Vagus nerve stimulation

The Vagus nerve is a crucial part of the autonomic nervous system, playing a significant role in regulating metabolic balance and maintaining homeostasis through its connections with the neuroendocrine and immune systems. It achieves this through both its sensory (afferent) and motor (afferent) pathways. 

Vagus nerve and its importance

Vagus nerve is the vital component of body's autonomic nervous system, significantly influencing many physiological processes. It acts as a key mediator in maintaining homeostasis by regulating various bodily functions through its extensive network of connections. 

Key Impacts of Vagus Nerve Stimulation:

• Stimulation of the vagus nerve sends signals that slow down the heart rate to maintain a healthy level of blood pressure.
• Modulation of inflammatory and immune responses relates to vagus nerve stimulation, protecting the body from excessive inflammation and supporting a balanced immune system.
• Vagus nerve stimulation helps regulate the muscles involved in breathing, ensuring proper respiratory function and response to changes in the body’s oxygen and carbon dioxide levels.
• By influencing the parasympathetic nervous system, vagus nerve stimulation promotes relaxation and reduces stress levels. It’s associated with improved mood and resilience against stress, contributing to better mental health.
• Acting as a communication superhighway, the vagus nerve relays information between the brain and various organs, including the heart, lungs, and digestive tract, helping to coordinate their activities efficiently when stimulated.
• Vagus nerve stimulation is integral to the neuroendocrine-immune axis, a complex network that manages the body’s stress response and maintains overall balance by interacting with the hormonal and immune systems.

Indications

Vagus nerve stimulation is indicated when the conditions are not controlled by medications. Some of them include:

Epilepsy

Vagus nerve stimulation (VNS) is used to treat drug-resistant epilepsy. It is approved in United States as an additional therapy for individuals aged 4 and older who have refractory focal onset seizures. VNS is recommended only after trying at least two appropriately chosen anti-seizure medications and if the patient is not a right candidate for epilepsy surgery, which has a higher likelihood of achieving seizure freedom. Patients who struggle with adherence to or tolerance of anti-seizure medications might benefit from VNS.

VNS may also be effective for specific epilepsy syndromes and seizure types, such as Lennox-Gastaut syndrome, epilepsy related to tuberous sclerosis complex, refractory absence seizures, and atonic seizures. 

Treatment-Resistant Depression

VNS is also used for treating major depressive disorders that does not respond to standard treatments.  It is approved for treating adults 18 years or older who experienced long-term or recurring depression which is not subsided by multiple therapy of anti-depressant treatments. 

Stroke Rehabilitation

The United States Food and Drug Administration (USFDA) approved vagus nerve stimulation (VNS) paired with MicroTransponder Vivistim as a drug-free rehabilitation to treat moderate to severe upper extremity motor deficits resulting from chronic ischemic stroke.

Parts of VNS device

VNS has two parts that are placed during a surgical procedure.

• A stimulator (also called generator) is implanted under the skin in the left chest area.
• A thin wire or lead is wrapped around the left vagus nerve in the neck. The lead goes under the skin and connects to the stimulator.

Mechanism of vagus nerve stimulation

The purpose of Vegas nerve stimulation is to prevent or minimize the frequency of seizures in individuals with epilepsy, especially if the condition is untreated by standard medication. The device used for this procedure is implanted in the body and sends regular small pulses of electrical energy to the brain via Vegas nerve located in the neck.

The device is programmed and designed to deliver electrical stimulation at regular intervals, it is also constructed to provide additional stimulation, when it detects periods of increased heart rate which can be an indicator of an impending seizure. This process of identifying the increased heart rate can help to stop seizure initiation at its early occurrence.

Efficacy:

The VNS device can be used in individuals who experience mild seizures. According to research using VNS in first 3 months has decreased seizures by 50% in 1 out of 3 people. Also, individuals who had been getting VNS for 10 years had seen a 75% reduction in seizure frequency. Overall, the use of VNS over time can typically control seizures in their lifetime. However, VNS does not cure epilepsy, it is used as an adjuvant therapy along with standard medications. 

Most individuals will still need to continue taking their prescribed seizure medications while using VNS.

Patient Follow-Up:

Regular follow up with healthcare provider is essential to monitor the effectiveness of the DNS and make necessary adjustment to the device settings. 

Sensation and Adjustment of the Vagus Nerve Stimulation Device

When the vagus nerve stimulation (VNS) device is active, you generally won't notice the stimulation. However, some people may experience:

• A tickling sensation in the throat or neck.

• Hoarseness in their voice.

• A mild cough.

If you find the stimulation uncomfortable or bothersome, contact your healthcare provider. They can adjust the device settings to reduce the stimulation level and improve your comfort

Criteria for Vagus Nerve Stimulation

When considering Vagus Nerve Stimulation (VNS), it’s best to first visit a comprehensive epilepsy center to ensure that all treatment options have been investigated and that VNS is appropriate. Here are key questions to discuss with your healthcare provider:

Seizures type:

VNS is found to be effective for focal seizures and some types of generalised seizures such as those associated with Lennox Gastaut Syndrome. This therapy is not effective for person you are not epileptic but have seizures that are not linked to electrical activity in the brain.

Drug-Resistant Epilepsy:

It is important to understand if epilepsy is truly drug-resistant and uncontrolled. It's crucial to rule out other factors that might affect seizure control, such as medication adherence or lifestyle issues. Counseling and education about managing triggers may be necessary first.

A neurologist will review the medication history to ensure that the patient has tried the right drugs for seizure type and for an adequate duration.

Other Health Conditions:

People with significant asthma, breathing issues, sleep apnea, or certain heart problems may be advised against VNS as it could exacerbate these conditions.

Accessibility to Follow-Up Care:

The individual should be accessible to the hospital or clinic for device programming and follow-up visits. It’s advisable to have a family member or friend accompany you to appointments initially. Once accustomed to the therapy, one can usually attend alone, but ensure to can travel safely.

Support System and Emotional Readiness:

Some people may initially be uncomfortable with having a device implanted, but most get used to it over time. The stimulation can be adjusted to minimize any sensation.

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