Vagus nerve stimulation therapy in depression and epilepsy: therapeutic parameter settings
Vagus nerve stimulation therapy in depression and epilepsy: therapeutic parameter settings
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DOI：
10.1111/j.1600-0404.2006.00732.x
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发表时间：
2007-01-01
影响因子：
3.5
通讯作者：
Ahern, Geoffrey L.
中科院分区：
文献类型：
--
作者：
Labiner, David M.;Ahern, Geoffrey L.
迷走神经刺激（VNS）治疗是成人慢性或复发性难治性抑郁症以及成人和青少年耐药癫痫的有效辅助治疗方法。迷走神经刺激疗法是通过植入的脉冲发生器进行的，该脉冲发生器通过植入的导线向左侧迷走神经传递程序化的电脉冲。可编程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。医生必须确定每个患者的最佳设置，同时平衡最大化疗效，最小化副作用和保持电池寿命的目标。输出电流从0.25 mA逐渐增加到最大可容忍水平（最大值，3.5 mA）；典型的治疗环境范围为1.0至1.5 mA。输出电流越大，副作用增加，包括声音改变、咳嗽、喉咙紧绷感和呼吸困难。频率通常在抑郁症中设定为20赫兹，在癫痫中设定为30赫兹。脉冲宽度一般为250 μ s或500 μ s，建议开机时间为30 s，关机时间为5 min；关闭时间>建议设置为打开时间。与药物治疗一样，VNS治疗必须以渐进、系统的方式进行调整，以针对每位患者进行个性化治疗。
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 mu s. 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.