Beyond the Treatment of Epilepsy: New Applications of Vagus Nerve Stimulation in Psychiatry

Department of Psychiatry, University Hospital, Bern, Switzerland.
CNS spectrums (Impact Factor: 1.3). 08/2003; 8(7):515-21.
Source: PubMed

ABSTRACT Vagus nerve stimulation (VNS) in humans generally refers to stimulation of the left vagus nerve at the cervical level VNS is an established treatment largely devoid of severe side effect for medically refractory partial onset seizures and has been used in more than 16,000 patients. Over the past 5 years, applications in other neuropsychiatric disorders have been investigated with a special emphasis on depression. Recent data from an open-label, multi-center pilot study involving 60 patients suggest a potential clinical usefulness in the acute and maintenance treatment of drug-resistant depressive disorder. The perspective of VNS as along-term treatment with the advantage of assured compliance makes it an interesting technique to potentially treat drug-resistant depression. However, definite therapeutic effects of clinical significance remain to be confirmed in large placebo-controlled trial. Results of clinical pilot studies involving patients suffering from obesity and Alzheimer's disease indicate that VNS might induce weight loss and improve cognition. Besides its clinical usefulness, VNS can be used as a research tool, allowing neurophysiologic investigations of the parasympathetic system and its interactions with other parts of the central nervous system.

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    • "Different modalities of neuromodulation such as repetitive transcranial magnetic stimulation (Schlaepfer et al., 2003; George, 2010), vagus nerve stimulation (Kosel and Schlaepfer, 2003; Schlaepfer et al., 2008b), and magnetic seizure therapy (Lisanby et al., 2001; Kayser et al., 2010) have been proposed and systematically studied in psychiatric different disorders (Schlaepfer et al., 2010). Both clinically and scientifically the most promising method of neuromodulation might be deep brain stimulation (DBS). "
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    ABSTRACT: Most patients suffering from psychiatric disorders respond to combinations of psycho- and psychopharmacotherapy; however there are patients who profit little if anything even after many years of treatment. Since about a decade different modalities of targeted neuromodulation - among them most prominently - deep brain stimulation (DBS) - are being actively researched as putative approaches to very treatment-resistant forms of those disorders. Recently, promising pilot data have been reported both for major depression (MD) and obsessive-compulsive disorder (OCD). Given the fact that patients included in DBS studies had been treated unsuccessfully for many years with conventional treatment methods, renders these findings remarkable. Remarkable is the fact, that in case of the long-term studies underway for MD, patients show a stable response. This gives hope to a substantial percentage of therapy-resistant psychiatric patients requiring new therapy approaches. There are no fundamental ethic objections to its use in psychiatric disorders, but until substantial clinical data is available, mandatory standards are needed. DBS is a unique and very promising method for the treatment of therapy-resistant psychiatric patients. The method allows manipulating pathological neuronal networks in a very precise way.
    Frontiers in Integrative Neuroscience 06/2011; 5:29. DOI:10.3389/fnint.2011.00029
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    • "In 2000, the new method to induce therapeutic seizures was first used in a proof of concept study in Switzerland, this demonstrated the feasibility of reproducibly inducing seizures in humans (Lisanby et al. 2001b). Effects of MST on cognitive functioning have been examined in humans and non-human primates (Kosel et al. 2003; Lisanby et al. 2003a; Moscrip et al. 2006). Moderate-dose MST, administered at 2.5 times the seizure threshold, resulted in fewer cognitive adverse "
    The World Journal of Biological Psychiatry 02/2010; 11(1):2-18. DOI:10.3109/15622970903170835 · 4.23 Impact Factor
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    • "Vagus nerve stimulation (VNS) is currently used as a nonpharmacologic treatment to control medically untreatable seizures [2] [37] [39] [43]. It has also been proposed as an alternative treatment for other neuropsychiatric disorders [28]. "
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    ABSTRACT: The vagus nerve participates in the control and regulation of important autonomous functions, emotional tasks, and neural activity. Electrical vagus nerve stimulation (VNS) is an approved procedure for the treatment of refractory epilepsy in humans. VNS has also been shown to improve mood complaints and cognitive function in both human patients and animals. Thus, the purpose of this study was to analyse and describe the effects of VNS on the development and establishment of sensory habituation and electrographic activity of the visual pathway in freely moving cats. Six cats had implants placed in the optic chiasm (OC), lateral geniculate body (LGB), mesencephalic reticular formation (MRF), primary visual cortex (VC) of the left hemisphere, and left vagus nerve. Immediately after surgery, all cats presented anisocoria and relaxation of the left nictitant membrane. Also showed vegetative-type responses such as myosis, licking, and swallowing during VNS. Animals were then subjected to repeated luminous stimuli at intervals of 1 and 3 s to cause habituation. The effect of VNS on the frequency and latency of the habituation episodes and the electrographic changes in the registered brain structures were analysed. Latency analysis showed that VNS delayed the first habituation episode. VNS had transitory effects on the neural activity of the primary visual pathway structures, which caused a small but measurable delay in the establishment of habituation. In conclusion, VNS interferes with the development and establishment of visual habituation, an elementary form of non-associative learning, in freely moving cats.
    Behavioural Brain Research 12/2009; 205(1-205):45-49. DOI:10.1016/j.bbr.2009.06.029 · 3.39 Impact Factor
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