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Yang Y, Wang J, Wang X, Tang C, Deng J, Yan Z, Deng Q, Chen D, Zhou J, Guan Y, Wang M, Li T, Luan G. Long-term effects of vagus nerve stimulation on EEG aperiodic components in patients with drug-resistant epilepsy. Ther Adv Neurol Disord 2024; 17:17562864241279124. [PMID: 39371641 PMCID: PMC11452897 DOI: 10.1177/17562864241279124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/12/2024] [Indexed: 10/08/2024] Open
Abstract
Background Drug-resistant epilepsy (DRE) affects approximately one-third of epilepsy patients who do not achieve adequate seizure control with medication. Vagus nerve stimulation (VNS) is an adjunctive therapy for DRE, but its long-term effects on cortical excitability remain unclear. Objectives This study aims to elucidate the long-term effects of VNS on electroencephalography (EEG) aperiodic components in patients with DRE. Our objective is to identify biomarkers that can serve as indicators of therapeutic efficacy and provide mechanistic insights into the underlying neural processes. Design This longitudinal observational study focused on patients with DRE undergoing VNS therapy at Sanbo Brain Hospital. The reduction in seizure frequency rates was quantified over short-term (⩽1 year), medium-term (1-3 years), and long-term (⩾3 years) intervals to assess the therapeutic efficacy of VNS. Both the periodic and aperiodic components of EEG data were analyzed. Methods Advanced signal processing techniques were utilized to parameterize the periodic and aperiodic components of EEG data, focusing particularly on "offset" and "exponent." These measures were compared before and after VNS therapy. Correlation analyses were conducted to explore the relationship between these EEG parameters and clinical outcomes. Results In all, 18 patients with DRE participated in this study. During the long-term follow-up period, the responder rate was 55.56%. Significant decreases were observed in aperiodic offset (p = 0.022) and exponent (p = 0.039) among responders. The impact of age on these results was not significant. Correlation analyses revealed a negative association between therapeutic efficacy and a decrease in offset (R = -0.546, p = 0.019) and exponent (R = -0.636, p = 0.019). Conclusion EEG aperiodic parameters, including offset and exponent, have the potential to serve as promising biomarkers for evaluating the efficacy of VNS. An understanding of the regulatory influence of VNS on cortical excitability through these aperiodic parameters could provide a basis for the development of more effective stimulation parameters and therapeutic strategies.
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Affiliation(s)
- Yujiao Yang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Beijing Key Laboratory of Epilepsy, Beijing, China
| | - Zhaofen Yan
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Qinqin Deng
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Dong Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, Beijing, China
| | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, No. 50 Xiang Shan Yi-Ke-Song Road, Haidian District, Beijing 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, No. 50 Xiang Shan Yi-Ke-Song Road, Haidian District, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, No. 50 Xiang Shan Yi-Ke-Song Road, Haidian District, Beijing 100093, China
- Beijing Key Laboratory of Epilepsy, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
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Berger A, Cerra M, Joris V, Danthine V, Macq B, Dricot L, Vandewalle G, Delinte N, El Tahry R. Identifying responders to vagus nerve stimulation based on microstructural features of thalamocortical tracts in drug-resistant epilepsy. Neurotherapeutics 2024:e00422. [PMID: 38964949 DOI: 10.1016/j.neurot.2024.e00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
The mechanisms of action of Vagus Nerve Stimulation (VNS) and the biological prerequisites to respond to the treatment are currently under investigation. It is hypothesized that thalamocortical tracts play a central role in the antiseizure effects of VNS by disrupting the genesis of pathological activity in the brain. This pilot study explored whether in vivo microstructural features of thalamocortical tracts may differentiate Drug-Resistant Epilepsy (DRE) patients responding and not responding to VNS treatment. Eighteen patients with DRE (37.11 ± 10.13 years, 10 females), including 11 responders or partial responders and 7 non-responders to VNS, were recruited for this high-gradient multi-shell diffusion Magnetic Resonance Imaging (MRI) study. Using Diffusion Tensor Imaging (DTI) and multi-compartment models - Neurite Orientation Dispersion and Density Imaging (NODDI) and Microstructure Fingerprinting (MF), we extracted microstructural features in 12 subsegments of thalamocortical tracts. These characteristics were compared between responders/partial responders and non-responders. Subsequently, a Support Vector Machine (SVM) classifier was built, incorporating microstructural features and 12 clinical covariates (including age, sex, duration of VNS therapy, number of antiseizure medications, benzodiazepine intake, epilepsy duration, epilepsy onset age, epilepsy type - focal or generalized, presence of an epileptic syndrome - no syndrome or Lennox-Gastaut syndrome, etiology of epilepsy - structural, genetic, viral, or unknown, history of brain surgery, and presence of a brain lesion detected on structural MRI images). Multiple diffusion metrics consistently demonstrated significantly higher white matter fiber integrity in patients with a better response to VNS (pFDR < 0.05) in different subsegments of thalamocortical tracts. The SVM model achieved a classification accuracy of 94.12%. The inclusion of clinical covariates did not improve the classification performance. The results suggest that the structural integrity of thalamocortical tracts may be linked to therapeutic effectiveness of VNS. This study reveals the great potential of diffusion MRI in improving our understanding of the biological factors associated with the response to VNS therapy.
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Affiliation(s)
- Alexandre Berger
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium; Synergia Medical SA, 1435, Mont-Saint-Guibert, Belgium; Sleep and Chronobiology Lab, GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, 4000, Liège, Belgium.
| | - Michele Cerra
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), Catholic University of Louvain, 1348, Louvain-la-Neuve, Belgium; Politecnico di Torino, Department of Control and Computer Engineering, Corso Duca Degli Abruzzi 24, 10129, Torino, Italy
| | - Vincent Joris
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium; Cliniques Universitaires Saint-Luc (CUSL), Department of Neurosurgery, 1200, Brussels, Belgium
| | - Venethia Danthine
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium
| | - Benoit Macq
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), Catholic University of Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Laurence Dricot
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium
| | - Gilles Vandewalle
- Sleep and Chronobiology Lab, GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, 4000, Liège, Belgium
| | - Nicolas Delinte
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium; Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), Catholic University of Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Riëm El Tahry
- Epilepsy and Neurostimulation Lab, Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Catholic University of Louvain, 1200, Brussels, Belgium; Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc (CUSL), Department of Neurology, 1200, Brussels, Belgium
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3
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Baek IS, Choi S, Yoon H, Chung G, Kim SK. Analgesic Effect of Auricular Vagus Nerve Stimulation on Oxaliplatin-induced Peripheral Neuropathic Pain in a Rodent Model. Exp Neurobiol 2024; 33:129-139. [PMID: 38993080 PMCID: PMC11247280 DOI: 10.5607/en24012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024] Open
Abstract
Cancer chemotherapy often triggers peripheral neuropathy in patients, leading to neuropathic pain in the extremities. While previous research has explored various nerve stimulation to alleviate chemotherapy-induced peripheral neuropathy (CIPN), evidence on the effectiveness of noninvasive auricular vagus nerve stimulation (aVNS) remains uncertain. This study aimed to investigate the efficacy of non-invasive aVNS in relieving CIPN pain. To induce CIPN in experimental animals, oxaliplatin was intraperitoneally administered to rats (6 mg/kg). Mechanical and cold allodynia, the representative symptoms of neuropathic pain, were evaluated using the von Frey test and acetone test, respectively. The CIPN animals were randomly assigned to groups and treated with aVNS (5 V, square wave) at different frequencies (2, 20, or 100 Hz) for 20 minutes. Results revealed that 20 Hz aVNS exhibited the most pronounced analgesic effect, while 2 or 100 Hz aVNS exhibited weak effects. Immunohistochemistry analysis demonstrated increased c-Fos expression in the locus coeruleus (LC) in the brain of CIPN rats treated with aVNS compared to sham treatment. To elucidate the analgesic mechanisms involving the adrenergic descending pathway, α1-, α2-, or β-adrenergic receptor antagonists were administered to the spinal cord before 20 Hz aVNS. Only the β-adrenergic receptor antagonist, propranolol, blocked the analgesic effect of aVNS. These findings suggest that 20 Hz aVNS may effectively alleviate CIPN pain through β-adrenergic receptor activation.
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Affiliation(s)
- In Seon Baek
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Seunghwan Choi
- Department of East-West Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Heera Yoon
- Division of Preclinical R&D, Neurogrin Inc., Seoul 02447, Korea
| | - Geehoon Chung
- Division of Preclinical R&D, Neurogrin Inc., Seoul 02447, Korea
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Sun Kwang Kim
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
- Department of East-West Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
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4
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Tovbis D, Yoo PB. Vagus nerve stimulation in bursts can efficiently modulate gastric contractions and contraction frequency at varying gastric pressures. Neurogastroenterol Motil 2024; 36:e14815. [PMID: 38735698 DOI: 10.1111/nmo.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE There has been recent clinical interest in the use of vagus nerve stimulation (VNS) for treating gastrointestinal disorders as an alternative to drugs or gastric electrical stimulation. However, effectiveness of burst stimulation has not been demonstrated. We investigated the ability of bursting and continuous VNS to influence gastric and pyloric activity under a range of stimulation parameters and gastric pressures. The goals of this study were to determine which parameters could optimally excite or inhibit gastric activity. MATERIALS AND METHODS Data were collected from 21 Sprague-Dawley rats. Under urethane anesthesia, a rubber balloon was implanted into the stomach, connected to a pressure transducer and a saline infusion pump. A pressure catheter was inserted at the pyloric sphincter and a bipolar nerve cuff was implanted onto the left cervical vagus nerve. The balloon was filled to 15 cmH2O. Stimulation trials were conducted in a consistent order; the protocol was then repeated at 25 and 35 cmH2O. The nerve was then transected and stimulation repeated to investigate directionality of effects. RESULTS Bursting stimulation at the bradycardia threshold caused significant increases in gastric contraction amplitude with entrainment to the bursting frequency. Some continuous stimulation trials could also cause increased contractions but without frequency changes. Few significant changes were observed at the pylorus, except for frequency entrainment. These effects could not be uniquely attributed to afferent or efferent activity. SIGNIFICANCE Our findings further elucidate the effects of different VNS parameters on the stomach and pylorus and provide a basis for future studies of bursting stimulation for gastric neuromodulation.
