Vonck K, De Herdt V, Boon P
Department of Neurology, Ghent University Hospital, Gent, Belgium.
Adv Tech Stand Neurosurg. 2009;34:111-46. doi: 10.1007/978-3-211-78741-0_5.
Neurostimulation is an emerging treatment for neurological diseases. Electrical stimulation of the tenth cranial nerve or vagus nerve stimulation (VNS) has become a valuable option in the therapeutic armamentarium for patients with refractory epilepsy. It is indicated in patients with refractory epilepsy who are unsuitable candidates for epilepsy surgery or who have had insufficient benefit from such a treatment. Vagus nerve stimulation reduces seizure frequency with > 50% in 1/3 of patients and has a mild side effects profile. Research to elucidate the mechanism of action of vagus nerve stimulation has shown that effective stimulation in humans is primarily mediated by afferent vagal A- and B-fibers. Crucial brainstem and intracranial structures include the locus coeruleus, the nucleus of the solitary tract, the thalamus and limbic structures. Neurotransmitters playing a role may involve the major inhibitory neurotransmitter GABA but also serotoninergic and adrenergic systems. This manuscript reviews the clinical studies investigating efficacy and side effects in patients and the experimental studies aiming to elucidate the mechanims of action.
神经刺激是一种新兴的神经系统疾病治疗方法。对第十对脑神经进行电刺激或迷走神经刺激（VNS）已成为难治性癫痫患者治疗手段中的一种有价值的选择。它适用于那些不适合进行癫痫手术或从该治疗中获益不足的难治性癫痫患者。迷走神经刺激可使三分之一的患者癫痫发作频率降低超过50%，且副作用轻微。旨在阐明迷走神经刺激作用机制的研究表明，人体中的有效刺激主要由迷走神经传入A纤维和B纤维介导。关键的脑干和颅内结构包括蓝斑、孤束核、丘脑和边缘结构。发挥作用的神经递质可能涉及主要的抑制性神经递质γ-氨基丁酸（GABA），但也包括血清素能和肾上腺素能系统。本文综述了研究患者疗效和副作用的临床研究以及旨在阐明作用机制的实验研究。
