Advertisement

Vagus Nerve Stimulation for Refractory Epilepsy

  • Tomislav Sajko
  • Krešimir Rotim
Chapter

Abstract

Vagus nerve stimulation (VNS) has confirmed its seizure suppression effect by randomized control trials [1]. More than 50% of seizure reductions have been reported in approximately 50% of patients after 2 years of treatment [2]. Independently of the reduction in seizure frequency, it has been reported that VNS improves attention, cognition, behavior, mood, and quality of life [3]. The hypothesis that afferent vagal signals modulate abnormal cortical excitability via various pathways has not been fully clarified. The relevant anatomy and physiology of the vagal nerve as well as indications for its clinical use and the implant operative technique are described.

Keywords

Nervus vagus Stimulation therapy Refractory epilepsy Surgery 

References

  1. 1.
    Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48–55.CrossRefGoogle Scholar
  2. 2.
    Elliott RE, Morsi A, Kalhorn SP, Marcus J, Sellin J, Kang M, et al. Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy Behav. 2011;20:57–63.CrossRefGoogle Scholar
  3. 3.
    Hallböök T, Lundgren J, Stjernqvist K, Blennow G, Strömblad LG, Rosén I. Vagus nerve stimulation in 15 children with therapy resistant epilepsy: its impact on cognition, quality of life, behavior and mood. Seizure. 2005;14:504–13.CrossRefGoogle Scholar
  4. 4.
    Foley JO, DuBois F. Quantitative studies of the vagus nerve in the cat. I. The ratio of sensory and motor fibers. J Comp Neurol. 1937;67:49–97.CrossRefGoogle Scholar
  5. 5.
    Agostini E, Chinnock JE, Daly MD, Murray JG. Functional and histological studies of the vagus nerve and its branches to the heart, lungs, and abdominal viscera in the cat. J Physiol. 1957;135:182–205.CrossRefGoogle Scholar
  6. 6.
    Saper CB, Kibbe MR, Hurley KM, Spencer S, Holmes HR, Leahy KM, et al. Brain natriuretic peptidelike immunoreactive innervation of the cardiovascular and cerebrovascular systems in the rat. Circ Res. 1990;67:1345–54.CrossRefGoogle Scholar
  7. 7.
    Prechtl JC, Powley TL. Organization and distribution of the rat subdiaphragmatic vagus and associated paraganglia. J Comp Neurol. 1985;235:82–95.CrossRefGoogle Scholar
  8. 8.
    Schahter SC, Saper CB. Vagus nerve stimulation. Epilepsia. 1998;39:677–86.CrossRefGoogle Scholar
  9. 9.
    Loewy AD, Burton H. Nuclei of the solitary tract: efferent projections to the lower brain stem and spinal cord. J Comp Neurol. 1978;18:421–50.CrossRefGoogle Scholar
  10. 10.
    Ruggiero DA, Cravo SL, Arango V, Reis DJ. Central control of the circulation by the rostral ventrolateral reticular nucleus: anatomical substrates. Prog Brain Res. 1989;81:49–79.CrossRefGoogle Scholar
  11. 11.
    Saper CB. The central autonomic system. In: Paxinos G, editor. The rat nervous system. 2nd ed. San Diego: Academic; 1995. p. 107–31.Google Scholar
  12. 12.
    Fulwiler CE, Saper CB. Subnuclear organization of the efferent connections of the parabrachial nucleus in the rat. Brain Res Rev. 1984;7:229–59.CrossRefGoogle Scholar
  13. 13.
    Cechetto DF, Saper CB. Evidence for a viscerotopic sensory representation in the cortex and thalamus in the rat. J Comp Neurol. 1987;262:27–45.CrossRefGoogle Scholar
  14. 14.
    Hurley KM, Herbert H, Moga MM, Saper CB. Efferent connections of the infralimbic cortex of the rat. J Comp Neurol. 1991;308:249–76.CrossRefGoogle Scholar
  15. 15.
