J Korean Neurosurg Soc.  2019 May;62(3):344-352. 10.3340/jkns.2019.0037.

The Present and Future of Vagus Nerve Stimulation

• Yang J
• Phi JH

• KMID: 2453240
• DOI: http://doi.org/10.3340/jkns.2019.0037

Abstract

Epilepsy is one of the major chronic neurological diseases affecting many patients. Resection surgery is the most effective therapy for medically intractable epilepsy, but it is not feasible in all patients. Vagus nerve stimulation (VNS) is an adjunctive neuromodulation therapy that was approved in 1997 for the alleviation of seizures; however, efforts to control epilepsy by stimulating the vagus nerve have been studied for over 100 years. Although its exact mechanism is still under investigation, VNS is thought to affect various brain areas. Hence, VNS has a wide indication for various intractable epileptic syndromes and epilepsy-related comorbidities. Moreover, recent studies have shown anti-inflammatory effects of VNS, and the indication is expanding beyond epilepsy to rheumatoid arthritis, chronic headaches, and depression. VNS yields a more than 50% reduction in seizures in approximately 60% of recipients, with an increase in reduction rates as the follow-up duration increases. The complication rate of VNS is 3-6%, and infection is the most important complication to consider. However, revision surgery was reported to be feasible and safe with appropriate measures. Recently, noninvasive VNS (nVNS) has been introduced, which can be performed transcutaneously without implantation surgery. Although more clinical trials are being conducted, nVNS can reduce the risk of infection and subsequent device failure. In conclusion, VNS has been demonstrated to be beneficial and effective in the treatment of epilepsy and various diseases, and more development is expected in the future.

Keyword

Vagus nerve stimulation; Epilepsy; Neuromodulation; Drug resistant epilepsy; Transcutaneous electric nerve stimulation

MeSH Terms

Arthritis, Rheumatoid
Brain
Comorbidity
Depression
Drug Resistant Epilepsy
Epilepsy
Equipment Failure
Follow-Up Studies
Headache Disorders
Humans
Seizures
Transcutaneous Electric Nerve Stimulation
Vagus Nerve Stimulation*
Vagus Nerve*

Figure

• 

  Fig. 1. A : Vagus nerve is exposed on a rubber sheet. The carotid sheath is opened and tied to adjacent soft tissue. The exposure should be at least 4 cm to properly locate the helical electrode. B : A helical electrode is successfully installed. Helices are composed of tethering anchor, positive and negative electrodes in order from the bottom, respectively.

Reference

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