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Affiliation(s)
- D Tovbis
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - P B Yoo
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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Abdullahi A, Etoom M, Badaru UM, Elibol N, Abuelsamen AA, Alawneh A, Zakari UU, Saeys W, Truijen S. Vagus nerve stimulation for the treatment of epilepsy: things to note on the protocols, the effects and the mechanisms of action. Int J Neurosci 2024; 134:560-569. [PMID: 36120993 DOI: 10.1080/00207454.2022.2126776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
Epilepsy is a chronic brain disorder that is characterized by repetitive un-triggered seizures that occur severally within 24 h or more. Non-pharmacological methods for the management of epilepsy were discussed. The non-pharmacological methods include the vagus nerve stimulation (VNS) which is subdivided into invasive and non-invasive techniques. For the non-invasive techniques, the auricular VNS, stimulation of the cervical branch of vagus nerve in the neck, manual massage of the neck, and respiratory vagal nerve stimulation were discussed. Similarly, the stimulation parameters used and the mechanisms of actions through which VNS improves seizures were also discussed. Use of VNS to reduce seizure frequency has come a long way. However, considering the cost and side effects of the invasive method, non-invasive techniques should be given a renewed attention. In particular, respiratory vagal nerve stimulation should be considered. In doing this, the patients should for instance carry out slow-deep breathing exercise 6 to 8 times every 3 h during the waking hours. Slow-deep breathing can be carried out by the patients on their own; therefore this can serve as a form of self-management.HIGHLIGHTSEpilepsy can interfere with the patients' ability to carry out their daily activities and ultimately affect their quality of life.Medications are used to manage epilepsy; but they often have their serious side effects.Vagus nerve stimulation (VNS) is gaining ground especially in the management of refractory epilepsy.The VNS is administered through either the invasive or the non-invasive methodsThe invasive method of VNS like the medication has potential side effects, and can be costly.The non-invasive method includes auricular VNS, stimulation of the neck muscles and skin and respiratory vagal nerve stimulation via slow-deep breathing exercises.The respiratory vagal nerve stimulation via slow-deep breathing exercises seems easy to administer even by the patients themselves.Consequently, it is our opinion that patients with epilepsy be made to carry out slow-deep breathing exercise 6-8 times every 3 h during the waking hours.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Nigeria
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Mohammad Etoom
- Department of Physiotherapy, Aqaba University of Technology, Aqaba, Jordan
| | | | - Nuray Elibol
- Department of Physiotherapy and Rehabilitation Sciences, Ege University, Izmir, Turkey
| | | | - Anoud Alawneh
- Department of Physiotherapy, Aqaba University of Technology, Aqaba, Jordan
| | - Usman Usman Zakari
- Department of Physiotherapy, Federal Medical Center, Birnin Kudu, Jigawa State, Nigeria
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Szaflarski JP, Allendorfer JB, Begnaud J, Ranuzzi G, Shamshiri E, Verner R. Optimized microburst VNS elicits fMRI responses beyond thalamic-specific response from standard VNS. Ann Clin Transl Neurol 2024; 11:1135-1147. [PMID: 38532258 DOI: 10.1002/acn3.52029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE In parallel to standard vagus nerve stimulation (VNS), microburst stimulation delivery has been developed. We evaluated the fMRI-related signal changes associated with standard and optimized microburst stimulation in a proof-of-concept study (NCT03446664). METHODS Twenty-nine drug-resistant epilepsy patients were prospectively implanted with VNS. Three 3T fMRI scans were collected 2 weeks postimplantation. The maximum tolerated VNS intensity was determined prior to each scan starting at 0.125 mA with 0.125 mA increments. FMRI scans were block-design with alternating 30 sec stimulation [ON] and 30 sec no stimulation [OFF]: Scan 1 utilized standard VNS and Scan 3 optimized microburst parameters to determine target settings. Semi-automated on-site fMRI data processing utilized ON-OFF block modeling to determine VNS-related fMRI activation per stimulation setting. Anatomical thalamic mask was used to derive highest mean thalamic t-value for determination of microburst stimulation parameters. Paired t-tests corrected at P < 0.05 examined differences in fMRI responses to each stimulation type. RESULTS Standard and microburst stimulation intensities at Scans 1 and 3 were similar (P = 0.16). Thalamic fMRI responses were obtained in 28 participants (19 with focal; 9 with generalized seizures). Group activation maps showed standard VNS elicited thalamic activation while optimized microburst VNS showed widespread activation patterns including thalamus. Comparison of stimulation types revealed significantly greater cerebellar, midbrain, and parietal fMRI signal changes in microburst compared to standard VNS. These differences were not associated with seizure responses. INTERPRETATION While standard and optimized microburst VNS elicited thalamic activation, microburst also engaged other brain regions. Relationship between these fMRI activation patterns and clinical response warrants further investigation. CLINICAL TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT03446664).
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Berger A, Beckers E, Joris V, Duchêne G, Danthine V, Delinte N, Cakiroglu I, Sherif S, Morrison EIG, Sánchez AT, Macq B, Dricot L, Vandewalle G, El Tahry R. Locus coeruleus features are linked to vagus nerve stimulation response in drug-resistant epilepsy. Front Neurosci 2024; 18:1296161. [PMID: 38469571 PMCID: PMC10926962 DOI: 10.3389/fnins.2024.1296161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 03/13/2024] Open
Abstract
The locus coeruleus-norepinephrine system is thought to be involved in the clinical effects of vagus nerve stimulation. This system is known to prevent seizure development and induce long-term plastic changes, particularly with the release of norepinephrine in the hippocampus. However, the requisites to become responder to the therapy and the mechanisms of action are still under investigation. Using MRI, we assessed the structural and functional characteristics of the locus coeruleus and microstructural properties of locus coeruleus-hippocampus white matter tracts in patients with drug-resistant epilepsy responding or not to the therapy. Twenty-three drug-resistant epileptic patients with cervical vagus nerve stimulation were recruited for this pilot study, including 13 responders or partial responders and 10 non-responders. A dedicated structural MRI acquisition allowed in vivo localization of the locus coeruleus and computation of its contrast (an accepted marker of LC integrity). Locus coeruleus activity was estimated using functional MRI during an auditory oddball task. Finally, multi-shell diffusion MRI was used to estimate the structural properties of locus coeruleus-hippocampus tracts. These characteristics were compared between responders/partial responders and non-responders and their association with therapy duration was also explored. In patients with a better response to the therapy, trends toward a lower activity and a higher contrast were found in the left medial and right caudal portions of the locus coeruleus, respectively. An increased locus coeruleus contrast, bilaterally over its medial portions, correlated with duration of the treatment. Finally, a higher integrity of locus coeruleus-hippocampus connections was found in patients with a better response to the treatment. These new insights into the neurobiology of vagus nerve stimulation may provide novel markers of the response to the treatment and may reflect neuroplasticity effects occurring in the brain following the implantation.
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Affiliation(s)
- Alexandre Berger
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
- Synergia Medical SA, Mont-Saint-Guibert, Belgium
- Sleep and Chronobiology Laboratory, GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | - Elise Beckers
- Sleep and Chronobiology Laboratory, GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer’s Centre Limburg, Maastricht University, Maastricht, Netherlands
| | - Vincent Joris
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gaëtan Duchêne
- GE Center MR Applications, General Electric Healthcare, Diegem, Belgium
| | - Venethia Danthine
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
| | - Nicolas Delinte
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Inci Cakiroglu
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
| | - Siya Sherif
- Sleep and Chronobiology Laboratory, GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | | | - Andres Torres Sánchez
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
- Innoviris, Brussels Institute for Research and Innovation, Brussels, Belgium
| | - Benoit Macq
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Laurence Dricot
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
| | - Gilles Vandewalle
- Sleep and Chronobiology Laboratory, GIGA-Cyclotron Research Center-in vivo Imaging, University of Liège, Liège, Belgium
| | - Riëm El Tahry
- Department of Clinical Neuroscience, Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium
- Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Shiraishi H, Egawa K, Murakami K, Nakajima M, Ueda Y, Nakakubo S, Narugami M, Kimura S, Goto T, Hiramatsu Y, Murakami M. Transcutaneous auricular vagus nerve stimulation therapy in patients with cognitively preserved structural focal epilepsy: A case series report. Brain Dev 2024; 46:49-56. [PMID: 37657962 DOI: 10.1016/j.braindev.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Transcutaneous auricular vagus nerve stimulation (taVNS) was performed in two patients suffering structural focal epilepsy with preserved intellectual ability to show the feasibility of taVNS for specific patient groups. CASE PRESENTATIONS Patient 1 was a 24-year-old woman with frontal lobe epilepsy who had weekly hyperkinetic seizures despite multiple anti-seizure medications. Patient 2 was a 27-year-old woman with parietal lobe epilepsy and focal cortical dysplasia in the vicinity of the lipoma in the corpus callosum. She experienced weekly focal-impaired awareness seizures even with anti-seizure medication. taVNS was applied to the left earlobe of both patients at 1.5 mA, 25 Hz, 250 μs pulse width, and 30 s stimulation with 30 s rest for 4 h per day. Over an 8-week baseline and 20 weeks of stimulation, the rate of reduction in seizure frequency was evaluated, along with quality-of-life using the Short-Form 36-Item Health survey. RESULTS At baseline, we measured up to 11 and 12 focal seizures per week in Patient 1 and 2, respectively, with both patients achieving seizure freedom after 4 and 20 weeks taVNS, respectively. Patient 1 and 2 were observed for 18 and 14 months, respectively, including the clinical trial and follow-up observation period. Quality-of-life ratings increased in both patients, and no significant adverse events occurred during the study period. During the maintenance period after 20 weeks, seizures remained absent in Patient 1, and seizures remained reduced in Patient 2. CONCLUSION Our results demonstrate that taVNS may be a promising tool for structural focal epilepsy with preserved cognitive function. A multicenter double-blind clinical trial is needed to confirm the role of taVNS as an anti-seizure tool.
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Affiliation(s)
- Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan.
| | - Kiyoshi Egawa
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Kaoru Murakami
- Division of Molecular Psychoneuroimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
| | - Midori Nakajima
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Sachiko Nakakubo
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Masashi Narugami
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Shuhei Kimura
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Takeru Goto
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Yasuyoshi Hiramatsu
- Department of Pediatrics, Hokkaido University Hospital Epilepsy Center, Sapporo 060-8638, Japan
| | - Masaaki Murakami
- Division of Molecular Psychoneuroimmunology, Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan; Group of Quantum Immunology, Institute for Quantum Life Science, National Institute for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan; Division of Molecular Neuroimmunology, Department of Homeostatic Regulation, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Aichi 444-8585, Japan; Institute for Vaccine Research and Development (HU-IVReD), Hokkaido University, Sapporo 001-0020, Japan.
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Theiss P, Pucci FG, Slavin KV. Invasive Neuromodulation Techniques for Treatment-Resistant Depression. Curr Top Behav Neurosci 2024; 66:297-311. [PMID: 38082109 DOI: 10.1007/7854_2023_460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Surgically implanted neurostimulation devices for the treatment of depression have been studied for the last three decades. While the surgical risk associated with these treatment approaches clearly limits their use to the most severely impacted depressed patients, they offer a unique opportunity to better understand the impact of relatively localized alteration of neural activity in patient groups. As a result, these approaches provide a strict test of the role of individual neural structures or networks in mechanistic models of depression. In this chapter, we review the proposed mechanisms of action and evidence for clinical efficacy of vagal nerve stimulation, deep brain stimulation, and epidural cortical stimulation in patients with depression. The evidence for efficacy remains limited for all three modalities, but the long-term follow-up studies of treated patients have highlighted the importance of interactions between neural regions in determining therapeutic response, and suggest that personalized approaches to stimulation are likely to be required.