    Saper CB. Reciprocal parabrachial-cortical projections in the rat. Brain Res. 1982;242:33–40.CrossRefGoogle Scholar
  16. 16.
    Allen GV, Saper CB, Hurley KM, Cechetto DF. Organization of visceral and limbic connections in the insular cortex of the rat. J Comp Neurol. 1991;31:1–16.CrossRefGoogle Scholar
  17. 17.
    Saper CB. Diffuse cortical projection systems: anatomical organization and role in cortical function. In: Plum F, editor. Handbook of physiology. The nervous system V. Bethesda: American Physiological Society; 1987. p. 169–210.Google Scholar
  18. 18.
    Krahl SE, Clark KB. Vagus nerve stimulation for epilepsy: a review of central mechanisms. Surg Neurol Int. 2012;3(Suppl 4):S255–9.CrossRefGoogle Scholar
  19. 19.
    Vonck K, Raedt R, Naulaerts J, De Vogelaere F, Thiery E, van Roost D, et al. Vagus nerve stimulation 25 years later! What do we know about the effects on cognition? Neurosci Biobehav Rev. 2014;45:63–71.CrossRefGoogle Scholar
  20. 20.
    Zanchetti A, Wpg SC, Moruzzi G. The effect of vagal stimulation on the EEG pattern of the cat. Electroencephalogr Clin Neurophysiol. 1952;4:357–461.CrossRefGoogle Scholar
  21. 21.
    Gamier L. EEG modifications produced by gastric distention in cats. C R Soc Seances Soc Biol Fil. 1968;162:2164–8.Google Scholar
  22. 22.
    Bridgers SL, Spencer SS, Spencer DD, Sasalu CT. A cerebral effect of carotid sinus stimulation. Observation during intraoperative electroencephalographic monitoring. Arch Neurol. 1985;42:574–7.CrossRefGoogle Scholar
  23. 23.
    Garnett ES, Nahmias C, Scheffel A, Firnau G, Upton ARM. Regional cerebral blood flow in man manipulated by direct vagal stimulation. Pacing Clin Electrophysiol. 1992;15:1579–80.CrossRefGoogle Scholar
  24. 24.
    Ko D, Heck C, Grafton S, Apuzzo ML, Couldwell WT, Chen T, et al. Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2150 blood flow imaging. Neurosurgery. 1996;39:426–31.CrossRefGoogle Scholar
  25. 25.
    Reis DJ, Iadecola C, Nakai M. Control of cerebral blood flow and metabolism by intrinsic neural systems in brain. In: Plum F, Pulsinelli W, editors. Cerebrovascular diseases. New York: Raven Press; 1985. p. l–25.Google Scholar
  26. 26.
    McLachlan RS. Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Epilepsia. 1993;34:918–23.CrossRefGoogle Scholar
  27. 27.
    Woodbury DM, Woodbury JW. Effects of vagal stimulation on experimentally induced seizures in rats. Epilepsia. 1990;3(Suppl 2):S7–19.CrossRefGoogle Scholar
  28. 28.
    Ben-Menachem E, Hamberger A, Hedner T, Hammond EJ, Uthman BM, Slater J, et al. Effects of vagus nerve stimulation on amino acids and other metabolites in the CSF of patients with partial seizures. Epilepsy Res. 1995;20:221–7.CrossRefGoogle Scholar
  29. 29.
    Takaya M, Terry WJ, Naritoku DK. Vagus nerve stimulation induces a sustained anticonvulsant effect. Epilepsia. 1996;37:111–4.CrossRefGoogle Scholar
  30. 30.
    Morris GL, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus nerve stimulation study group E01-E05. Neurology. 1999;53:1731–5.CrossRefGoogle Scholar
  31. 31.
    Uthman BM, Reichl AM, Dean JC, Eisenschenk S, Gilmore R, Reid S, et al. Effectiveness of vagus nerve stimulation in epilepsy patients: a 12-year observation. Neurology. 2004;63:1124–6.CrossRefGoogle Scholar
  32. 32.
    Lulic D, Ahmadian A, Baaj AA, Benbadis S, Vale FL. Vagus nerve stimulation. Neurosurg Focus. 2009;27:E5.CrossRefGoogle Scholar
  33. 33.
    Amar AP, Heck CN, Levy ML, Smith T, DeGiorgio CM, Oviedo S, et al. An institutinal experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique and outcome. Neurosurgery. 1998;43:1265–80.PubMedGoogle Scholar
