No abstract availabe.
Vagus Nerve Stimulation*

There are virtually no cognitive and systemic side-effects associated with vagus nerve stimulation (VNS), which makes it a valuable treatment modality for patients with a poor tolerance to antiepileptic drugs. The safety of VNS therapy have been established in clinical studies, but there are few reports on the cardiac side effect associated with the intraoperative lead testing for implantation of the device for VNS. We report a patient with refractory epilepsy who experienced a complete atrioventricular block intraoperatively as a result of inadvertently high current intensity during the initial testing for implantation of a left vagus nerve stimulator.
Anticonvulsants ; Atrioventricular Block ; Epilepsy ; Humans ; Vagus Nerve Stimulation* ; Vagus Nerve*

As non-pharmaceutical interventions, non-invasive electrical neuromodulation techniques are promising in pain management. With many advantages, such as low costs, high usability, and non-invasiveness, they have been exploited to treat multiple types of clinical pain. Proper use of these techniques requires a comprehensive understanding of how they work. In this article, we reviewed recent studies concerning non-invasive electrical peripheral nerve stimulation (transcutaneous electrical nerve stimulation and transcutaneous vagus/vagal nerve stimulation) as well as electrical central nerve stimulation (transcranial direct current stimulation and transcranial alternating current stimulation). Specifically, we discussed their analgesic effects on acute and chronic pain, and the neural mechanisms thereof. We then contrasted the four kinds of nerve stimulation techniques, pointing out limitations of existing studies and proposing directions for future research. With more extensive and in-depth research to overcome these limitations, we shall witness more clinical applications of non-invasive electrical nerve stimulations to alleviate patients' pain and ease the crippling medical and economic burden imposed on patients, their families, and the entire society.
Analgesics ; Chronic Pain ; Humans ; Transcranial Direct Current Stimulation ; Transcutaneous Electric Nerve Stimulation ; Vagus Nerve Stimulation

OBJECTIVES: Several novel and minimally invasive techniques to stimulate the brain have recently developed. Among these newer somatic interventions, vagus nerve stimulation(VNS) is regarded as a promising tool in the treatment of various neuropsychiatric disorders. This article reviews the history, methodology, and the future of VNS technique and its emerging research and therapeutic applications in the field of neuropsychiatry. METHODS: Wide ranged literature reviews and discussion with pioneering researchers were performed. RESULTS: VNS has been used in the treatment of refractory seizure disorder and depression. There are some reasons to hope that VNS might have other therapeutic applications in neuropsychiatric disorders, as well as advanced understanding about the pathophysiology of these disorders. CONCLUSION: Regardless of its clinical role as a new therapeutic technique, the capacity of VNS as a research tool to alter brain activity should lead to important advances in the understanding of brain-behavior relationships.
Brain ; Depression ; Epilepsy ; Hope ; Neuropsychiatry* ; Seizures ; Vagus Nerve Stimulation* ; Vagus Nerve*

Vagal nerve stimulation is an important therapy for medically refractory epilepsy and major depression. Additionally, it may prove effective in treating obesity, Alzheimer's disease, and some neuropsychiatic disorders. As the number of approved indications increases, more patients are becoming eligible for surgical placement of a vagal nerve stimulator. Vagus nerve stimulator placement typically requires general anesthesia, and patients with previously implanted devices may present for other surgical procedures requiring anesthetic management. We have experienced anesthesia for 18 patients, which will be considered to help in anesthesia for vagus nerve stimulator in the future.
Alzheimer Disease ; Anesthesia ; Anesthesia, General ; Depression ; Epilepsy* ; Humans ; Obesity ; Vagus Nerve Stimulation ; Vagus Nerve*

OBJECTIVE: To observe the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on the sleep quality and nocturnal heart rate variability (HRV) in patients with primary insomnia. METHODS: Twenty-one patients with primary insomnia were included. Using SDZ-ⅡB electric acupuncture apparatus, Xin (CO₁₅) and Shen (CO₁₀) were stimulated with disperse-dense wave, 4 Hz/ 20 Hz in frequency, (0.2±30%) ms of pulse width and tolerable intensity. Electric stimulation was given once every morning and evening of a day, 30 min each time, for 4 weeks totally. Before and after treatment, the score of Pittsburgh sleep quality index (PSQI), objective sleep structure (total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], sleep efficiency [SE], the percentages of non-rapid eye movement period 1, 2, 3, and the percentage of rapid eye movement period to TST [N1%, N2%, N3%, REM%] ) and nocturnal HRV (high frequency [HF], low frequency [LF], the ratio of LF to HF [LF/HF], standard deviation for the normal RR intervals [SDNN], squared root of the mean sum of squares of differences between adjacent intervals RR [RMSSD], the percentage of adjacent RR intervals with differences larger than 50 ms in the entire recording [PNN50%], the mean of sinus RR intervals [NNMean] ) were compared in the patients separately. RESULTS: After treatment, the score of each item and the total score of PSQI and SL were all reduced as compared with those before treatment (P<0.01, P<0.001); SE, N3%, LF, HF, LF/HF, SDNN, NNMean and RMSSD were all increased compared with those before treatment (P<0.001, P<0.01). CONCLUSION The taVNS improves the sleep quality and objective sleep structure in patients with primary insomnia, which is probably related to the regulation of autonomic nervous functions.
Heart Rate/physiology* ; Humans ; Sleep/physiology* ; Sleep Initiation and Maintenance Disorders/therapy* ; Vagus Nerve ; Vagus Nerve Stimulation

