Posts Tagged vagus nerve stimulator
Vagus nerve stimulation (VNS) was the first neuromodulation device approved for treatment of epilepsy. In more than 20 years of study, VNS has consistently demonstrated efficacy in treating epilepsy. After 2 years, approximately 50% of patients experience at least 50% reduced seizure frequency. Adverse events with VNS treatment are rare and include surgical adverse events (including infection, vocal cord paresis, and so forth) and stimulation side effects (hoarseness, voice change, and cough). Future developments in VNS, including closed-loop and noninvasive stimulation, may reduce side effects or increase efficacy of VNS.
For people with treatment-resistant depression, adding vagus nerve stimulation to medication can drastically improve their quality of life, concludes a new study.
Of these, more than 10 million adults report that the condition severely impaired their quality of life.
There are a variety of treatments available for depression, including therapy, medication, and making changes to one’s lifestyle. However, for some, these therapies are not enough to relieve the symptoms and improve quality of life.
Some with treatment-resistant depression turn to neurostimulation. One type of neurostimulation is vagus nerve stimulation (VNS).
In VNS, a device is fitted in the patient’s chest or neck, under the skin. These devices send pulses of electrical stimulation to the vagus nerve, which starts in the brain, goes through the neck, and ends in the chest and abdomen.
However, does VNS really improve the quality of life of those who opt for it? A new study, just published in The Journal of Clinical Psychiatry, aims to answer this question.
The researchers were led by Dr. Charles R. Conway, a professor of psychiatry at Washington University in St. Louis, MO.
VNS makes a big difference in people’s lives
Dr. Conway and team examined the effects of VNS on nearly 600 people with treatment-resistant depression. The participants had tried four or more antidepressants, with no success, before resorting to VNS.
The scientists compared 328 patients with treatment-resistant depression who had a vagus nerve stimulator — some of whom were also taking medication — with 271 study participants who only received “treatment as usual.”
“Treatment as usual” included antidepressants, psychotherapy, transcranial magnetic stimulation, and electroconvulsive therapy. These treatments were taken separately or in combination.
To evaluate the participants’ quality of life, Dr. Conway and team used 14 parameters, including:
- “perceived physical health”
- ability to work
- ability to get around
- family relationships
- leisure activities
- overall well-being
Dr. Conway summarizes the findings, saying, “On about 10 of the 14 measures, those with vagus nerve stimulators did better.”
“For a person to be considered to have responded to a depression therapy, he or she needs to experience a 50 percent decline in his or her standard depression score,” he explains.
“But we noticed, anecdotally, that some patients with stimulators reported they were feeling much better even though their scores were only dropping 34 to 40 percent.”
One such piece of anecdotal evidence comes from study participant Charles Donovan. “Slowly but surely, my mood brightened,” he explains. “I went from being basically catatonic to feeling little or no depression.”
“Before the stimulator,” Donovan recalls, “I never wanted to leave my home […] It was stressful to go to the grocery store. I couldn’t concentrate to sit and watch a movie with friends.”
“But after I got the stimulator,” he goes on, “my concentration gradually returned. I could do things like read a book, read the newspaper, watch a show on television. Those things improved my quality of life.”
Dr. Conway thinks that improving focus is at the heart of VNS’s benefits. “It improves alertness, and that can reduce anxiety,” he notes. “And when a person feels more alert and more energetic and has a better capacity to carry out a daily routine, anxiety and depression levels decline.”
“A lot of patients are on as many as three, four, or five antidepressant medications, and they are just barely getting by. But when you add a vagus nerve stimulator, it really can make a big difference in people’s everyday lives.”
Dr. Charles R. Conway
Researchers at The Ohio State University Wexner Medical Center are among the first in the world studying how a specific type of neurostimulator can improve rehabilitation for stroke patients.
As part of the clinical trial, an electrical device called a vagus nerve stimulator is surgically implanted in the patient’s chest wall. The Vivistim device, which connects to the vagus nerve in the neck, is used to “rewire” circuits in the brain associated with certain motor functions. Stroke can result in the loss of brain tissue and negatively affect various bodily functions from speech to movement, depending on the location of the stroke.
In an earlier pilot study, this approach known as Paired Vagus Nerve Stimulation was shown to benefit approximately 85 percent of the people who received the nerve stimulation, said Dr. Marcie Bockbrader, research physiatrist for the Neurological Institute at The Ohio State University Wexner Medical Center.
“This nerve stimulation is like turning on a switch, making the patient’s brain more receptive to therapy,” Bockbrader said. “The goal is to see if we can improve motor recovery in people who have what is, in effect, a brain pacemaker implanted in their body. The idea is to combine this brain pacing with normal rehab, and see if patients who’ve been through all of the other usual therapies after a stroke can get even better.”
The study is recruiting patients who suffered a stroke and have been left with poor arm function as a result. The study is open to patients who have suffered a stroke at least nine months ago up to 10 years ago.
Each participant will receive three one-hour sessions of intensive physiotherapy each week for six weeks to help improve their arm function.
Half of the group will also receive an implanted vagus nerve stimulator. During rehabilitation therapy sessions, when a patient correctly performs an exercise, the therapist pushes a button to trigger the device to stimulate the vagus nerve. This neurostimulator signals the brain to remember that movement.
“We are trying to see if this neurostimulator could be used to boost the effective therapy, creating a sort of ‘supercharged therapy.’ We want to determine if patients can recover more quickly through the use of this stimulation,” Bockbrader said.
Previous research indicates that vagus nerve stimulation causes the release of the brain’s own chemicals, called neurotransmitters that will help the brain form new neural connections which might improve participant’s ability to use their arm.
Traditional vagus nerve stimulation has been used in the United States and around the world to treat more than 100,000 patients for epilepsy.
Having a Vagus Nerve Stimulator implanted can be a tough decision. Is it right for you? Will it work? What are the side effects and consequences?
I did some research and got the low-down on what it is, how it works and some interesting statistics. (If you are already acquainted with the VNS and are on the fence, you might want to just skip down to risks and benefits sections.)
How it works
Vagus Nerve Stimulation (VNS) has been used to treat more than 30,000 epilepsy patients worldwide. It’s designed to prevent or interrupt seizures or electrical disturbances in the brain for people with hard to control seizures. Used in conjunction with anti-seizure medications, the VNS uses electrical pulses that are delivered to the vagus nerve in the neck and travel up into the brain.
The good news is that the vagus nerve has very few pain fibers, so it’s…
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