  34. 34.
    Amar AP, Levy ML, McComb JG, Apuzzo MLJ. Vagus nerve stimulation for control of intractable seizures in childhood. Pediatr Neurosurg. 2001;34:218–23.CrossRefGoogle Scholar
  35. 35.
    Hosain S, Nikalov B, Harden C, Li M, Fraser R, Labar D. Vagus nerve stimulation treatment for Lennox-Gastaut syndrome. J Child Neurol. 2000;15:509–12.CrossRefGoogle Scholar
  36. 36.
    Ng M, Devinsky O. Vagus nerve stimulation for refractory idiopathic generalised epilepsy. Seizure. 2004;13:176–8.CrossRefGoogle Scholar
  37. 37.
    Ventureyra EC. Transcutaneous vagus nerve stimulation for partial onset seizure therapy: a new concept. Childs Nerv Syst. 2000;16:101–2.CrossRefGoogle Scholar
  38. 38.
    Ellrich J. Transcutaneous vagus nerve stimulation. Eur Neurol Rev. 2011;6:254–6.CrossRefGoogle Scholar
  39. 39.
    Dietrich S, Smith J, Scherzinger C, Hofmann-Preiss K, Freitag T, Eisenkolb A, et al. A novel transcutaneous vagus nerve stimulation leads to brainstem and cerebral activations measured by functional MRI. Biomed Tech (Berl). 2008;53:104–11.CrossRefGoogle Scholar
  40. 40.
    Kraus T, Kiess O, Hosl K, Terekhin P, Kornhuber J, Forster C, et al. CNS BOLD fMRI effects of sham-controlled transcutaneous electrical nerve stimulation in the left outer auditory canal—a pilot study. Brain Stimul. 2013;6:798–804.CrossRefGoogle Scholar
  41. 41.
    Friedley J. Brain stimulation for the treatment of epilepsy. Neurosurg Focus. 2012;32(3):e13.CrossRefGoogle Scholar
  42. 42.
    Panebianco M, Rigby A, Weston J, Marson AG. Vagus nerve stimulation for partial seizures. Cochrane Database Syst Rev. 2015;494(4):CD002896.Google Scholar
  43. 43.
    DeGiorgio C, Heck C, Bunch S, Britton J, Green P, Lancman M, et al. Vagus nerve stimulation for epilepsy: randomized comparison of three stimulation paradigms. Neurology. 2005;65:317–9.CrossRefGoogle Scholar
  44. 44.
    Klinkenberg S, Aalbers MW, Vles JSH, Cornips EMJ, Rijkers K, Leenen L, et al. Vagus nerve stimulation in children with intractable epilepsy: a randomized controlled trial. Dev Med Child Neurol. 2012;54:855–61.CrossRefGoogle Scholar
  45. 45.
    Michael JE, Wegener K, Barners DW. Vagus nerve stimulation for intractable seizures: one year follow-up. J Neurosci Nurs. 1993;25:362–6.CrossRefGoogle Scholar
  46. 46.
    Ben-Menachem E, Manon-Espaillat R, Ristanovic R, Wilder BJ, Stefan H, Mirza W, et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. Epilepsia. 1994;35:616–26.CrossRefGoogle Scholar
  47. 47.
    Ramsay RE, Uthman BM, Augustinsson LE, Upton ARM, Naritoku D, Willis J, Treig T, et al. First International Vagus Nerve Stimulation Study Group. Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. Epilepsia. 1994;35:627–36.CrossRefGoogle Scholar
  48. 48.
    The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology. 1995;45:224–30.CrossRefGoogle Scholar
  49. 49.
    Howland RH. Vagus nerve stimulation. Curr Behav Neurosci Rep. 2014;1:64–73.CrossRefGoogle Scholar
  50. 50.
    Gorny KR, Bernstein MA, Watson RE Jr. 3 tesla MRI of patients with a vagus nerve stimulator: initial experience using a T/R head coil under controlled conditions. J Magn Reson Imaging. 2010;31:475–81.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Tomislav Sajko
    • 1
  • Krešimir Rotim
    • 1
  1. 1.Department of NeurosurgerySestre Milosrdnice University Hospital CenterZagrebCroatia

Personalised recommendations