In conventional vagus nerve stimulation, a device is surgically implanted under the skin on your chest, and a wire is threaded under your skin connecting the device to the left vagus nerve. When activated, the device sends electrical signals along the left vagus nerve to your brainstem, which then sends signals to certain areas in your brain. The right vagus nerve isn't used because it's more likely to carry fibers that supply nerves to the heart.
New, noninvasive vagus nerve stimulation devices, which don't require surgical implantation, have been approved in Europe to treat epilepsy, depression and pain. A noninvasive device that stimulates the vagus nerve was recently approved by the Food and Drug Administration for the treatment of cluster headaches in the United States."
- Invasive Vagus Nerve Stimulator
An invasive vagus nerve stimulator consists of a pulse generator, a lead, and in some cases a programming software. The VNS is a flat and round device made of metal. The device measures an inch and a half (approximately 4 centimeters) across and around 10-13 mm in thickness. Implantation of the VNS device is usually done as an outpatient procedure and requires two small incisions for placement of the device beneath the skin near the chest area. The first incision is done near the upper left side of the chest where the generator is implanted into a little “pouch” situated under the collarbone. To access the vagus nerve situated near the neck, the second incision is created by the surgeons. The leads are then wrapped around the left branch of the vagus nerve and the electrodes are connected to the generator. Once the stimulator is implanted successfully, the generator transmits electric impulses to the vagus nerve at regular intervals. Instead of the right vagus nerve, the left vagus nerve is stimulated because the right nerve has a major role in cardiac function, and stimulating it could have negative cardiac effects.
An example of invasive VNS devices is Symmetry Vagus Nerve Stimulator by Livanova available as a small device that works by regularly transmitting micropulse via a thin wire to the vagus nerve in the neck region. Other examples include SENTIVA® (Livanova), ReShape™ vBloc therapy (ReShape Lifesciences), and NeuroPace RNS System (NeuroPace) among others.
- Non-invasive Vagus Nerve Stimulator
Non-invasive or external vagus nerve stimulators are not implanted inside the body rather these are small either hand-held devices that transmit electrical impulses through surface or skin contacts. These devices sometimes comprise an ear electrode that is capable of activating particular nerve fibers via electric impulses, also known as neurostimulation.
These devices are mainly based on transcutaneous vagus nerve stimulation technology. gammaCore™ is a non-invasive vagus nerve stimulator that has been approved by the US FDA. The device is also approved in the European region. Some of the non-invasive devices present in the Vagus nerve stimulator Market are VITOS (tVNS Technologies), Parasym Device (Parasym Ltd.), and Transcutaneous Neurostimulator (Soterix Medical), among others.
- "Epilepsy
Epilepsy is a neurological disorder that is associated with seizures and result in involuntary movements of different extremities due to the abnormal electrical discharge in the brain. VNS therapy was first approved for the treatment of drug-resistant epilepsy. In 1997, FDA has approved VNS for seizure treatment among those patients who have shown no effective response to two or more anti-epileptic drugs and also have no sufficient control over their seizures. VNS is used simultaneously with anti-epileptic drugs (AEDs) and is not an alternative treatment. The treatment does not aim to completely eradicate seizures but is used in combination with AEDs as an alternative treatment for ameliorating seizure control.
- Depression
Depression is a mental disorder characterized by sadness, loss of interest in normal daily activities, feelings of dejection and hopelessness, and diminished ability to experience pleasure. According to World Health Organization Global Health Estimates, 2017 the proportion of the global population with depression in 2015 is estimated to be 4.4% which is approximately 322 million. Depression is more common among females (5.1%) than males (3.6%). Most of the depressive episodes are treatable with medications, however, roughly 30% of the population with major depression are less likely to respond to the medication. Thus, among individuals with chronic or recurrent treatment-resistant depression (TRD) and those who have failed to respond to four or more adequate treatments, Vagus nerve stimulation (VNS) clinically has shown to be efficacious for the long-term management of patients with treatment-resistant depression (Aaronson et al., 2017).
- Migraine
Migraine is a neurologic syndrome accompanied by recurrent episodes of painful, usually unilateral headaches and nausea. Clinical studies showed that VNS reduces the pain level of a migraine at 30 minutes and 60 minutes after using the device.
- Alzheimer’s
Alzheimer’s disease is the most common type of dementia and is a progressive disease that damages brain cells and destroys memory and other important mental functions. The disease is characterized by the loss of cognitive functions. Clinical evidence has proved VNS therapy to be effective in the form of motor speed, psychomotor function, language, and executive functions after 10 weeks of stimulation as it activates the degenerated and damaged regions of the brain.
- Heart failure
Chronic heart failure (HF) is linked with autonomic dysregulation. It is characterized by an increase in sympathetic drive and by the withdrawal of parasympathetic activity. There is an increased heart rate in patients and results in increased mortality and morbidity in myocardial infarction and HF. Studies showed an increase in long-term survival rates in the rat with VNS therapy.
- Obesity
Obesity resulted due to the ingestion of calories above the normal biological requirement is a major risk for a variety of chronic diseases, including cardiovascular disease, diabetes mellitus, chronic kidney disease, gallbladder diseases, and others. Obesity treatment can impose an enormous economic burden on the global healthcare system. VNS can be a potent tool for the treatment of obesity."
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Jane Leu Rekas, LCSW
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