TECHNIQUES Empirically Based Guidelines for Selecting Vagus Nerve Stimulation Parameters in Epilepsy and Heart Failure

Vagus nerve stimulation (VNS) is a promising therapy to treat patients with epilepsy and heart failure. Outcomes of preclinical studies and clinical trials indicate that the selection of stimulation parameters has a direct impact on therapeutic efficacy and patient tolerability, suggesting that both the efficacy and tolerability of VNS could potentially be improved with a change in stimulation parameters. In this review, the success of translating stimulation parameters for epilepsy and heart failure from preclinical studies in animal models to human use in the clinic is evaluated on the basis of patient outcomes and stimulation-induced side effects. Data suggest that patients receiving VNS for epilepsy may experience improved seizure reduction by increasing the frequency and/or duty cycle of stimulation as well as incorporating closed-loop systems to deliver stimulation closer to seizure onset. Further, data suggest that VNS for heart failure is limited by the inability to activate the nerve fibers mediating therapeutic benefit without co-activation of side effect–inducing fibers. This may explain why pivotal trials of VNS for heart failure failed to meet primary efficacy outcomes despite promising preclinical outcomes in animal models. Improved characterization of the relationship between the stimulation parameter space and recruitment of the underlying fiber populations will likely expand the use of VNS to treat a variety of diseases and also improve upon current und...
Source: Cold Spring Harbor perspectives in medicine - Category: Research Authors: Tags: Bioelectronic Medicine TECHNIQUES Source Type: research

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Autonomic Regulation Therapy (ART) is a novel therapy for heart failure (HF) that has been shown in a pilot study to be associated with improvement in left ventricular function, 6-minute walk distance, NYHA class, and quality of life. ART is provided using chronic stimulation through a self-sizing lead that is placed on the cervical vagus nerve without any need for response-mapping. The lead is functionally identical in its design and manufacture to a commercially available lead that has been implanted since February 2009 for the treatment of refractory epilepsy and treatment-resistant depression.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 486 Source Type: research
Authors: Mertens A, Raedt R, Gadeyne S, Carrette E, Boon P, Vonck K Abstract INTRODUCTION: Vagus nerve stimulation (VNS) has become a valuable treatment option for refractory epilepsy and depression. To improve clinical efficacy and minimize side effects, novel device technology for vagus nerve stimulation is under development and investigation. Areas covered: For epilepsy, the AspireSR® and SenTiva™ VNS therapy systems are the 2 most recently developed VNS devices. These novel devices have implemented a closed-loop approach and contain a cardiac based seizure detection algorithm. The mechanism of action ...
Source: Expert Review of Medical Devices - Category: Medical Devices Tags: Expert Rev Med Devices Source Type: research
Electrical vagus nerve stimulation (VNS) has been approved adjunctive therapy for patients with refractory epilepsy and major depression for more than 20 years and is currently been investigated as a potential therapy for a range of medical conditions, such as heart failure and hypertension among several others. As of September 2016, over 90,000 VNS devices have been implanted worldwide (data on file 2016, LivaNova, Houston, TX).
Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation - Category: Neurology Authors: Source Type: research
AbstractThe vagus nerve is responsible for the parasympathetic innervation of the major thoracic and abdominal organs. It also carries sensory afferent fibres from these viscera and reaches different brain structures. These connections have proven useful in the treatment of different diseases. Afferent stimulation of the left vagus nerve is used to treat epilepsy and major depression, and stimulation of the right vagus nerve is being tried for the treatment of heart failure. The device used for the therapy delivers intermittent stimuli. It is indicated worldwide for the treatment of drug-resistant epilepsy in patients who ...
Source: Clinical Autonomic Research - Category: Research Source Type: research
CONCLUSIONS: VNS activates central then peripheral aspects of the cardiac nervous system. VNS control over cardiac function is maintained during chronic therapy. This article is protected by copyright. All rights reserved. PMID: 28862330 [PubMed - as supplied by publisher]
Source: The Journal of Physiology - Category: Physiology Authors: Tags: J Physiol Source Type: research
Vagus nerve stimulation (VNS) currently treats patients with drug-resistant epilepsy, depression, and heart failure. The mild intensities used in chronic VNS suggest that primary visceral afferents and central nervous system activation are involved. Here, we measured the activity of neurons in the nucleus of the solitary tract (NTS) in anesthetized rats using clinically styled VNS. Our chief findings indicate that VNS at threshold bradycardic intensity activated NTS neuron discharge in one-third of NTS neurons. This VNS directly activated only myelinated vagal afferents projecting to second-order NTS neurons. Most VNS-indu...
Source: AJP: Heart and Circulatory Physiology - Category: Cardiology Authors: Tags: RESEARCH ARTICLE Source Type: research
Abstract Vagus nerve stimulation (VNS) currently treats patients with drug resistant epilepsy, depression and heart failure. The mild intensities used in chronic VNS suggest that primary visceral afferents and central nervous system activation are involved. Here we measured the activity of neurons in the nucleus of the solitary tract (NTS) in anesthetized rats using clinically-styled VNS. Our chief findings indicate that VNS at threshold bradycardic intensity activated NTS neuron discharge in one third of NTS neurons. This VNS directly activated only myelinated vagal afferents projecting to second order NTS neuron...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
Abstract Cardiovascular disease degrades the regulatory function of the autonomic nervous system. Cyclic vagus nerve stimulation (VNS) is an already FDA‐approved therapy for drug‐resistant epilepsy and depression, and has been shown to normalize autonomic function and improve objective measures of heart function and subjective measures of heart failure symptoms. However, it remains unclear whether VNS may induce negative effects in patients with potentially healthy hearts where VNS can be used for epileptic patients. Hence, this study aims to investigate the effects of VNS on the hearts of healthy rats with normal auto...
Source: Physiological Reports - Category: Physiology Authors: Tags: Original Research Source Type: research
We present a patient treated with VNS for psychiatric indications who developed episodic bradycardia and orthostasis years after device placement.
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Abstract The development of vagus nerve stimulation (VNS) began in the 19th century. Although it did not work well initially, it introduced the idea that led to many VNS-related animal studies for seizure control. In the 1990s, with the success of several early clinical trials, VNS was approved for the treatment of refractory epilepsy, and later for the refractory depression. To date, several novel electrical stimulating devices are being developed. New invasive devices are designed to automate the seizure control and for use in heart failure. Non-invasive transcutaneous devices, which stimulate auricular VN or ca...
Source: Headache - Category: Neurology Authors: Tags: Headache Source Type: research
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