Location AMC: Amsterdam UMC, University of Amsterdam, Dept of Medical Biology, section Systems Physiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Biol Psychol. 2022 Jul;172:108378. doi: 10.1016/j.biopsycho.2022.108378. Epub 2022 Jun 7.
This paper reviews the many functions of the vagus nerve, to understand how they interact in daily life and what might be accomplished by therapeutical electrical stimulation. A short historical introduction on the discovery and name-giving of the cranial nerves numbers 9-12 is followed by an overview of the functions that are under lower brain stem control: heart (rate, contractility), intestine (swallowing, peristalsis and glands secretions, feeling of satiety), lungs (bronchoconstriction, lung-irritant and stretch receptor signaling), blood pressure (by vascular wall stress sensing) and blood gases by specialized receptors. Key in the review is the physiology behind beat-by-beat heart rate variations, how everyday life is reflected in its variability, from exciting moments to quiet sleep, with the 'common faint' or vasovagal collapse as extreme example. Next, the recently proposed role of the vagus nerve in limiting inflammation is discussed. This has led to adoption of an earlier developed technique for epilepsy treatment, i.e., electrical stimulation of one vagus nerve bundle in the neck, but now for immune diseases like rheumatoid arthritis and the scope is even widening to depression and cluster headache. However, the problem in application of whole vagus nerve stimulation is the lack of specificity: there is no way to titrate the stimulation to an observable effect variable. All nerves in the bundle, incoming and outgoing, can be 'hit', leading to side-effects which limit the intended application.
本文综述了迷走神经的许多功能,以了解它们在日常生活中如何相互作用,以及电刺激治疗可能会产生什么效果。本文首先简要介绍了颅神经 9-12 的发现和命名历史,然后概述了受脑干控制的功能:心脏(心率、收缩性)、肠道(吞咽、蠕动和腺体分泌、饱腹感)、肺(支气管收缩、肺刺激和拉伸感受器信号)、血压(通过血管壁压力感应)和血液气体通过专门的感受器。本文的重点是心跳逐拍变化背后的生理学原理,以及日常生活如何反映在其可变性中,从兴奋时刻到安静睡眠,以“常见晕厥”或血管迷走性晕厥为极端例子。接下来,本文讨论了迷走神经在限制炎症中的作用。这导致了一种早期开发的用于治疗癫痫的技术,即颈部单一迷走神经束的电刺激,但现在已经用于类风湿性关节炎等免疫性疾病,并且应用范围还在扩大到抑郁症和丛集性头痛。然而,整个迷走神经刺激应用的问题在于缺乏特异性:无法将刺激滴定到可观察的效应变量。束中的所有传入和传出神经都可能受到“刺激”,导致限制预期应用的副作用。
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