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Affiliation(s)
- Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Francesco G Pucci
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
- Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA.
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10
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Nicksic PJ, Donnelly DT, Zeng W, Seitz AJ, Poore SO, Suminski AJ, Dingle AM. Trigeminal or peripheral nerve stimulation improves functional outcomes of nerve recovery in a rodent forelimb gap repair model. J Plast Reconstr Aesthet Surg 2024; 88:57-65. [PMID: 37952438 DOI: 10.1016/j.bjps.2023.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The hypothesis of this study was that trigeminal nerve stimulation (TNS) or peripheral nerve stimulation (PNS) could improve functional outcomes of peripheral nerve injury in a rat forelimb model when compared to control rats not receiving electrical stimulation (ES). While PNS is known to improve outcomes after nerve surgery, the role of TNS has not been explored. METHODS Lewis rats were trained to perform a reach and grasp task before receiving a 2 mm gap repair of the ulnar and median nerves and randomized into four treatment groups: (1) sham injury, (2) nerve injury with sham ES, (3) nerve injury with PNS, and (4) nerve injury with TNS. Functional motor (median pull force and percent success in motor task) and sensory metrics (forelimb paw withdrawal thresholds) were collected both pre-injury and throughout rehabilitation. Nerves stained using Gomori's trichrome were assessed quantitatively and qualitatively. RESULTS The sham ES group did not recover their pre-injury baseline functional outcomes. In contrast, the TNS and PNS groups fully recovered following injury, with no difference in functional outcomes between the pre-injury baseline and the final week of rehabilitation (P > 0.05, all). Histomorphology results demonstrated no quantitative difference, but qualitative differences in architecture were evident. CONCLUSIONS Electrical stimulation of the trigeminal nerve or the injured nerve improved the functional outcomes of nerve regeneration in rodents. Histomorphology results of nerves from the TNS group support the proposed central mechanisms. This is an important step in translating this therapy as an adjunct, non-invasive treatment for high, mixed nerve injuries in humans.
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Affiliation(s)
- Peter J Nicksic
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - D'Andrea T Donnelly
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Weifeng Zeng
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Allison J Seitz
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Samuel O Poore
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States
| | - Aaron J Suminski
- University of Wisconsin, Department of Neurological Surgery, Madison, WI, United States; Wisconsin Institute for Translational Neuroengineering, Madison, WI, United States
| | - Aaron M Dingle
- University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, United States.
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11
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Gonçalves-Sánchez J, Sancho C, López DE, Castellano O, García-Cenador B, Servilha-Menezes G, Corchado JM, García-Cairasco N, Gonçalves-Estella JM. Effect of Vagus Nerve Stimulation on the GASH/Sal Audiogenic-Seizure-Prone Hamster. Int J Mol Sci 2023; 25:91. [PMID: 38203262 PMCID: PMC10778912 DOI: 10.3390/ijms25010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Vagus nerve stimulation (VNS) is an adjuvant neuromodulation therapy for the treatment of refractory epilepsy. However, the mechanisms behind its effectiveness are not fully understood. Our aim was to develop a VNS protocol for the Genetic Audiogenic Seizure Hamster from Salamanca (GASH/Sal) in order to evaluate the mechanisms of action of the therapy. The rodents were subject to VNS for 14 days using clinical stimulation parameters by implanting a clinically available neurostimulation device or our own prototype for laboratory animals. The neuroethological assessment of seizures and general behavior were performed before surgery, and after 7, 10, and 14 days of VNS. Moreover, potential side effects were examined. Finally, the expression of 23 inflammatory markers in plasma and the left-brain hemisphere was evaluated. VNS significantly reduced seizure severity in GASH/Sal without side effects. No differences were observed between the neurostimulation devices. GASH/Sal treated with VNS showed statistically significant reduced levels of interleukin IL-1β, monocyte chemoattractant protein MCP-1, matrix metalloproteinases (MMP-2, MMP-3), and tumor necrosis factor TNF-α in the brain. The described experimental design allows for the study of VNS effects and mechanisms of action using an implantable device. This was achieved in a model of convulsive seizures in which VNS is effective and shows an anti-inflammatory effect.
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Affiliation(s)
- Jaime Gonçalves-Sánchez
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Consuelo Sancho
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Dolores E. López
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Orlando Castellano
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Begoña García-Cenador
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Department of Surgery, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Gabriel Servilha-Menezes
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, SP, Brazil; (G.S.-M.); (N.G.-C.)
| | - Juan M. Corchado
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Bioinformatics, Intelligent Systems and Educational Technology (BISITE) Research Group, 37007 Salamanca, Spain
| | - Norberto García-Cairasco
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, SP, Brazil; (G.S.-M.); (N.G.-C.)
| | - Jesús M. Gonçalves-Estella
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Department of Surgery, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
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12
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Downes MH, Kalagara R, Chennareddy S, Vasan V, Reford E, Schuldt BR, Odland I, Tosto-Mancuso J, Putrino D, Panov F, Kellner CP. Vagal Nerve Stimulation: A Bibliometric Analysis of Current Research Trends. Neuromodulation 2023; 26:529-537. [PMID: 35970764 DOI: 10.1016/j.neurom.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vagal nerve stimulation (VNS) has become established as an effective tool for the management of various neurologic disorders. Consequently, a growing number of VNS studies have been published over the past four decades. This study presents a bibliometric analysis investigating the current trends in VNS literature. MATERIALS AND METHODS Using the Web of Science collection data base, a search was performed to identify literature that discussed applications of VNS from 2000 to 2021. Analysis and visualization of the included literature were completed with VOSviewer. RESULTS A total of 2895 publications were identified. The number of articles published in this area has increased over the past two decades, with the most citations (7098) occurring in 2021 and the most publications (270) in 2020. The h-index, i-10, and i-100 were 97, 994, and 91, respectively, with 17.0 citations per publication on average. The highest-producing country and institution of VNS literature were the United States and the University of Texas, respectively. The most productive journal was Epilepsia. Epilepsy was the predominant focus of VNS research, with the keyword "epilepsy" having the greatest total link strength (749) in the keyword analysis. The keyword analysis also revealed two major avenues of VNS research: 1) the mechanisms by which VNS modulates neural circuitry, and 2) therapeutic applications of VNS in a variety of diseases beyond neurology. It also showed a significant prevalence of noninvasive VNS research. Although epilepsy research appears more linked to implanted VNS, headache and depression specialists were more closely associated with noninvasive VNS. CONCLUSION VNS may serve as a promising intervention for rehabilitation beyond neurologic applications, with an expanding base of literature over the past two decades. Although epilepsy researchers have produced most current literature, other fields have begun to explore VNS as a potential treatment, likely owing to the rise of noninvasive forms of VNS.
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Affiliation(s)
- Margaret H Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susmita Chennareddy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Reford
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Braxton R Schuldt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ian Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenna Tosto-Mancuso
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fedor Panov
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Domenech P. Stimulation du nerf vague pour traiter l’épilepsie et la dépression résistante : vers une physiopathologie commune ? BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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14
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Osorio-Forero A, Cherrad N, Banterle L, Fernandez LMJ, Lüthi A. When the Locus Coeruleus Speaks Up in Sleep: Recent Insights, Emerging Perspectives. Int J Mol Sci 2022; 23:ijms23095028. [PMID: 35563419 PMCID: PMC9099715 DOI: 10.3390/ijms23095028] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
For decades, numerous seminal studies have built our understanding of the locus coeruleus (LC), the vertebrate brain’s principal noradrenergic system. Containing a numerically small but broadly efferent cell population, the LC provides brain-wide noradrenergic modulation that optimizes network function in the context of attentive and flexible interaction with the sensory environment. This review turns attention to the LC’s roles during sleep. We show that these roles go beyond down-scaled versions of the ones in wakefulness. Novel dynamic assessments of noradrenaline signaling and LC activity uncover a rich diversity of activity patterns that establish the LC as an integral portion of sleep regulation and function. The LC could be involved in beneficial functions for the sleeping brain, and even minute alterations in its functionality may prove quintessential in sleep disorders.
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15
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Theiss P, Slavin KV. Vagal nerve stimulation for treatment-resistant depression: An update on mechanism of action and clinical use. PROGRESS IN BRAIN RESEARCH 2022; 270:97-104. [PMID: 35396032 DOI: 10.1016/bs.pbr.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Among few available therapeutic options for patients with treatment-resistant depression, chronic stimulation of the vagus nerve using an implanted stimulator, the so-called vagal nerve stimulation (VNS), has been shown to be both effective and safe technique, based on the multitude of studies. While the exact degree of its efficacy remains a subject of discussion, the strong scientific basis and a large body of data from completed and ongoing clinical trials suggest that VNS remains a viable option for those patients, who have exhausted less invasive treatment approaches.
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Affiliation(s)
- Peter Theiss
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States; Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, United States.
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16
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Clark KB. Smart Device-Driven Corticolimbic Plasticity in Cognitive-Emotional Restructuring of Space-Related Neuropsychiatric Disease and Injury. Life (Basel) 2022; 12:236. [PMID: 35207523 PMCID: PMC8875345 DOI: 10.3390/life12020236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Escalating government and commercial efforts to plan and deploy viable manned near-to-deep solar system exploration and habitation over the coming decades now drives next-generation space medicine innovations. The application of cutting-edge precision medicine, such as brain stimulation techniques, provides powerful clinical and field/flight situation methods to selectively control vagal tone and neuroendocrine-modulated corticolimbic plasticity, which is affected by prolonged cosmic radiation exposure, social isolation or crowding, and weightlessness in constricted operational non-terran locales. Earth-based clinical research demonstrates that brain stimulation approaches may be combined with novel psychotherapeutic integrated memory structure rationales for the corrective reconsolidation of arousing or emotional experiences, autobiographical memories, semantic schema, and other cognitive structures to enhance neuropsychiatric patient outcomes. Such smart cotherapies or countermeasures, which exploit natural, pharmaceutical, and minimally invasive neuroprosthesis-driven nervous system activity, may optimize the cognitive-emotional restructuring of astronauts suffering from space-related neuropsychiatric disease and injury, including mood, affect, and anxiety symptoms of any potential severity and pathophysiology. An appreciation of improved neuropsychiatric healthcare through the merging of new or rediscovered smart theragnostic medical technologies, capable of rendering personalized neuroplasticity training and managed psychotherapeutic treatment protocols, will reveal deeper insights into the illness states experienced by astronauts. Future work in this area should emphasize the ethical role of telemedicine and/or digital clinicians to advance the (semi)autonomous, technology-assisted medical prophylaxis, diagnosis, treatment, monitoring, and compliance of astronauts for elevated health, safety, and performance in remote extreme space and extraterrestrial environments.
