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Central parasympathetic excitation in real-time during left vagal nerve stimulation in fully conscious patients with drug-resistant epilepsy

      Background and aim: Not enough is known about the effects of vagal nerve stimulation (VNS) on the many functions of the central autonomic nervous system. Our aim was to quantify the changes in central parasympathetic activity during VNS. Methods: Heart rate (HR), mean arterial pressure (MAP), cardiac vagal tone (CVT) and cardiac sensitivity to baroreflex (CSB) were monitored continuously in seven patients who had vagal nerve stimulators implanted for treatment of epilepsy. Results: Vagal nerve stimulation increased CSB from the onset of the stimulus while HR, MAP and CVT increased gradually during the stimulation period. Conclusion: All aspects of brainstem activity studied were affected by VNS. Cardiac parasympathetic activity was most affected among the cardiovascular parameters we measured. Increased central parasympathetic tone may play a major role in the therapeutic mechanism of VNS and this can now be monitored non-invasively in real-time. Our results suggest that post-stimulus brainstem plasticity during VNS may have key therapeutic role.
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