Introduction and methodology. Despite a recent surge in availability of new antiepileptic medications and advances in surgical therapy for intractable epilepsy remains a very significant problem. At least 25 to 50% of patients with epilepsy suffer from breakthrough seizures or debilitating side effects of medications. We need a safe and effective treatment for these people, even if it is only palliative. Vagus nerve stimulation (VNS) has been argued to be such a treatment. This assessment was compiled from literature obtained primarily by search of the Medline database, under the key words phrase andneurostimulation, joined by the logical OR, and then joined by a logicalAND with epilepsy, for the time period 1966 to 1996. A total of 104 articles were found by this search strategy. Titles and abstracts (where available) were reviewed to select relevant articles. Additional written material, including a compendium of abstracts on VNS (not listed in Medline), was solicited and obtained from Cyberonics. A draft of this review was prepared from the written material, circulated to committee members, and thereby revised. Consensus was reached by written communications and phone conferences among members of the committee. Animal studies. Cranial nerve X, the vagus nerve, serves as a major source of parasympathetic innovation to the viscera, and a source of fibers to branchiomeric muscles derived from the nucleus ambiguus. According to a recent review by Rutecki,1 afferents in the vagus nerve connect to the solitary nucleus, medullary reticular formation, area postrema, dorsal nucleus of X, and nucleus cuneatus. From these sites secondary connections proceed to the limbic system, hypothalamus, thalamus, and insular cortex. VNS affects the EEG in a frequency- and intensity-dependent manner.2,3 Antiepileptic effects of VNS were first demonstrated by Zanchetti et al.4 in a topical strychnine model in cats, and later by …
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Fisher et al. (1997) studied this question.