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Affiliation(s)
- Kevin B. Clark
- Felidae Conservation Fund, Mill Valley, CA 94941, USA;
- Cures Within Reach, Chicago, IL 60602, USA
- Domain and Campus Champions Program, NSF Extreme Science and Engineering Discovery Environment (XSEDE), National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Multi-Omics and Systems Biology Analysis Working Group, NASA GeneLab, NASA Ames Research Center, Mountain View, CA 94035, USA
- SETI Institute, Mountain View, CA 94043, USA
- NASA NfoLD, NASA Astrobiology Program, NASA Ames Research Center, Mountain View, CA 94035, USA
- Universities Space Research Association, Columbia, MD 21046, USA
- Expert Network, Penn Center for Innovation, University of Pennsylvania, Philadelphia, PA 19104, USA
- Peace Innovation Institute, The Hague 2511, Netherlands and Stanford University, Palo Alto, CA 94305, USA
- Shared Interest Group for Natural and Artificial Intelligence (sigNAI), Max Planck Alumni Association, 14057 Berlin, Germany
- Nanotechnology and Biometrics Councils, Institute for Electrical and Electronics Engineers (IEEE), New York, NY 10016-5997, USA
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17
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Berger A, Vespa S, Dricot L, Dumoulin M, Iachim E, Doguet P, Vandewalle G, El Tahry R. How Is the Norepinephrine System Involved in the Antiepileptic Effects of Vagus Nerve Stimulation? Front Neurosci 2021; 15:790943. [PMID: 34924947 PMCID: PMC8675889 DOI: 10.3389/fnins.2021.790943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 01/09/2023] Open
Abstract
Vagus Nerve Stimulation (VNS) is an adjunctive treatment for patients suffering from inoperable drug-resistant epilepsy. Although a complete understanding of the mediators involved in the antiepileptic effects of VNS and their complex interactions is lacking, VNS is known to trigger the release of neurotransmitters that have seizure-suppressing effects. In particular, norepinephrine (NE) is a neurotransmitter that has been associated with the clinical effects of VNS by preventing seizure development and by inducing long-term plastic changes that could restore a normal function of the brain circuitry. However, the biological requisites to become responder to VNS are still unknown. In this review, we report evidence of the critical involvement of NE in the antiepileptic effects of VNS in rodents and humans. Moreover, we emphasize the hypothesis that the functional integrity of the noradrenergic system could be a determining factor to obtain clinical benefits from the therapy. Finally, encouraging avenues of research involving NE in VNS treatment are discussed. These could lead to the personalization of the stimulation parameters to maximize the antiepileptic effects and potentially improve the response rate to the therapy.
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Affiliation(s)
- Alexandre Berger
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Synergia Medical SA, Mont-Saint-Guibert, Belgium.,GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Simone Vespa
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Manon Dumoulin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Evelina Iachim
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Department of Pediatric Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Gilles Vandewalle
- GIGA-Cyclotron Research Center-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Center for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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18
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Potential roles of vagus nerve stimulation on traumatic brain injury: Evidence from in vivo and clinical studies. Exp Neurol 2021; 347:113887. [PMID: 34624329 DOI: 10.1016/j.expneurol.2021.113887] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 01/08/2023]
Abstract
Traumatic Brain Injury (TBI) is a one of the leading causes of death and disability worldwide. The consequences of TBI can be divided into two stages: 1) the immediate neuronal destruction during the initial trauma, resulting in the primary brain injury and pathophysiologic sequelae, and 2) the secondary brain injury, encompassing mitochondrial dysfunction, inflammation, cellular excitotoxicity, oxidative stress, and cortical edema, resulting in increased intracranial pressure (ICP) with exacerbated brain damage. Although the pathophysiology in TBI has been thoroughly investigated, the effectivity of therapeutic approaches for TBI is still lacking. Vagus nerve stimulation (VNS) has been used for treating medical refractory epilepsy and chronic drug-resistant depression. Several previous studies also demonstrated that VNS has beneficial effects for TBI in animal models and patients. The neuroprotective effects of VNS on TBI are possibly explained through several mechanisms, including a noradrenergic mechanism, anti-inflammatory effects, regulation of neurotransmitters, and attenuation of blood brain barrier breakdown, and brain edema. The aims of this review are to summarize and discuss the current evidence pertinent to the effect of VNS on both primary and secondary brain injury following TBI from both in vivo and clinical studies.
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19
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Altidor LKP, Bruner MM, Deslauriers JF, Garman TS, Ramirez S, Dirr EW, Olczak KP, Maurer AP, Lamb DG, Otto KJ, Burke SN, Bumanglag AV, Setlow B, Bizon JL. Acute vagus nerve stimulation enhances reversal learning in rats. Neurobiol Learn Mem 2021; 184:107498. [PMID: 34332068 DOI: 10.1016/j.nlm.2021.107498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023]
Abstract
Cognitive flexibility is a prefrontal cortex-dependent neurocognitive process that enables behavioral adaptation in response to changes in environmental contingencies. Electrical vagus nerve stimulation (VNS) enhances several forms of learning and neuroplasticity, but its effects on cognitive flexibility have not been evaluated. In the current study, a within-subjects design was used to assess the effects of VNS on performance in a novel visual discrimination reversal learning task conducted in touchscreen operant chambers. The task design enabled simultaneous assessment of acute VNS both on reversal learning and on recall of a well-learned discrimination problem. Acute VNS delivered in conjunction with stimuli presentation during reversal learning reliably enhanced learning of new reward contingencies. Enhancement was not observed, however, if VNS was delivered during the session but was not coincident with presentation of to-be-learned stimuli. In addition, whereas VNS delivered at 30 HZ enhanced performance, the same enhancement was not observed using 10 or 50 Hz. Together, these data show that acute VNS facilitates reversal learning and indicate that the timing and frequency of the VNS are critical for these enhancing effects. In separate rats, administration of the norepinephrine reuptake inhibitor atomoxetine also enhanced reversal learning in the same task, consistent with a noradrenergic mechanism through which VNS enhances cognitive flexibility.
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Affiliation(s)
| | - Matthew M Bruner
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | | | - Tyler S Garman
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Saúl Ramirez
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Elliott W Dirr
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Kaitlynn P Olczak
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Andrew P Maurer
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA; Engineering School of Sustainable Infrastructure and Environment, University of Florida, Gainesville, FL, USA
| | - Damon G Lamb
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Department of Psychiatry, University of Florida, Gainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA; Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
| | - Kevin J Otto
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA
| | - Sara N Burke
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA
| | - Argyle V Bumanglag
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA
| | - Barry Setlow
- Department of Psychiatry, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA
| | - Jennifer L Bizon
- Department of Neuroscience, University of Florida, Gainesville, FL, USA; Evelyn F. & William L. McKnight Brain Institute, University of Florida, USA.
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20
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Kulju T, Haapasalo J, Verner R, Dibué-Adjei M, Lehtimäki K, Rainesalo S, Peltola J. Frequency of Automatic Stimulations in Responsive Vagal Nerve Stimulation in Patients With Refractory Epilepsy. Neuromodulation 2021; 23:852-858. [PMID: 32840019 DOI: 10.1111/ner.13238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND In vagal nerve stimulation (VNS) therapy, the release of VNS model 106 (AspireSR) allowed for responsive VNS (rVNS). rVNS utilizes a cardiac-based seizure detection algorithm to detect seizure-induced tachycardia to trigger additional stimulation. There are some studies suggesting clinical benefits of rVNS over traditional VNS, but the performance and significance of autostimulation mode in clinical practice are poorly understood. OBJECTIVES To assess the effect of initiation of rVNS therapy and altered stimulation settings on the number of daily stimulations and energy consumption in VNS therapy and to compare autostimulation performance in different epilepsy types. MATERIALS AND METHODS Retrospective follow-up of 30 patients with drug-resistant epilepsy treated with rVNS including 17 new implantations and 13 battery replaces at a single center in Finland. Our data consist of 208 different stimulation periods, that is, episodes with defined stimulation settings and both autostimulation and total stimulation performance-related data along with clinical follow-up. RESULTS The variation in autostimulation frequency was highly dependent on the duration of the OFF-time and autostimulation threshold (p < 0.05). There was a large additional effect of autostimulation mode on therapy time and energy consumption with longer OFF-times, but a minor effect with shorter OFF-times. Significantly more autostimulations were triggered in the temporal lobe and multifocal epilepsies than in extratemporal lobe epilepsies. CONCLUSIONS The initiation of autostimulation mode in VNS therapy increased the total number of stimulations. Shortening the OFF-time leads to a decreased number and share of automatic activations. Epilepsy type may affect autostimulation activity.
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Affiliation(s)
- Toni Kulju
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Joonas Haapasalo
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ryan Verner
- LivaNova USA, Neuromodulation Unit, Houston, TX, USA
| | - Maxine Dibué-Adjei
- Neuromodulation Medical Affairs, LivaNova PLC, London, UK.,Department of Neurosurgery, Heinrich Heine University Düsseldorf, Germany
| | - Kai Lehtimäki
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Sirpa Rainesalo
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Jukka Peltola
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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21
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Thompson SL, O'Leary GH, Austelle CW, Gruber E, Kahn AT, Manett AJ, Short B, Badran BW. A Review of Parameter Settings for Invasive and Non-invasive Vagus Nerve Stimulation (VNS) Applied in Neurological and Psychiatric Disorders. Front Neurosci 2021; 15:709436. [PMID: 34326720 PMCID: PMC8313807 DOI: 10.3389/fnins.2021.709436] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Vagus nerve stimulation (VNS) is an established form of neuromodulation with a long history of promising applications. Earliest reports of VNS in the literature date to the late 1800’s in experiments conducted by Dr. James Corning. Over the past century, both invasive and non-invasive VNS have demonstrated promise in treating a variety of disorders, including epilepsy, depression, and post-stroke motor rehabilitation. As VNS continues to rapidly grow in popularity and application, the field generally lacks a consensus on optimum stimulation parameters. Stimulation parameters have a significant impact on the efficacy of neuromodulation, and here we will describe the longitudinal evolution of VNS parameters in the following categorical progression: (1) animal models, (2) epilepsy, (3) treatment resistant depression, (4) neuroplasticity and rehabilitation, and (5) transcutaneous auricular VNS (taVNS). We additionally offer a historical perspective of the various applications and summarize the range and most commonly used parameters in over 130 implanted and non-invasive VNS studies over five applications.
