Clinical perspectives on vagus nerve stimulation: present and future

Abstract

The vagus nerve, the great wanderer, is involved in numerous processes throughout the body and vagus nerve stimulation (VNS) has the potential to modulate many of these functions. This wide-reaching capability has generated much interest across a range of disciplines resulting in several clinical trials and studies into the mechanistic basis of VNS. This review discusses current preclinical and clinical evidence supporting the efficacy of VNS in different diseases and highlights recent advancements. Studies that provide insights into the mechanism of VNS are considered.

Keywords: neuro–immune interactions; optogenetics; vagus nerve stimulation.

Figure 1. FDA-approved clinical uses of VNS

The FDA approved an implanted cervical VNS device consisting of the pulse generator, lead wire, and external remote controls for epilepsy and depression, and non-invasive VNS device (applied to the neck) for migraine and cluster headache. In transcutaneous aVNS, the auricular branch of VN is stimulated with electrodes placed on the skin of the external ear in a non-invasive manner for epilepsy, depression, migraine, and pain. The FDA also approved the Maestro Rechargeable System, with implanted electrode wires at the subdiaphragmatic level, for the treatment of obesity.