Abstract
Stimulation of peripheral cranial nerves has been shown to exert anticonvulsant effects in animal models as well as in human patients. Specifically, stimulation of both the trigeminal and vagus nerves has been shown in multiple clinical trials to be anticonvulsant, and stimulation of these nerves at therapeutic levels does not cause pain or negatively affect brain function. However, the neuronal mechanisms by which such stimulation exerts therapeutic effects are not well understood. In this review, the possible locations of action for trigeminal nerve stimulation (TNS) and vagus nerve stimulation (VNS) are explored. Additionally, the multiple time scales on which TNS and VNS function are discussed.
Highlights
There exist multiple types of direct or indirect neuro-stimulation methods for therapeutically altering brain activity
Trigeminal nerve stimulation (TNS) has been shown to reduce seizures in both animal models [27] and in a series of clinical trials with epilepsy patients. [232460] trigeminal nerve stimulation (TNS) has been shown in a preliminary clinical trial to be effective against symptoms of depression. [67]
Because the limbic system is heavily implicated in many epilepsies, it is important to consider the effects of TNS and vagus nerve stimulation (VNS) on this region
Summary
There exist multiple types of direct or indirect neuro-stimulation methods for therapeutically altering brain activity Such techniques include stimulating the brain indirectly, as with transcranial magnetic stimulation, stimulating the brain directly, as with deep brain stimulation, or affecting the brain indirectly via stimulation of peripheral nerves. The mechanism by which stimulation of peripheral cranial nerves can exert central therapeutic effects, including affecting the propensity for seizures, is essentially an open question. This is due in part to a lack of knowledge about the feedforward and feedback effects of such stimulation throughout the central nervous system, and in part to a lack of understanding of the pathological mechanisms that underlie disorders such as epilepsy. Different mechanisms might be optimally evoked by specific stimulus parameters and may be uniquely suited for treating specific types of seizures or other disorders
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