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Affiliation(s)
- Sean L Thompson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Georgia H O'Leary
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Christopher W Austelle
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Elise Gruber
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Alex T Kahn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew J Manett
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Baron Short
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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22
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Transcutaneous auricular vagus nerve stimulation induces stabilizing modifications in large-scale functional brain networks: towards understanding the effects of taVNS in subjects with epilepsy. Sci Rep 2021; 11:7906. [PMID: 33846432 PMCID: PMC8042037 DOI: 10.1038/s41598-021-87032-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/22/2021] [Indexed: 02/01/2023] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive brain stimulation technique considered as a potential supplementary treatment option for subjects with refractory epilepsy. Its exact mechanism of action is not yet fully understood. We developed an examination schedule to probe for immediate taVNS-induced modifications of large-scale epileptic brain networks and accompanying changes of cognition and behaviour. In this prospective trial, we applied short-term (1 h) taVNS to 14 subjects with epilepsy during a continuous 3-h EEG recording which was embedded in two standardized neuropsychological assessments. From these EEG, we derived evolving epileptic brain networks and tracked important topological, robustness, and stability properties of networks over time. In the majority of investigated subjects, taVNS induced measurable and persisting modifications in network properties that point to a more resilient epileptic brain network without negatively impacting cognition, behaviour, or mood. The stimulation was well tolerated and the usability of the device was rated good. Short-term taVNS has a topology-modifying, robustness- and stability-enhancing immediate effect on large-scale epileptic brain networks. It has no detrimental effects on cognition and behaviour. Translation into clinical practice requires further studies to detail knowledge about the exact mechanisms by which taVNS prevents or inhibits seizures.
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23
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Mridha Z, de Gee JW, Shi Y, Alkashgari R, Williams J, Suminski A, Ward MP, Zhang W, McGinley MJ. Graded recruitment of pupil-linked neuromodulation by parametric stimulation of the vagus nerve. Nat Commun 2021; 12:1539. [PMID: 33750784 PMCID: PMC7943774 DOI: 10.1038/s41467-021-21730-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Vagus nerve stimulation (VNS) is thought to affect neural activity by recruiting brain-wide release of neuromodulators. VNS is used in treatment-resistant epilepsy, and is increasingly being explored for other disorders, such as depression, and as a cognitive enhancer. However, the promise of VNS is only partially fulfilled due to a lack of mechanistic understanding of the transfer function between stimulation parameters and neuromodulatory response, together with a lack of biosensors for assaying stimulation efficacy in real time. We here develop an approach to VNS in head-fixed mice on a treadmill and show that pupil dilation is a reliable and convenient biosensor for VNS-evoked cortical neuromodulation. In an 'optimal' zone of stimulation parameters, current leakage and off-target effects are minimized and the extent of pupil dilation tracks VNS-evoked basal-forebrain cholinergic axon activity in neocortex. Thus, pupil dilation is a sensitive readout of the moment-by-moment, titratable effects of VNS on brain state.
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Affiliation(s)
- Zakir Mridha
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Jan Willem de Gee
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Yanchen Shi
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | | | | | | | - Matthew P Ward
- Department of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Wenhao Zhang
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Matthew James McGinley
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA.
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA.
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24
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Derr JB, Tamayo J, Clark JA, Morales M, Mayther MF, Espinoza EM, Rybicka-Jasińska K, Vullev VI. Multifaceted aspects of charge transfer. Phys Chem Chem Phys 2020; 22:21583-21629. [PMID: 32785306 PMCID: PMC7544685 DOI: 10.1039/d0cp01556c] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Charge transfer and charge transport are by far among the most important processes for sustaining life on Earth and for making our modern ways of living possible. Involving multiple electron-transfer steps, photosynthesis and cellular respiration have been principally responsible for managing the energy flow in the biosphere of our planet since the Great Oxygen Event. It is impossible to imagine living organisms without charge transport mediated by ion channels, or electron and proton transfer mediated by redox enzymes. Concurrently, transfer and transport of electrons and holes drive the functionalities of electronic and photonic devices that are intricate for our lives. While fueling advances in engineering, charge-transfer science has established itself as an important independent field, originating from physical chemistry and chemical physics, focusing on paradigms from biology, and gaining momentum from solar-energy research. Here, we review the fundamental concepts of charge transfer, and outline its core role in a broad range of unrelated fields, such as medicine, environmental science, catalysis, electronics and photonics. The ubiquitous nature of dipoles, for example, sets demands on deepening the understanding of how localized electric fields affect charge transfer. Charge-transfer electrets, thus, prove important for advancing the field and for interfacing fundamental science with engineering. Synergy between the vastly different aspects of charge-transfer science sets the stage for the broad global impacts that the advances in this field have.
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Affiliation(s)
- James B Derr
- Department of Biochemistry, University of California, Riverside, CA 92521, USA.
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25
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Identification of vagus nerve stimulation parameters affecting rat hippocampal electrophysiology without temperature effects. Brain Stimul 2020; 13:1198-1206. [PMID: 32454214 DOI: 10.1016/j.brs.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent experiments in rats have demonstrated significant effects of VNS on hippocampal excitability but were partially attributed to hypothermia, induced by the applied VNS parameters. OBJECTIVE To allow meaningful preclinical research on the mechanisms of VNS and translation of rodent results to clinical VNS trials, we aimed to identify non-hypothermia inducing VNS parameters that significantly affect hippocampal excitability. METHODS VNS was administered in cycles of 30 s including either 0.1, 0.16, 0.25, 0.5, 1.5, 3 or 7 s of VNS ON time (biphasic pulses, 250μs/phase, 1 mA, 30 Hz) and the effect of different VNS ON times on brain temperature was evaluated. VNS paradigms with and without hypothermia were compared for their effects on hippocampal neurophysiology in freely moving rats. RESULTS Using VNS parameters with an ON time/OFF time of up to 0.5 s/30 s did not cause hypothermia, while clear hypothermia was detected with ON times of 1.5, 3 and 7 s/30 s. Relative to SHAM VNS, the normothermic 0.5 s VNS condition significantly decreased hippocampal EEG power and changed dentate gyrus evoked potentials with an increased field excitatory postsynaptic potential slope and a decreased population spike amplitude. CONCLUSION VNS can be administered in freely moving rats without causing hypothermia, while profoundly affecting hippocampal neurophysiology suggestive of reduced excitability of hippocampal neurons despite increased synaptic transmission efficiency.
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26
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Yokoyama R, Akiyama Y, Enatsu R, Suzuki H, Suzuki Y, Kanno A, Ochi S, Mikuni N. The Immediate Effects of Vagus Nerve Stimulation in Intractable Epilepsy: An Intra-operative Electrocorticographic Analysis. Neurol Med Chir (Tokyo) 2020; 60:244-251. [PMID: 32295979 PMCID: PMC7246227 DOI: 10.2176/nmc.oa.2019-0221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to investigate whether and how vagus nerve stimulation (VNS) reduces the epileptogenic activity in the bilateral cerebral cortex in patients with intractable epilepsy. We analyzed the electrocorticograms (ECoGs) of five patients who underwent callosotomy due to intractable epilepsy even after VNS implantation. We recorded ECoGs and analyzed power spectrum in both VNS OFF and ON phases. We counted the number of spikes and electrodes with epileptic spikes, distinguishing unilaterally and bilaterally hemispherically spread spikes as synchronousness of the epileptic spikes in both VNS OFF and ON phases. There were 24.80 ± 35.55 and 7.20 ± 9.93 unilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.157), and 35.8 ± 29.21 and 10.6 ± 13.50 bilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.027). The number of electrodes with unilaterally and bilaterally spread spikes in the VNS OFF and ON phases was 3.84 ± 2.13 and 3.59 ± 1.82 (P = 0.415), and 8.20 ± 3.56 and 6.89 ± 2.89 (P = 0.026), respectively. The ECoG background power spectra recordings in the VNS OFF and ON phases were also analyzed. The spectral power tended to be greater in the high-frequency band at VNS ON phase than OFF phase. This study showed the reduction of epileptogenic spikes and spread areas of the spikes by VNS as immediate effects, electrophysiologically.
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Affiliation(s)
| | | | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University
| | - Yuto Suzuki
- Department of Neurosurgery, Sapporo Medical University
| | - Aya Kanno
- Department of Neurosurgery, Sapporo Medical University
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University
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27
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Rosso P, Iannitelli A, Pacitti F, Quartini A, Fico E, Fiore M, Greco A, Ralli M, Tirassa P. Vagus nerve stimulation and Neurotrophins: a biological psychiatric perspective. Neurosci Biobehav Rev 2020; 113:338-353. [PMID: 32278791 DOI: 10.1016/j.neubiorev.2020.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023]
Abstract
Since 2004, vagus nerve stimulation (VNS) has been used in treatment-resistant or treatment-intolerant depressive episodes. Today, VNS is suggested as possible therapy for a larger spectrum of psychiatric disorders, including schizophrenia, obsessive compulsive disorders, and panic disorders. Despite a large body of literature supports the application of VNS in patients' treatment, the exact mechanism of action of VNS remains not fully understood. In the present study, the major knowledges on the brain areas and neuronal pathways regulating neuroimmune and autonomic response subserving VNS effects are reviewed. Furthermore, the involvement of the neurotrophins (NTs) Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF) in vagus nerve (VN) physiology and stimulation is revised. The data on brain NGF/BDNF synthesis and in turn on the activity-dependent plasticity, connectivity rearrangement and neurogenesis, are presented and discussed as potential biomarkers for optimizing stimulatory parameters for VNS. A vagus nerve-neurotrophin interaction model in the brain is finally proposed as a working hypothesis for future studies addressed to understand pathophysiology of psychiatric disturbance.
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Affiliation(s)
- Pamela Rosso
- National Research Council (CNR), Institute of Biochemistry & Cell Biology (IBBC), Rome, Italy
| | - Angela Iannitelli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Psychiatry Unit San Salvatore Hospital, L'Aquila, Italy
| | - Adele Quartini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elena Fico
- National Research Council (CNR), Institute of Biochemistry & Cell Biology (IBBC), Rome, Italy
| | - Marco Fiore
- National Research Council (CNR), Institute of Biochemistry & Cell Biology (IBBC), Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Paola Tirassa
- National Research Council (CNR), Institute of Biochemistry & Cell Biology (IBBC), Rome, Italy.
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Bharwani A, West C, Champagne-Jorgensen K, McVey Neufeld KA, Ruberto J, Kunze WA, Bienenstock J, Forsythe P. The vagus nerve is necessary for the rapid and widespread neuronal activation in the brain following oral administration of psychoactive bacteria. Neuropharmacology 2020; 170:108067. [PMID: 32224131 DOI: 10.1016/j.neuropharm.2020.108067] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/08/2020] [Accepted: 03/22/2020] [Indexed: 12/17/2022]
Abstract
There is accumulating evidence that certain gut microbes modulate brain chemistry and have antidepressant-like behavioural effects. However, it is unclear which brain regions respond to bacteria-derived signals or how signals are transmitted to distinct regions. We investigated the role of the vagus in mediating neuronal activation following oral treatment with Lactobacillus rhamnosus (JB-1). Male Balb/c mice were orally administered a single dose of saline or a live or heat-killed preparation of a physiologically active bacterial strain, Lactobacillus rhamnosus (JB-1). 165 min later, c-Fos immunoreactivity in the brain was mapped, and mesenteric vagal afferent fibre firing was recorded. Mice also underwent sub-diaphragmatic vagotomy to investigate whether severing the vagus prevented JB-1-induced c-Fos expression. Finally, we examined the ΔFosB response following acute versus chronic bacterial treatment. While a single exposure to live and heat-killed bacteria altered vagal activity, only live treatment induced rapid neural activation in widespread but distinct brain regions, as assessed by c-Fos expression. Sub-diaphragmatic vagotomy abolished c-Fos immunoreactivity in most, but not all, previously responsive regions. Chronic, but not acute treatment induced a distinct pattern of ΔFosB expression, including in previously unresponsive brain regions. These data identify that specific brain regions respond rapidly to gut microbes via vagal-dependent and independent pathways, and demonstrate that acute versus long-term exposure is associated with differential responses in distinct brain regions.
