Chronic Stimulation of the Left Vagus Nerve in Epilepsy: Balance Effects

Beverley M. Clarke, A.R.M. Upton, Helene Griffin, Debbie Fitzpatrick and Marijane DeNardis

Abstract: Background: Stimulation of the left vagus nerve (VNS) has been shown to control seizures in double blinded crossover studies in man. Animal studies have reported vagal afferent induced depression of nociceptive and motor reflexes which may be caused by an effect on the descending reticular system controlling spinal cord function. Anticonvulsant drug therapy may cause postural instability. The effects of VNS are assessed not only from the perspective of seizure control but also from the view of potential harm to other bodily systems. Long term (2 1/4 years) effects of VNS were compared to postural stability analyses. Methods: 8 subjects, 2 were females, mean age 34.5 ± 8.23 SD years, with intractable complex partial seizures, taking 3 anticonvulsant drugs were assessed for postural stability in quiet standing and while moving forwards, backwards and sideways with eyes open (EO) and eyes closed (EC). Data were collected and collated using an AMTI Biomechanics immovable forceplate, Newton M.A. U.S.A. The study design was longitudinal with pre-operative baseline data collected prior to neurostimulation and at intervals post operatively. Results: 4/8 balance measures showed significant changes from pre-operative values and after 2 1/4 years of stimulation. Area of sway (EO) in quiet standing p = .022 and total sway (EC) in the moving state p = .019 and total sway (EC) in quiet standing showed an increase in sway p = .003. Area of sway (EC) p = .004 tended to decrease. Regression analysis for frequency of stimulation showed an increase in sway with higher frequencies T = 1.99, P = .05. Conclusion: Chronic VNS does not augment postural instability.

Can. J. Neurol. Sci. 1997; 24: 230-234