Depressive disorder is one of the very serious mental diseases in terms of personal, social, economical losses. It is not clear for the pathogenesis of the depression, however, even though decreased 5-HT and NE may be the biological causing factors in the neuronal synapses. Moreover, there are many depressive patients who are treatment resistant or partial responders. Thus, we have been needed the other therapeutic methods for those cases. Repeated transcranial magnetic stimulation (rTMS) & VNS are the newly introduced methods for the treatment of refractory or partial responders with depression, which nature of therapeutic effect is the stimulation of the CNS. VNS has been used to treat the refractory epilepsy patients. Despite of numerous empirical and preclinical data, although VNS may be effective for the treatment of depression, the parameters for the treatment of depression using the VNS device have not been confirmed yet. However, from the several reports clinical effectiveness were described about 40%, thus, it is interested that VNS will be able to use for the treatment of depression in a future.
Depression* ; Depressive Disorder ; Depressive Disorder, Treatment-Resistant ; Epilepsy ; Humans ; Neurons ; Serotonin ; Synapses ; Transcranial Magnetic Stimulation ; Vagus Nerve Stimulation* ; Vagus Nerve*

OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.
Brain Injuries ; Electric Stimulation ; Epilepsy ; Epilepsy, Post-Traumatic ; Follow-Up Studies ; Humans ; Seizures ; Vagus Nerve ; Vagus Nerve Stimulation

Neuro-stimulation techniques have gradually evolved over the decades and have emerged potential therapeutic modalities for the treatment of psychiatric disorders, especially treatment refractory cases. The neuro-stimulation techniques involves modalities like electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS) and others. This review discusses the role of neuro-stimulation techniques in the treatment of anxiety disorders. The various modalities of neuro-stimulation techniques are briefly discussed. The evidence base relating to use of these techniques in the treatment of anxiety disorders is discussed further. The review then highlights the challenges in conducting research in relation to the use of neuro-stimulation techniques with reference to patients with anxiety disorders. The review provides the future directions of research and aimed at expanding the evidence base of treatment of anxiety disorders and providing neuro-stimulation techniques as promising effective and acceptable alternative in select cases.
Anxiety Disorders* ; Anxiety* ; Electroconvulsive Therapy ; Humans ; Transcranial Direct Current Stimulation ; Transcranial Magnetic Stimulation ; Vagus Nerve Stimulation

PURPOSE: This study is to evaluate the efficacy and safety of vagus nerve stimulation (VNS) in intractable childhood onset epilepsy by reviewing our experiences. MEHTHOD: Involved in the study are five patients who underwent VNS from July 23th, 1999 and had been followed up over 12 months. We reviewed data prospectively collected with a focus on clinical features, therapeutic outcomes and safety, developmental progress, and EEG findings. RESULTS: Three patients were classified as Lennox-Gastaut syndrome. One patient of the two remaining patients had gelastic seizure caused by hypothalamic harmatoma, while the other patient had partial seizure with secondary generalization. Among the 5 patients, one patient showed a seizure frequency reduction rate of about 50% from baseline in 3 months after VNS implantation and more than 90% in 12 months, 2 patients of about 50% in 3 months and of about 75% in 12 months, but the other two patients didn't show any change in seizure frequency. Side effects such as hoarseness, dyspnea during sleep and wound infection could be controlled simply through the adjustment of output current or wound revision. However, efficacy in cognitive function and EEG findings was not satisfactory. CONCLUSIONS: VNS might be an effective adjunctive therapy for intractable childhood epilepsy and transient side effects can be controlled without discontinuation of VNS therapy.
Dyspnea ; Electroencephalography ; Epilepsy* ; Generalization (Psychology) ; Hoarseness ; Humans ; Prospective Studies ; Seizures ; Vagus Nerve Stimulation* ; Vagus Nerve* ; Wound Infection ; Wounds and Injuries