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Affiliation(s)
- Aadil Bharwani
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Canada; McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Christine West
- McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada
| | | | - Karen-Anne McVey Neufeld
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Canada; McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada
| | - Joseph Ruberto
- McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada
| | - Wolfgang A Kunze
- McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada
| | - John Bienenstock
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Canada; McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada
| | - Paul Forsythe
- McMaster Brain-Body Institute, St. Joseph's Healthcare, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada.
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29
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Gummadavelli A, Quraishi IH, Gerrard JL. Responsive Neurostimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Senova S, Rabu C, Beaumont S, Michel V, Palfi S, Mallet L, Domenech P. Stimulation du nerf vague dans le traitement de la dépression. Presse Med 2019; 48:1507-1519. [DOI: 10.1016/j.lpm.2019.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
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Katagiri M, Iida K, Ishihara K, Nair D, Harada K, Kagawa K, Seyama G, Hashizume A, Kuramoto T, Hanaya R, Arita K, Kurisu K. Anti-seizure effect and neuronal activity change in the genetic-epileptic model rat with acute and chronic vagus nerve stimulation. Epilepsy Res 2019; 155:106159. [PMID: 31277035 DOI: 10.1016/j.eplepsyres.2019.106159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND VNS showed time-dependent anti-seizure effect. However, the precise mechanism of VNS in acute and chronic anti-seizure effect has not been fully elucidated. Noda epileptic rat (NER) is genetic epilepsy model rat which exhibits spontaneous generalized tonic-clonic seizure (GTC) approximately once per 30 h and frequent dialeptic seizure (DS). We performed acute and chronic VNS on NER to focus on the acute and chronic anti-epileptic effect and neuronal activity change by VNS. METHODS We performed acute VNS (2 h) on 22 NERs (VNS, n = 11, control, n = 11), then subsequently administered chronic (4 weeks) VNS on 10 of 22 NERs (VNS n = 5, control n = 5). We evaluated the acute and chronic anti-seizure effects of VNS on GTC and DS by behavioral and electroencephalographical observation (2 h every week). We carried out double immunofluorescence for biomarkers of short-term (c-Fos) and long-term (ΔFosB) neuronal activation to map regions in the brain that were activated by acute (VNS n = 6, control n = 6) or chronic VNS (VNS n = 5, control n = 5). Furthermore, we performed chronic VNS (4 w) on 12 NERs (VNS n = 6, control n = 6) with long-term observation (8 h a day, 5d per week) to obtain an adequate number of GTCs to elucidate the time dependent anti-epileptic effect on GTC. RESULTS Acute VNS treatment reduced GTC seizure frequency and total duration of the DS. Chronic VNS resulted in a time-dependent reduction of DS frequency and duration. However, chronic VNS did not show time-dependent reduction of GTC frequency. There were significant c-Fos expressions in the central medial nucleus (CM), mediodorsal thalamic nucleus (MDM), locus coeruleus (LC), and nucleus of solitary tract (NTS) after acute VNS. And there were significant ΔFosB expressions in the lateral septal nucleus (LSV), medial septal nucleus (MSV), MDM, and pontine reticular nucleus caudal (PnC) after chronic VNS. Any decrease in frequency of GTCs by chronic VNS could not be confirmed even with long-term observation. CONCLUSION We confirmed acute VNS significantly reduced the frequency of GTC and duration of DS. Chronic VNS decreased the frequency and duration of DS in a time-dependent manner. The brainstem and midline thalamus were activated after acute and chronic VNS. The forebrain was activated only after chronic VNS.
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Affiliation(s)
- Masaya Katagiri
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kumatoshi Ishihara
- Laboratory of Neuropharmacology, Faculty of Pharmaceutical Sciences, Hiroshima International University, 5-1-1, Hirokoshingai, Kure, 737-0112, Japan.
| | - Dileep Nair
- Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Kana Harada
- Laboratory of Neuropharmacology, Faculty of Pharmaceutical Sciences, Hiroshima International University, 5-1-1, Hirokoshingai, Kure, 737-0112, Japan.
| | - Kota Kagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Go Seyama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Akira Hashizume
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Epilepsy Center, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takashi Kuramoto
- Institute of Laboratory Animals, Graduate School of Medicine, Kyoto University, Yoshida-Konoe cho, 606-8501, Kyoto, Japan.
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Kucia K, Merk W, Zapalowicz K, Medrala T. Vagus Nerve Stimulation For Treatment Resistant Depression: Case Series Of Six Patients - Retrospective Efficacy And Safety Observation After One Year Follow Up. Neuropsychiatr Dis Treat 2019; 15:3247-3254. [PMID: 31819452 PMCID: PMC6883943 DOI: 10.2147/ndt.s217816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE One year observation and evaluation of the VNS (vagus nerve stimulation) efficacy and safety for patients with treatment resistant depression in Polish conditions. METHODS An open label, uncontrolled and one center retrospective study of VNS therapy was implemented with stable pharmacotherapy in 6 patients with treatment resistant depression (TRD). For the first 3 months, only VNS parameters were altered but the pharmacological treatment was unchanged and in the following 9 months, medication and VNS dosing parameters were altered according to the clinical state of the patients. RESULTS The baseline 24-item Hamilton Depression Rating Scale (HAMD-24) score averaged 24. Both response (>50% reduction in baseline scores) and remission rates after 3 months of treatment were only 40%. After 1 year of VNS therapy, the response rates increased to 86%. Most frequent side-effects were voice alteration (86% at 3 months of stimulation) and headaches (40%). CONCLUSION VNS treatment was safe and effective in TRD patients and its efficacy increased with time. Efficacy ratings are similar to the previously reported studies using a congenial protocol.
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Affiliation(s)
- Krzysztof Kucia
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
| | - Wojciech Merk
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
| | | | - Tomasz Medrala
- Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia, GCM, Katowice 40-635, Poland
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Kulju T, Haapasalo J, Rainesalo S, Lehtimäki K, Peltola J. Autostimulation in Vagus Nerve Stimulator Treatment: Modulating Neuromodulation. Neuromodulation 2018; 22:630-637. [DOI: 10.1111/ner.12897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Toni Kulju
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Joonas Haapasalo
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Sirpa Rainesalo
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Kai Lehtimäki
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
| | - Jukka Peltola
- Department of Neurosciences and RehabilitationTampere University Hospital Tampere Finland
- Faculty of Medicine and Life SciencesUniversity of Tampere Tampere Finland
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Yakunina N, Kim SS, Nam EC. BOLD fMRI effects of transcutaneous vagus nerve stimulation in patients with chronic tinnitus. PLoS One 2018; 13:e0207281. [PMID: 30485375 PMCID: PMC6261575 DOI: 10.1371/journal.pone.0207281] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/29/2018] [Indexed: 12/25/2022] Open
Abstract
Objective Vagus nerve stimulation (VNS) is a neuromodulation method used for treatment of epilepsy and depression. Transcutaneous VNS (tVNS) has been gaining popularity as a noninvasive alternative to VNS. Previous tVNS neuroimaging studies revealed brain (de)activation patterns that involved multiple areas implicated in tinnitus generation and perception. In this study, functional magnetic resonance imaging (fMRI) was used to explore the effects of tVNS on brain activity in patients with tinnitus. Methods Thirty-six patients with chronic tinnitus received tVNS to the inner tragus, cymba conchae, and earlobe (sham stimulation). Results The locus coeruleus and nucleus of the solitary tract in the brainstem were activated in response to stimulation of both locations compared with the sham stimulation. The cochlear nuclei were also activated, which was not observed in healthy subjects with normal hearing. Multiple auditory and limbic structures, as well as other brain areas associated with generation and perception of tinnitus, were deactivated by tVNS, particularly the parahippocampal gyrus, which was recently speculated to cause tinnitus in hearing-impaired patients. Conclusions tVNS via the inner tragus or cymba conchae suppressed neural activity in the auditory, limbic, and other tinnitus-related non-auditory areas through auditory and vagal ascending pathways in tinnitus patients. The results from this study are discussed in the context of several existing models of tinnitus. They indicate that the mechanism of action of tVNS might be involved in multiple brain areas responsible for the generation of tinnitus, tinnitus-related emotional annoyance, and their mutual reinforcement.
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Affiliation(s)
- Natalia Yakunina
- Institute of Medical Science, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sam Soo Kim
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Radiology, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
| | - Eui-Cheol Nam
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Otolaryngology, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
- * E-mail:
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35
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Hachem LD, Wong SM, Ibrahim GM. The vagus afferent network: emerging role in translational connectomics. Neurosurg Focus 2018; 45:E2. [DOI: 10.3171/2018.6.focus18216] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Vagus nerve stimulation (VNS) is increasingly considered for the treatment of intractable epilepsy and holds potential for the management of a variety of neuropsychiatric conditions. The emergence of the field of connectomics and the introduction of large-scale modeling of neural networks has helped elucidate the underlying neurobiology of VNS, which may be variably expressed in patient populations and related to responsiveness to stimulation. In this report, the authors outline current data on the underlying neural circuitry believed to be implicated in VNS responsiveness in what the authors term the “vagus afferent network.” The emerging role of biomarkers to predict treatment effect is further discussed and important avenues for future work are highlighted.
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Affiliation(s)
- Laureen D. Hachem
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Simeon M. Wong
- 2Department of Diagnostic Imaging, Hospital for Sick Children, Toronto; and
| | - George M. Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 3Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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36
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Bassi GS, Ulloa L, Santos VR, Del Vecchio F, Delfino-Pereira P, Rodrigues GJ, Castania JA, Cunha FDQ, Salgado HC, Cunha TM, Garcia-Cairasco N, Kanashiro A. Cortical stimulation in conscious rats controls joint inflammation. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:201-213. [PMID: 29522782 PMCID: PMC7592443 DOI: 10.1016/j.pnpbp.2018.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 12/16/2022]
Abstract
The neuronal control of the immune system is fundamental to the development of new therapeutic strategies for inflammatory disorders. Recent studies reported that afferent vagal stimulation attenuates peripheral inflammation by activating specific sympathetic central and peripheral networks, but only few subcortical brain areas were investigated. In the present study, we report that afferent vagal stimulation also activates specific cortical areas, as the parietal and cingulate cortex. Since these cortical structures innervate sympathetic-related areas, we investigate whether electrical stimulation of parietal cortex can attenuate knee joint inflammation in non-anesthetized rats. Our results show that cortical stimulation in rats increased sympathetic activity and improved joint inflammatory parameters, such as local neutrophil infiltration and pro-inflammatory cytokine levels, without causing behavioral disturbance, brain epileptiform activity or neural damage. In addition, we superposed the areas activated by afferent vagal or cortical stimulation to map common central structures to depict a brain immunological homunculus that can allow novel therapeutic approaches against inflammatory joint diseases, such as rheumatoid arthritis.
