Vagus nerve stimulation for epilepsy: A review of the peripheral mechanisms

Vagus nerve stimulation (VNS) is a unique epilepsy treatment in that a peripheral intervention is used to treat a disease that is entirely related to pathological events occurring within the brain. To understand how stimulation of the vagus nerve can be used to stop seizures, an understanding of the peripheral anatomy and physiology of the vagus nerve is essential. The peripheral aspects of the vagus nerve are discussed in this review, with an explanation of which fibers and branches are involved in producing these antiepileptic effects, along with speculation about the potential for improving the therapy.

[1]  R. Ideker,et al.  Vagus nerve stimulation for induced spinal cord seizures: insights into seizure cessation. , 2005, Journal of neurosurgery.

[2]  Mario Mariani,et al.  Analysis of RR variability in drug-resistant epilepsy patients chronically treated with vagus nerve stimulation , 2003, Autonomic Neuroscience.

[3]  W. J. Oakes,et al.  Right‐sided vagus nerve stimulation inhibits induced spinal cord seizures , 2007, Clinical anatomy.

[4]  A. Ebner,et al.  Vagus nerve stimulation: predictors of seizure freedom , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[5]  D. Hopkins,et al.  Ultrastructure and synaptology of the nucleus ambiguus in the rat: The semicompact and loose formations , 1996, The Journal of comparative neurology.

[6]  S. Krahl,et al.  Right-sided vagus nerve stimulation reduces generalized seizure severity in rats as effectively as left-sided , 2003, Epilepsy Research.

[7]  M. Mesulam,et al.  Brain stem projections of sensory and motor components of the vagus complex in the cat: II. Laryngeal, tracheobronchial, pulmonary, cardiac, and gastrointestinal branches , 1980, The Journal of comparative neurology.

[8]  J. Zabara Inhibition of Experimental Seizures in Canines by Repetitive Vagal Stimulation , 1992, Epilepsia.

[9]  V. Tronnier,et al.  Right-sided vagus nerve stimulation in humans: An effective therapy? , 2008, Epilepsy Research.

[10]  Lippincott Williams Wilkins,et al.  A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures , 1995, Neurology.

[11]  J. Zabara,et al.  The Implantable Neurocybernetic Prosthesis System , 1991, Pacing and clinical electrophysiology : PACE.

[12]  D. Woodbury,et al.  Effects of Vagal Stimulation on Experimentally Induced Seizures in Rats , 1990, Epilepsia.

[13]  A. Upton,et al.  Balance and Cognitive Impairment in Two Epileptic Patients Before and After Vagal Nerve Stimulation , 1991, Pacing and clinical electrophysiology : PACE.

[14]  R. Lesser Ventricular asystole during vagus nerve stimulation for epilepsy in humans. , 2000, Neurology.

[15]  G. Gebhart,et al.  A critical review of the afferent pathways and the potential chemical mediators involved in cardiac pain , 1992, Neuroscience.

[16]  Terry L. Powley,et al.  The fiber composition of the abdominal vagus of the rat , 2004, Anatomy and Embryology.

[17]  S. Schachter Therapeutic effects of vagus nerve stimulation in epilepsy and implications for sudden unexpected death in epilepsy , 2006, Clinical Autonomic Research.

[18]  D Paydarfar,et al.  Cardiorespiratory variables and sensation during stimulation of the left vagus in patients with epilepsy , 1999, Epilepsy Research.

[19]  D. Bettis,et al.  Right‐sided Vagus Nerve Stimulation as a Treatment for Refractory Epilepsy in Humans , 2005, Epilepsia.

[20]  H. Berthoud,et al.  Abdominal pathways and central origin of rat vagal fibers that stimulate gastric acid. , 1991, Gastroenterology.

[21]  J. O. Foley,et al.  Quantitative studies of the vagus nerve in the cat. I. The ratio of sensory to motor fibers , 1937 .

[22]  V. Venkataraman Vagus nerve stimulation and drug reduction , 2001, Neurology.

[23]  S. Krahl,et al.  Destruction of Peripheral C‐Fibers Does Not Alter Subsequent Vagus Nerve Stimulation‐Induced Seizure Suppression in Rats , 2001, Epilepsia.

[24]  R. Gilmartin,et al.  Prospective Long‐Term Study of Vagus Nerve Stimulation for the Treatment of Refractory Seizures , 2000, Epilepsia.

[25]  B. Uthman,et al.  Vagus nerve stimulation therapy for partial-onset seizures , 1998, Neurology.

[26]  A. Pelleg,et al.  Electrophysiological-anatomic correlates of ATP-triggered vagal reflex in dogs. , 1993, The American journal of physiology.

[27]  J. Pastor,et al.  Treatment of refractory epilepsy in adult patients with right-sided vagus nerve stimulation , 2010, Epilepsy Research.

[28]  J. Dean,et al.  Prevention of Intractable Partial Seizures by Intermittent Vagal Stimulation in Humans: Preliminary Results , 1990, Epilepsia.