STIMULATION OF THE WAVE NERVE
General overview
Vagus nerve stimulation is a method that may or may not be invasive and has been used for a long time in reducing epilepsy in children and adults. It is based on the crucial role of the vagus nerve, the longest nerve connecting the brain to the rest of the body, and playing a crucial role in the transmission of information between the brain and the body. It has been used for more than 20 years as a non-pharmacological treatment for epilepsy. The role of the vagus nerve has been the subject of many recent studies to better understand its role and to expand the potential of vagus nerve stimulation. Already used to reduce depression, it is now also used to reduce autistic disorders, improve motor recovery after a stroke… Non-invasive stimulation is now possible thanks to electrical stimulation in the neck or ear, and therefore more easily accessible to patients.
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Main objectives of the method
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Implant stimulation
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Invasive method but which allows continuous stimulation
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A generator is implemented in the patient's neck to stimulate the vagus nerve
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This stimulation is used to reduce seizures
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Non-invasive stimulation
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A non-invasive method, allowing to generate a punctual stimulation at the level of the ear or the neck, reaching the vagus nerve
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Allows you to have control over the triggering of pulsations Helps stimulate the vagus and reduce symptoms related to mood (such as depressive, anxiety disorders ...) and develop social commitment
Specificities of the method
The vagus nerve is one of 12 pairs of cranial nerves that originate in the brain and are part of the autonomic nervous system, which controls involuntary bodily functions. The nerve goes through the neck as it travels between the chest and abdomen and the lower part of the brain. It is related to the motor functions of the larynx, diaphragm, stomach and heart and to the sensory functions of the ears and tongue. It is linked to the motor and sensory functions of the sinuses and the esophagus. Vagus Nerve Stimulation (VNS) sends regular, light pulses of electrical energy to the brain through the vagus nerve, using an invasive device similar to a pacemaker, or a portable non-invasive device . Implant The method usually requires an operation under general anesthesia to implant an influx generator into the patient's body, using two incisions (one in the neck, one in the chest). The generator is connected to the vagus nerve and is programmed by the doctor to transmit electrical pulses of low intensity regularly and intermittently, all day and night, stimulating the vagus nerve. These stimulations are supposed to prevent crises, and can be partially increased or decreased by the wearer of the generator by means of a magnet. Regular monitoring is necessary to ensure the proper functioning of the device. A study also highlighted the very positive impact of the implant on improving motor function, associated with intensive post-stroke rehabilitation. NSVT TVNS is developing as a non-invasive method, acting transcutaneously, but these developments are still recent. The manufacturers of the devices, like Parasym, generally recommend sessions of minimum 60 minutes to maximum 90 minutes, so as not to make the stimulation zone too sensitive. There are other, more natural ways to stimulate the vagus nerve, such as breathing and meditation.
Who is this method for ?
The method is historically intended for children with epilepsy, for whom drug treatments do not work, and for whom other forms of operations are not possible for any reason. It is also traditionally addressed to the treatment of depression and to the improvement of the digestive system. More recently, this method has seen many promising developments, for example to treat patients with stroke and autistic disorders.
Side effects to consider: The generator sometimes changes the voice of the child (more serious), can cause some tingling or pain, shortness of breath, upset stomach, nausea, or more rarely discharge of drool.
What parents say about it
“The operation is done under general anesthesia, not long, with police custody for 24 hours after. One night in the hospital, what. My epileptologist is now taking care of it. [My stimulator] is connected to the nerve by three small electrodes which send more or less strong electrical impulses at regular intervals. We feel them well, but we get used to it quickly. Sometimes I have a derailed voice but it's very transient. The epileptologist adjusts this remotely using a small device, palm style, or iPhone.
I am set to 1.5mA pulses every 3 min. It is quite bearable. We get used to it quickly :). "
“We hesitated for a while before having the operation done. We had to accept the idea of letting an electrical impulse be sent to our child's brain on a regular and voluntary basis, then because there is no guarantee of results. But as Theo was getting worse and worse, we finally decided to try the experiment. The operation went well and Théo does not seem to be suffering. He does not complain of pain or discomfort. "
Scientific references
Vagus nerve stimulation for medication-resistant generalized epilepsy
https://n.neurology.org/content/52/7/1510
Our results suggest that VNS is an effective treatment for generalized drug-resistant epilepsy, even in patients as young as 4 years old.
Interest of vagus nerve stimulation therapy in refractory epilepsy - study at the Nancy University Hospital Center
"SNV therapy would seem to be interesting since, even if its effectiveness on the frequency of seizures is not systematic, it would have a beneficial effect on the quality of life of certain patients and in particular on their psychological state. "
Stimulation of the vagus nerve (SNV). A neuromodulation method for resistant depressions?
"The level of proof of the efficacy of vagus nerve stimulation in the treatment of major depressive episode remains limited, in particular given the dif fi culties of setting up high-performance clinical trials of good methodological quality. Numerous theoretical and clinical arguments suggest a signi fi cant therapeutic interest in this innovative technique in the field of severe and resistant mood disorders. "
Vagus Nerve as Modulator of the Brain – Gut Axis in Psychiatric and Inflammatory Disorders
https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00044/full
"Vagus nerve stimulation is an effective anticonvulsant device and has been shown in observational studies of antidepressant effects in the treatment of chronic resistant depression. As the vagus nerve sends information to the regions of the brain that play an important role in the stress response (LC, orbitofrontal cortex, insula, hippocampus and tonsil), it could be one of the vectors of the various somatic and cognitive symptoms characteristic of disorders associated with stress, or have a role in their perception and appearance. "
Autism
Transcutaneous Vagus Nerve Stimulation: A Promising Method for Treatment of Autism Spectrum Disorders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247460/
In summary, tVNS may be a promising method for treating ASD. It has the potential not only to relieve basic symptoms of ASD, but also comorbidities of ASD such as epilepsy, depression and anxiety. As a non-invasive, inexpensive and convenient method with no side effects on heart rate, blood pressure or peripheral microcirculation, VNSt is a promising treatment option for ASD
Vagus nerve stimulation as a potential adjuvant to behavioral therapy for autism and other neurodevelopmental disorders
https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-017-9203-z
The tVNS associated with rehabilitation has proven to be an intervention which considerably improves the sensory, motor and cognitive deficits of several neurological disorders. Here, we suggest that combining tVNS with rehabilitation therapy may represent a potential new approach to improve current rehabilitation therapies and improve the functional outcomes of people with neurodevelopmental disorders. The significant development of tVNS therapy and its administration may be limited by the cost of the device, surgical complications, side effects, and the possibility that therapies including tVNS may not promote healing in all patients.
Post Stroke Rehabilitation
The University of Dallas, Texas has combined vagal nerve stimulation with traditional physical rehabilitation, and has precisely programmed nerve stimulation during movement of the affected limb. The team found that the vagal implant doubled the effectiveness of rehabilitation, resulting in twice the recovery of movement in treated patients.
Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022279
This pilot study showed that rehabilitation combined with tVNS is a safe and feasible intervention acceptable for the treatment of weakness of the upper limbs after an ischemic stroke. The study demonstrated sufficient safety, feasibility and potential effectiveness to support a larger pivotal trial.
Any remarks or comments ?
This work is based on a collaborative approach to sharing research and family experience.
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