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Affiliation(s)
- Gabriel Shimizu Bassi
- Department of Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium.
| | - Luis Ulloa
- Department of Surgery, Center of Immunology and Inflammation, Rutgers - New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA.
| | - Victor Rodrigues Santos
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Flávio Del Vecchio
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Polianna Delfino-Pereira
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Gerson Jhonatan Rodrigues
- Department of Physiological Sciences, Federal University of São Carlos (UFSCAR), São Carlos, SP, Brazil
| | - Jaci Airton Castania
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando de Queiróz Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Hélio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Thiago Mattar Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Norberto Garcia-Cairasco
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Alexandre Kanashiro
- Department of Physiological Sciences, Federal University of São Carlos (UFSCAR), São Carlos, SP, Brazil; Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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37
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Kanashiro A, Shimizu Bassi G, de Queiróz Cunha F, Ulloa L. From neuroimunomodulation to bioelectronic treatment of rheumatoid arthritis. ACTA ACUST UNITED AC 2018; 1:151-165. [PMID: 30740246 DOI: 10.2217/bem-2018-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neuronal stimulation is an emerging field in modern medicine to control organ function and reestablish physiological homeostasis during illness. The nervous system innervates most of the peripheral organs and provides a fine tune to control the immune system. Most of these studies have focused on vagus nerve stimulation and the physiological, cellular and molecular mechanisms regulating the immune system. Here, we review the new results revealing afferent vagal signaling pathways, immunomodulatory brain structures, spinal cord-dependent circuits, neural and non-neural cholinergic/catecholaminergic signals and their respective receptors contributing to neuromodulation of inflammation in rheumatoid arthritis. These new neuromodulatory networks and structures will allow the design of innovative bioelectronic or pharmacological approaches for safer and low-cost treatment of arthritis and related inflammatory disorders.
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Affiliation(s)
- Alexandre Kanashiro
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,Department of Physiological Sciences, Federal University of São Carlos (UFSCAR), São Carlos, SP, Brazil
| | - Gabriel Shimizu Bassi
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fernando de Queiróz Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Luis Ulloa
- Department of Surgery, Center of Immunology & Inflammation, Rutgers-New Jersey Medical School, Rutgers University, Newark, NJ 07101, USA
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38
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Bonaz B, Sinniger V, Pellissier S. The Vagus Nerve in the Neuro-Immune Axis: Implications in the Pathology of the Gastrointestinal Tract. Front Immunol 2017; 8:1452. [PMID: 29163522 PMCID: PMC5673632 DOI: 10.3389/fimmu.2017.01452] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022] Open
Abstract
The vagus nerve (VN) is the longest nerve of the organism and a major component of the parasympathetic nervous system which constitutes the autonomic nervous system (ANS), with the sympathetic nervous system. There is classically an equilibrium between the sympathetic and parasympathetic nervous systems which is responsible for the maintenance of homeostasis. An imbalance of the ANS is observed in various pathologic conditions. The VN, a mixed nerve with 4/5 afferent and 1/5 efferent fibers, is a key component of the neuro-immune and brain-gut axes through a bidirectional communication between the brain and the gastrointestinal (GI) tract. A dual anti-inflammatory role of the VN is observed using either vagal afferents, targeting the hypothalamic–pituitary–adrenal axis, or vagal efferents, targeting the cholinergic anti-inflammatory pathway. The sympathetic nervous system and the VN act in synergy, through the splenic nerve, to inhibit the release of tumor necrosis factor-alpha (TNFα) by macrophages of the peripheral tissues and the spleen. Because of its anti-inflammatory effect, the VN is a therapeutic target in the treatment of chronic inflammatory disorders where TNFα is a key component. In this review, we will focus on the anti-inflammatory role of the VN in inflammatory bowel diseases (IBD). The anti-inflammatory properties of the VN could be targeted pharmacologically, with enteral nutrition, by VN stimulation (VNS), with complementary medicines or by physical exercise. VNS is one of the alternative treatments for drug resistant epilepsy and depression and one might think that VNS could be used as a non-drug therapy to treat inflammatory disorders of the GI tract, such as IBD, irritable bowel syndrome, and postoperative ileus, which are all characterized by a blunted autonomic balance with a decreased vagal tone.
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Affiliation(s)
- Bruno Bonaz
- Division of Hepato-Gastroenterology, Grenoble University Hospital, Grenoble, Alpes, France.,U1216, INSERM, GIN, Grenoble Institute of Neurosciences, University Grenoble Alpes, Grenoble, France
| | - Valérie Sinniger
- Division of Hepato-Gastroenterology, Grenoble University Hospital, Grenoble, Alpes, France.,U1216, INSERM, GIN, Grenoble Institute of Neurosciences, University Grenoble Alpes, Grenoble, France
| | - Sonia Pellissier
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition et Changement Social LIP/PC2S-EA4145, University Savoie Mont Blanc, Chambéry, France
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39
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Yasuhara T, Date I, Liska MG, Kaneko Y, Vale FL. Translating regenerative medicine techniques for the treatment of epilepsy. Brain Circ 2017; 3:156-162. [PMID: 30276318 PMCID: PMC6057691 DOI: 10.4103/bc.bc_21_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023] Open
Abstract
Epilepsy is considered a chronic neurological disorder and is accompanied by persistent and diverse disturbances in electrical brain activity. While antiepileptic pharmaceuticals are still the predominant treatment for epilepsy, the advent of numerous surgical interventions has further improved outcomes for patients. Despite these advancements, a subpopulation continues to experience intractable seizures which are resistant to current conventional and nonconventional therapeutic options. In this review, we begin with an introduction to the clinical presentation of epilepsy before discussing the clinically relevant laboratory models of epilepsy. Finally, we explore the implications of regenerative medicine – including cell therapy, neuroprotective agents, and electrical stimulation – for epilepsy, supplemented with our laboratory's data. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed. Some original points in this article come from the laboratory practice in our research center and the authors’ experiences.
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Affiliation(s)
- Takao Yasuhara
- Department of Neurological Surgery, Okayama University, Graduate School of Medicine, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University, Graduate School of Medicine, Okayama, Japan
| | - M Grant Liska
- Department of Neurosurgery and Brain Repair, USF Morsani College of Medicine, Tampa, FL 33612, USA
| | - Yuji Kaneko
- Department of Neurosurgery and Brain Repair, USF Morsani College of Medicine, Tampa, FL 33612, USA
| | - Fernando L Vale
- Department of Neurosurgery and Brain Repair, USF Morsani College of Medicine, Tampa, FL 33612, USA
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40
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Presurgical thalamocortical connectivity is associated with response to vagus nerve stimulation in children with intractable epilepsy. NEUROIMAGE-CLINICAL 2017; 16:634-642. [PMID: 28971013 PMCID: PMC5619991 DOI: 10.1016/j.nicl.2017.09.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/16/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
Although chronic vagus nerve stimulation (VNS) is an established treatment for medically-intractable childhood epilepsy, there is considerable heterogeneity in seizure response and little data are available to pre-operatively identify patients who may benefit from treatment. Since the therapeutic effect of VNS may be mediated by afferent projections to the thalamus, we tested the hypothesis that intrinsic thalamocortical connectivity is associated with seizure response following chronic VNS in children with epilepsy. Twenty-one children (ages 5-21 years) with medically-intractable epilepsy underwent resting-state fMRI prior to implantation of VNS. Ten received sedation, while 11 did not. Whole brain connectivity to thalamic regions of interest was performed. Multivariate generalized linear models were used to correlate resting-state data with seizure outcomes, while adjusting for age and sedation status. A supervised support vector machine (SVM) algorithm was used to classify response to chronic VNS on the basis of intrinsic connectivity. Of the 21 subjects, 11 (52%) had 50% or greater improvement in seizure control after VNS. Enhanced connectivity of the thalami to the anterior cingulate cortex (ACC) and left insula was associated with greater VNS efficacy. Within our test cohort, SVM correctly classified response to chronic VNS with 86% accuracy. In an external cohort of 8 children, the predictive model correctly classified the seizure response with 88% accuracy. We find that enhanced intrinsic connectivity within thalamocortical circuitry is associated with seizure response following VNS. These results encourage the study of intrinsic connectivity to inform neural network-based, personalized treatment decisions for children with intractable epilepsy.
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41
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Bassi GS, Dias DPM, Franchin M, Talbot J, Reis DG, Menezes GB, Castania JA, Garcia-Cairasco N, Resstel LBM, Salgado HC, Cunha FQ, Cunha TM, Ulloa L, Kanashiro A. Modulation of experimental arthritis by vagal sensory and central brain stimulation. Brain Behav Immun 2017; 64:330-343. [PMID: 28392428 PMCID: PMC6330674 DOI: 10.1016/j.bbi.2017.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/25/2017] [Accepted: 04/04/2017] [Indexed: 12/20/2022] Open
Abstract
Articular inflammation is a major clinical burden in multiple inflammatory diseases, especially in rheumatoid arthritis. Biological anti-rheumatic drug therapies are expensive and increase the risk of systemic immunosuppression, infections, and malignancies. Here, we report that vagus nerve stimulation controls arthritic joint inflammation by inducing local regulation of innate immune response. Most of the previous studies of neuromodulation focused on vagal regulation of inflammation via the efferent peripheral pathway toward the viscera. Here, we report that vagal stimulation modulates arthritic joint inflammation through a novel "afferent" pathway mediated by the locus coeruleus (LC) of the central nervous system. Afferent vagal stimulation activates two sympatho-excitatory brain areas: the paraventricular hypothalamic nucleus (PVN) and the LC. The integrity of the LC, but not that of the PVN, is critical for vagal control of arthritic joint inflammation. Afferent vagal stimulation suppresses articular inflammation in the ipsilateral, but not in the contralateral knee to the hemispheric LC lesion. Central stimulation is followed by subsequent activation of joint sympathetic nerve terminals inducing articular norepinephrine release. Selective adrenergic beta-blockers prevent the effects of articular norepinephrine and thereby abrogate vagal control of arthritic joint inflammation. These results reveals a novel neuro-immune brain map with afferent vagal signals controlling side-specific articular inflammation through specific inflammatory-processing brain centers and joint sympathetic innervations.
