Labiner David M, Ahern Geoffrey L
Department of Neurology, University of Arizona Health Sciences Center, Tucson, AZ, USA.
Acta Neurol Scand. 2007 Jan;115(1):23-33. doi: 10.1111/j.1600-0404.2006.00732.x.
Vagus nerve stimulation (VNS) therapy is an effective adjunctive treatment for chronic or recurrent treatment-resistant depression in adults, and for pharmacoresistant epilepsy in adults and adolescents. VNS therapy is administered through an implanted pulse generator that delivers programmed electrical pulses through an implanted lead to the left vagus nerve. Programmable pulse parameters include output current, frequency, pulse width, and ON/OFF times. Within a range of typical values, individual patients respond best to different combinations of parameter settings. The physician must identify the optimum settings for each patient while balancing the goals of maximizing efficacy, minimizing side effects, and preserving battery life. Output current is gradually increased from 0.25 mA to the maximum tolerable level (maximum, 3.5 mA); typical therapeutic settings range from 1.0 to 1.5 mA. Greater output current is associated with increased side effects, including voice alteration, cough, a feeling of throat tightening, and dyspnea. Frequency is typically programmed at 20 Hz in depression and 30 Hz in epilepsy. Pulse width is typically 250 or 500 micros. The recommended initial ON time is 30 s, followed by 5 min OFF; OFF time > ON time is recommended. As with pharmacotherapy, VNS therapy must be adjusted in a gradual, systematic fashion to individualize therapy for each patient.
迷走神经刺激（VNS）疗法是治疗成人慢性或复发性难治性抑郁症以及成人和青少年药物难治性癫痫的一种有效辅助疗法。VNS疗法通过植入式脉冲发生器实施，该发生器通过植入式导线向左侧迷走神经输送程控电脉冲。可程控的脉冲参数包括输出电流、频率、脉冲宽度和开/关时间。在典型值范围内，个体患者对不同的参数设置组合反应最佳。医生必须在平衡疗效最大化、副作用最小化和延长电池寿命这些目标的同时，为每位患者确定最佳设置。输出电流从0.25毫安逐渐增加到最大耐受水平（最大为3.5毫安）；典型的治疗设置范围是1.0至1.5毫安。更高的输出电流会带来更多副作用，包括声音改变、咳嗽、喉咙发紧感和呼吸困难。抑郁症治疗中频率通常程控为20赫兹，癫痫治疗中为30赫兹。脉冲宽度通常为250或500微秒。推荐的初始开启时间为30秒，随后关闭5分钟；建议关闭时间大于开启时间。与药物治疗一样，VNS疗法必须以渐进、系统的方式进行调整，以实现每位患者的个体化治疗。
