Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

Yuan Yuan, Jonathan L. Hassel, Anisiia Doytchinova, David Adams, Keith C. Wright, Chad Meshberger, Lan Chen, Maria P. Guerra, Changyu Shen, Shien-Fong Lin, Thomas Everett, Vicenta Salanova, Peng-Sheng Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear. Objective: The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy. Methods: ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA. Results: VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 μV (95% confidence interval [CI] 0.93-1.18) in lead I and 1.13 μV (95% CI 0.99-1.27) in lead II, which was significantly lower than 1.38 μV (95% CI 1.01-1.75; P = .036) and 1.38 μV (95% CI 0.98-1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95% CI 59-71) in the VNS group, which was significantly lower than 77 bpm (95% CI 71-83) in the control group. Conclusion: Patients with VNS had significantly lower SKNA than those without VNS.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2017

Fingerprint

Vagus Nerve Stimulation
Skin
Confidence Intervals
Stellate Ganglion
Electrocardiography
Drug Resistant Epilepsy
Control Groups
Cardiac Arrhythmias
Electrodes
Animal Models
Heart Rate

Keywords

  • Autonomic nervous system
  • Neuromodulation
  • Sudden unexpected death in epilepsy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy. / Yuan, Yuan; Hassel, Jonathan L.; Doytchinova, Anisiia; Adams, David; Wright, Keith C.; Meshberger, Chad; Chen, Lan; Guerra, Maria P.; Shen, Changyu; Lin, Shien-Fong; Everett, Thomas; Salanova, Vicenta; Chen, Peng-Sheng.

In: Heart Rhythm, 2017.

Research output: Contribution to journalArticle

Yuan, Yuan ; Hassel, Jonathan L. ; Doytchinova, Anisiia ; Adams, David ; Wright, Keith C. ; Meshberger, Chad ; Chen, Lan ; Guerra, Maria P. ; Shen, Changyu ; Lin, Shien-Fong ; Everett, Thomas ; Salanova, Vicenta ; Chen, Peng-Sheng. / Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy. In: Heart Rhythm. 2017.
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title = "Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy",
abstract = "Background: We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear. Objective: The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy. Methods: ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA. Results: VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 μV (95{\%} confidence interval [CI] 0.93-1.18) in lead I and 1.13 μV (95{\%} CI 0.99-1.27) in lead II, which was significantly lower than 1.38 μV (95{\%} CI 1.01-1.75; P = .036) and 1.38 μV (95{\%} CI 0.98-1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95{\%} CI 59-71) in the VNS group, which was significantly lower than 77 bpm (95{\%} CI 71-83) in the control group. Conclusion: Patients with VNS had significantly lower SKNA than those without VNS.",
keywords = "Autonomic nervous system, Neuromodulation, Sudden unexpected death in epilepsy",
author = "Yuan Yuan and Hassel, {Jonathan L.} and Anisiia Doytchinova and David Adams and Wright, {Keith C.} and Chad Meshberger and Lan Chen and Guerra, {Maria P.} and Changyu Shen and Shien-Fong Lin and Thomas Everett and Vicenta Salanova and Peng-Sheng Chen",
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journal = "Heart Rhythm",
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T1 - Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

AU - Yuan, Yuan

AU - Hassel, Jonathan L.

AU - Doytchinova, Anisiia

AU - Adams, David

AU - Wright, Keith C.

AU - Meshberger, Chad

AU - Chen, Lan

AU - Guerra, Maria P.

AU - Shen, Changyu

AU - Lin, Shien-Fong

AU - Everett, Thomas

AU - Salanova, Vicenta

AU - Chen, Peng-Sheng

PY - 2017

Y1 - 2017

N2 - Background: We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear. Objective: The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy. Methods: ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA. Results: VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 μV (95% confidence interval [CI] 0.93-1.18) in lead I and 1.13 μV (95% CI 0.99-1.27) in lead II, which was significantly lower than 1.38 μV (95% CI 1.01-1.75; P = .036) and 1.38 μV (95% CI 0.98-1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95% CI 59-71) in the VNS group, which was significantly lower than 77 bpm (95% CI 71-83) in the control group. Conclusion: Patients with VNS had significantly lower SKNA than those without VNS.

AB - Background: We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear. Objective: The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy. Methods: ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA. Results: VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 μV (95% confidence interval [CI] 0.93-1.18) in lead I and 1.13 μV (95% CI 0.99-1.27) in lead II, which was significantly lower than 1.38 μV (95% CI 1.01-1.75; P = .036) and 1.38 μV (95% CI 0.98-1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95% CI 59-71) in the VNS group, which was significantly lower than 77 bpm (95% CI 71-83) in the control group. Conclusion: Patients with VNS had significantly lower SKNA than those without VNS.

KW - Autonomic nervous system

KW - Neuromodulation

KW - Sudden unexpected death in epilepsy

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