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Affiliation(s)
- Gabriel Shimizu Bassi
- Department of Immunology, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Marcelo Franchin
- Department of Pharmacology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jhimmy Talbot
- Department of Pharmacology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Gustavo Reis
- Department of Pharmacology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Gustavo Batista Menezes
- Center for Gastrointestinal Biology, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jaci Airton Castania
- Department of Physiology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Norberto Garcia-Cairasco
- Department of Physiology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Queiró Cunha
- Department of Pharmacology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Thiago Mattar Cunha
- Department of Pharmacology, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Luis Ulloa
- Department of Surgery, Center of Immunology & Inflammation, Rutgers-New Jersey Medical School, Rutgers University, Newark, NJ 07101, USA.
| | - Alexandre Kanashiro
- Department of Pharmacology, Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Physiological Sciences, Federal University of São Carlos, São Carlos, SP, Brazil.
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42
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Ravan M. Investigating the correlation between short-term effectiveness of VNS Therapy in reducing the severity of seizures and long-term responsiveness. Epilepsy Res 2017; 133:46-53. [DOI: 10.1016/j.eplepsyres.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/08/2017] [Accepted: 04/08/2017] [Indexed: 12/18/2022]
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43
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Cognitive effects of subdiaphragmatic vagal deafferentation in rats. Neurobiol Learn Mem 2017; 142:190-199. [DOI: 10.1016/j.nlm.2017.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/22/2017] [Accepted: 05/07/2017] [Indexed: 12/26/2022]
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44
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Bonaz B, Sinniger V, Pellissier S. Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease. J Intern Med 2017; 282:46-63. [PMID: 28421634 DOI: 10.1111/joim.12611] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), that is Crohn's disease (CD) and ulcerative colitis, affects about 1.5 million persons in the USA and 2.2 million in Europe. The pathophysiology of IBD involves immunological, genetic and environmental factors. The treatment is medico-surgical but suspensive. Anti-TNFα agents have revolutionized the treatment of IBD but have side effects. In addition, a non-negligible percentage of patients with IBD stop or take episodically their treatment. Consequently, a nondrug therapy targeting TNFα through a physiological pathway, devoid of major side effects and with a good cost-effectiveness ratio, would be of interest. The vagus nerve has dual anti-inflammatory properties through its afferent (i.e. hypothalamic-pituitary-adrenal axis) and efferent (i.e. the anti-TNFα effect of the cholinergic anti-inflammatory pathway) fibres. We have shown that there is an inverse relationship between vagal tone and plasma TNFα level in patients with CD, and have reported, for the first time, that chronic vagus nerve stimulation has anti-inflammatory properties in a rat model of colitis and in a pilot study performed in seven patients with moderate CD. Two of these patients failed to improve after 3 months of vagus nerve stimulation but five were in deep remission (clinical, biological and endoscopic) at 6 months of follow-up and vagal tone was restored. No major side effects were observed. Thus, vagus nerve stimulation provides a new therapeutic option in the treatment of CD.
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Affiliation(s)
- B Bonaz
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,University Grenoble Alpes, Grenoble Institute of Neurosciences (GIN), Inserm (U1216), Grenoble, France
| | - V Sinniger
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,University Grenoble Alpes, Grenoble Institute of Neurosciences (GIN), Inserm (U1216), Grenoble, France
| | - S Pellissier
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition et Changement Social (LIP/PC2S), University Savoie Mont-Blanc, Chambéry, France
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45
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Al Omari AI, Alzoubi FQ, Alsalem MM, Aburahma SK, Mardini DT, Castellanos PF. The vagal nerve stimulation outcome, and laryngeal effect: Otolaryngologists roles and perspective. Am J Otolaryngol 2017; 38:408-413. [PMID: 28390806 DOI: 10.1016/j.amjoto.2017.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/05/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12years. VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively. OBJECTIVES This study is to review the outcomes of vagal nerve stimulator (VNS) implantation in terms of the surgical procedures, complications, seizure frequency, and the clinical effect on larynx and vocal folds motion. METHODS Series of thirty consecutive patients who had VNS implantation between 2007 and 2014 were recruited. Seizure-frequency outcome, surgical complications and device adverse effects of VNS were retrospectively reviewed. Additional evaluation included use of the Voice Handicap Index and Maximum Phonation Time (MPT) were conducted before and after the implantation. Videolaryngoscopy was used to evaluate the vocal fold mobility before and after the VNS implantation. RESULTS Seizure frequency reduction over a minimum of 2years of follow up demonstrated: 100% in seizure frequency reduction in 1 patient, drastic reduction in seizure frequency (70-90%) in 9 patients, a good reduction in terms of seizure frequency (50%) in 8 patients, a 30% reduction in 5 patients, no response in 6 patients, and 1 patient had increased frequency. The most commonly reported adverse effects after VNS activation were coughing and voice changes with pitch breaks, as well as mild intermittent shortness of breath in 33% of patients. For those patients secondary supraglottic muscle tension and hyper function with reduced left vocal fold mobility were noticed on videolaryngoscopy, though none had aspiration problems. Surgical complications included a wound dehiscence in one patient (3%) which was surgically managed, minor intra-operative bleeding 3%; a superficial wound infection in one patient (3%) which was treated conservatively, none of the complications necessitated VNS removal. CONCLUSIONS VNS appears to be an effective non-pharmacologic adjuvant therapy in patients with medically refractory seizures. With the favorable adverse-effect profile previously described, VNS is generally well tolerated and of a great benefit to such patients. Laryngeal side effects, of which hoarseness being of the greatest repetition, are the most common after the VNS implantation. VNS can affect the voice and reduced vocal cord motion on the implantation side with secondary supraglottic muscle tension. Otolaryngologists are not only capable of performing VNS implantation, but can also manage surgical complications, assess laryngeal side effects and treat them as needed.
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Abstract
Major depressive disorder (MDD) is prevalent. Although standards antidepressants are more effective than placebo, up to 35% of patients do not respond to 4 or more conventional treatments and are considered to have treatment-resistant depression (TRD). Considerable effort has been devoted to trying to find effective treatments for TRD. This review focuses on vagus nerve stimulation (VNS), approved for TRD in 2005 by the Food and Drugs Administration. Stimulation is carried by bipolar electrodes on the left cervical vagus nerve, which are attached to an implanted stimulator generator. The vagus bundle contains about 80% of afferent fibers terminating in the medulla, from which there are projections to many areas of brain, including the limbic forebrain. Various types of brain imaging studies reveal widespread functional effects in brain after either acute or chronic VNS. Although more randomized control trials of VNS need to be carried out before a definitive conclusion can be reached about its efficacy, the results of open studies, carried out over period of 1 to 2 years, show much more efficacy when compared with results from treatment as usual studies. There is an increase in clinical response to VNS between 3 and 12 months, which is quite different from that seen with standard antidepressant treatment of MDD. Preclinically, VNS affects many of the same brain areas, neurotransmitters (serotonin, norepinephrine) and signal transduction mechanisms (brain-derived neurotrophic factor-tropomyosin receptor kinase B) as those found with traditional antidepressants. Nevertheless, the mechanisms by which VNS benefits patients nonresponsive to conventional antidepressants is unclear, with further research needed to clarify this.
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Affiliation(s)
- Flavia R Carreno
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Alan Frazer
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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Vagus Nerve Stimulation and Other Neuromodulation Methods for Treatment of Traumatic Brain Injury. Neurocrit Care 2017; 24:308-19. [PMID: 26399249 DOI: 10.1007/s12028-015-0203-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The objective of this paper is to review the current literature regarding the use of vagus nerve stimulation (VNS) in preclinical models of traumatic brain injury (TBI) as well as discuss the potential role of VNS along with alternative neuromodulation approaches in the treatment of human TBI. Data from previous studies have demonstrated VNS-mediated improvement following TBI in animal models. In these cases, VNS was observed to enhance motor and cognitive recovery, attenuate cerebral edema and inflammation, reduce blood brain barrier breakdown, and confer neuroprotective effects. Yet, the underlying mechanisms by which VNS enhances recovery following TBI remain to be fully elucidated. Several hypotheses have been offered including: a noradrenergic mechanism, reduction in post-TBI seizures and hyper-excitability, anti-inflammatory effects, attenuation of blood-brain barrier breakdown, and cerebral edema. We present other potential mechanisms by which VNS acts including enhancement of synaptic plasticity and recruitment of endogenous neural stem cells, stabilization of intracranial pressure, and interaction with the ghrelin system. In addition, alternative methods for the treatment of TBI including deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, and focused ultrasound stimulation are discussed. Although the primary source data show that VNS improves TBI outcomes, it remains to be determined if these findings can be translated to clinical settings.
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Childs JE, DeLeon J, Nickel E, Kroener S. Vagus nerve stimulation reduces cocaine seeking and alters plasticity in the extinction network. ACTA ACUST UNITED AC 2016; 24:35-42. [PMID: 27980074 PMCID: PMC5159656 DOI: 10.1101/lm.043539.116] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022]
Abstract
Drugs of abuse cause changes in the prefrontal cortex (PFC) and associated regions that impair inhibitory control over drug-seeking. Breaking the contingencies between drug-associated cues and the delivery of the reward during extinction learning reduces rates of relapse. Here we used vagus nerve stimulation (VNS) to induce targeted synaptic plasticity to facilitate extinction of appetitive behaviors and to reduce relapse. Rats self-administered cocaine and were given VNS during extinction. Relapse to drug-seeking was assessed in a cued reinstatement session. We used immunohistochemistry to measure changes in the expression of the phosphorylated transcription factor cAMP response-element binding protein (pCREB) in the PFC and the basolateral amygdala (BLA), which regulate cue learning and extinction. In vivo recordings of evoked field potentials measured drug- and VNS-induced changes in metaplasticity in the pathway from the PFC to the BLA. VNS-treated rats showed improved rates of extinction and reduced reinstatement. Following reinstatement, pCREB levels were reduced in the IL and BLA of VNS-treated rats. Evoked responses in the BLA were greatly reduced in VNS-treated rats, and these rats were also resistant to the induction of LTD. Taken together, these results show that VNS facilitates extinction and reduces reinstatement. Changes in the pathway between the PFC and the amygdala may contribute to these beneficial effects.
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Affiliation(s)
- Jessica E Childs
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas 75080, USA
| | - Jaime DeLeon
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas 75080, USA
| | - Emily Nickel
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas 75080, USA
| | - Sven Kroener
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas 75080, USA
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The antidepressant mechanism of action of vagus nerve stimulation: Evidence from preclinical studies. Neurosci Biobehav Rev 2015; 56:26-34. [DOI: 10.1016/j.neubiorev.2015.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/21/2015] [Indexed: 01/22/2023]
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Conway CR, Colijn MA, Schachter SC. Vagus Nerve Stimulation for Epilepsy and Depression. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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