant margin in patients who underwent VNS when compared to sham patients.
VNS must alter cardiovascular control due to the convergence of inputs in the autonomic control centers of the brain stem, but for how long and to what extent is unknown. The descending cardiac branch of the vagus is key for normal cardiac function. In the CARDIA study, Sloan et al showed that there was an inverse relationship between inflammatory markers and vagus nerve activity, measured by heart rate variability, suggesting that VNS is key to anti-inflammatory tone.
They also suggest that high levels of pro-inflammatory markers such as IL-6 and C-reactive protein may indicate a predisposition to coronary artery disease. Zhang et al used a canine model to show that chronic VNS helps to regulate heart rate and improves heart function in a high-rate ventricular pacing model. Chapleau et al used a high salt, spontaneously hypertensive rat model to show that right VNS prevented aortic stiffening and slowed the progression of endothelial dysfunction.
VNS is being considered as a treatment for ventilator-induced lung injury VILI caused by pressure-induced damage to lung alveoli. Inflammation has been shown to increase the likelihood of VILI, which is often the result of severe lung infection. Other respiratory disorders such as acute lung injury and acute respiratory distress syndrome, both of which can be complicated by sepsis, can also result in pronounced pulmonary inflammation.
VNS may also be useful in treating gut and lung injuries together. In a study of lung injury caused by hemorrhagic shock, Reys et al showed that VNS prevents intestinal barrier failure and protects against lung injury. In addition, preventing gut—barrier interaction that contributes to visceral inflammation also deserves further study.
Since ghrelin is mediated through acetylcholine levels, it is reasonable to assume that VNS may have an application in treating TBI through a ghrelin or other hypothalamic-gated mechanism.
Regulation of cytokine expression by VNS may provide significant therapeutic value in these patients. Because VNS is known to have anti-inflammatory properties and affect the levels of acetylcholine, these changes in cytokine upregulation and rebalancing of neurotransmitter release may provide an immediate and controllable way to modulate injury due to stroke, ischemia, or trauma. Diabetes is another inflammatory-related disorder that may benefit from treatment with VNS. Recent work has shown the role of the vagus nerve in the pathophysiology of diabetes and other related diseases, which may, in turn, suggest that VNS could be useful in treating such disorders.
Cardiovascular risk has long been associated with diabetes, but the exact mechanism by which increased risk and diabetes synergize to exacerbate morbidity is not known. Pal et al found that relatives of type 2 diabetics had increased risk for cardiovascular diseases, which they attributed to sympathovagal imbalance. Woie and Reed showed a relationship between changes in tracheal edema in control, diabetic, and insulin-treated diabetic rats which suggests that barrier breakdown was significantly greater in control animals but was attenuated in diabetic rats.
A broader concern is the role vagal tone plays in metabolic disease and obesity. Vagal afferents and projections to the hypothalamus play a significant role in satiety and feeding behavior, and disruption of vagal afferent traffic may contribute to obesity and downregulation of cholinergic descending tone to arrest inflammation.
This study by Meyers et al uses a crude method of selective efferent stimulation, by cutting the vagus nerve above the stimulating electrode. However, selective blockade of vagal fibers using different electrical stimulation parameters may provide the answer for using VNS to affect metabolism. Patel and Butera have achieved such results by using high-frequency stimulation in both the vagus and the sciatic nerves in rats.
RA is a chronic, inflammatory autoimmune disease of unknown origin, which results in chronic synovial inflammation and damage to cartilage and bone due to release of cytokines and progressive inflammatory damage. VNS has been proven to be a useful treatment across a number of domains and has been used effectively to treat epilepsy and depression in adults. There is accumulating evidence to suggest that it can be used to help quell inflammation in a number of other autonomic or inflammatory disorders, which would make it useful for a wider range of pediatric patients as well.
Many of these studies are not mechanistic in nature, and further pathway analysis and studies focused on the mechanisms by which VNS alters autonomic tone are key to further our understanding of vagus nerve modification. We have summarized some of these key inflammatory markers in Figure 3. There is an overwhelming evidence to suggest that vagus nerve is an important component of the immune response and manipulating vagal tone is a way to modulate the immune system. Using VNS to manipulate vagal tone provides an exciting new opportunity for minimally invasive therapeutic intervention in adult and pediatric patients.
This results in output that generates an inflammatory signal.
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National Center for Biotechnology Information , U. Journal List J Inflamm Res v. Published online May This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https: By accessing the work you hereby accept the Terms.
Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Abstract In this review, we provide an overview of the US Food and Drug Administration FDA -approved clinical uses of vagus nerve stimulation VNS as well as information about the ongoing studies and preclinical research to expand the use of VNS to additional applications. Open in a separate window.
Overview of vagal circuitry linking the central and peripheral nervous system. Putative pathways involved in vagus nerve stimulation. Treatment of depression Chronic or severe depression affects up to 1.
Vagus Nerve Stimulation (VNS) for Depression
Sepsis Sepsis is a multibillion dollar health care burden typically due to systemic bacterial infection and chronic activation of the pro-inflammatory cytokine cascade. Pain management The applications of VNS also extend to widespread inflammatory disorders associated with chronic or intermittent bouts of pain such as fibromyalgia and migraines. Obesity Although VNS would not likely be recommended as a first-line defense against obesity, research on the effects of VNS on diet and weight have been performed to evaluate VNS for its use as an adjunct treatment in controlling obesity.
Cardiovascular disease VNS must alter cardiovascular control due to the convergence of inputs in the autonomic control centers of the brain stem, but for how long and to what extent is unknown. Lung injury VNS is being considered as a treatment for ventilator-induced lung injury VILI caused by pressure-induced damage to lung alveoli. Diabetes Diabetes is another inflammatory-related disorder that may benefit from treatment with VNS.
In this section
RA RA is a chronic, inflammatory autoimmune disease of unknown origin, which results in chronic synovial inflammation and damage to cartilage and bone due to release of cytokines and progressive inflammatory damage. Conclusion VNS has been proven to be a useful treatment across a number of domains and has been used effectively to treat epilepsy and depression in adults. Flow diagram showing the inflammatory neural circuit. Footnotes Disclosure The authors report no conflicts of interest in this work. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin.
A distinct vagal anti-inflammatory pathway modulates intestinal muscularis resident macrophages independent of the spleen. Acetylcholine- synthesizing T cells relay neural signals in a vagus nerve circuit. Splenic nerve is required for cholinergic antiinflammatory pathway control of TNF in endotoxemia. Functional and chemical anatomy of the afferent vagal system. Central nervous system control of gastrointestinal motility and secretion and modulation of gastrointestinal functions.
The health care burden of patients with epilepsy in the United States: Corning and vagal nerve stimulation for seizures in the s. Long-term expectations of vagus nerve stimulation: Right-sided vagus nerve stimulation in humans: Treatment of refractory epilepsy in adult patients with right-sided vagus nerve stimulation.
Right-sided vagus nerve stimulation as a treatment for refractory epilepsy in humans. Review of the uses of vagal nerve stimulation in chronic pain management. Curr Pain Headache Rep. Vagus nerve stimulation for children with treatment-resistant epilepsy: Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. Vagus nerve stimulation for epilepsy: Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. Management of epilepsy during pregnancy: Ther Adv Neurol Disord.
Vagal nerve stimulator use during pregnancy for treatment of refractory seizure disorder. Vagus nerve stimulation during pregnancy: