A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders
Background: Vagus nerve stimulation (VNS) is an effective anticonvulsant device and has shown antidepressant effects in chronic treatment resistant depression. Because the vagus nerve sends information to brain regions important in anxiety regulation (locus coeruleus, orbitofrontal cortex, insula, h...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2008-04-01
|
Series: | Brain Stimulation |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X0800003X |
id |
doaj-1233e4a2eec041ab92724666f50aa939 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mark S. George, MD Herbert E. Ward, Jr., MD Philip T. Ninan, MD Mark Pollack, MD Ziad Nahas, MD Berry Anderson, RN Samet Kose, MD Robert H. Howland, MD Wayne K. Goodman, MD James C. Ballenger, MD |
spellingShingle |
Mark S. George, MD Herbert E. Ward, Jr., MD Philip T. Ninan, MD Mark Pollack, MD Ziad Nahas, MD Berry Anderson, RN Samet Kose, MD Robert H. Howland, MD Wayne K. Goodman, MD James C. Ballenger, MD A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders Brain Stimulation vagus nerve stimulation (VNS) anxiety disorder obsessive compulsive disorder panic disorder posttraumatic stress disorder clinical trial |
author_facet |
Mark S. George, MD Herbert E. Ward, Jr., MD Philip T. Ninan, MD Mark Pollack, MD Ziad Nahas, MD Berry Anderson, RN Samet Kose, MD Robert H. Howland, MD Wayne K. Goodman, MD James C. Ballenger, MD |
author_sort |
Mark S. George, MD |
title |
A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders |
title_short |
A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders |
title_full |
A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders |
title_fullStr |
A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders |
title_full_unstemmed |
A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disorders |
title_sort |
pilot study of vagus nerve stimulation (vns) for treatment-resistant anxiety disorders |
publisher |
Elsevier |
series |
Brain Stimulation |
issn |
1935-861X |
publishDate |
2008-04-01 |
description |
Background: Vagus nerve stimulation (VNS) is an effective anticonvulsant device and has shown antidepressant effects in chronic treatment resistant depression. Because the vagus nerve sends information to brain regions important in anxiety regulation (locus coeruleus, orbitofrontal cortex, insula, hippocampus and amygdala), this pathway might be involved in perceiving or manifesting various somatic and cognitive symptoms that characterize anxiety disorders. On the basis of this reasoning and reports of anxiolytic effects of VNS in patients treated for epilepsy and depression, we organized an open-label pilot acute trial of adjunctive VNS on top of stable medications, followed by long-term follow-up, to assess the safety and potential efficacy of VNS for patients with treatment resistant anxiety disorders. Methods: Eleven adult outpatients with treatment resistant obsessive-compulsive disorder (OCD), panic disorder (PD), or posttraumatic stress disorder (PTSD) were recruited. Patients had failed several medication trials as well as cognitive behavioral therapy (CBT). All patients were rated with the Hamilton Anxiety Scale (HAM-A) and the clinical global impressions improvement scale (CGI-I). Patients with OCD were also rated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Patients were maintained on their current psychotropic medications at fixed doses during the acute 12-week phase. Changes in medications and VNS stimulus parameters were allowed during the long-term follow-up. Response was defined as a 50% or greater improvement on the HAM-A for all patients and a 25% or greater improvement on the Y-BOCS for patients with OCD. Results: Eleven patients were recruited. Seven patients had a primary diagnosis of OCD, two had PTSD, and one had PD. One OCD patient changed their mind and was never implanted. One patient with OCD withdrew consent before the end of the acute phase, so long-term results were available for nine patients. Three patients were acute responders, based on the HAM-A, and there was some improvement in anxiety ratings over time (with statistically significant improvements at 14 of 18 quarters during long-term follow-up). Of the seven patients with OCD who received stimulation, three were acute responders, based on the Y-BOCS, and there was some improvement in Y-BOCS scores over time (with statistically significant improvements at 7 of 18 quarters during long-term follow-up). VNS was relatively well tolerated. Four years after implantation, four patients (diagnoses two OCD, one PD, one PTSD) were still receiving VNS with continued and sustained improvement in anxiety scores compared with their baseline scores. Conclusions: These patients with treatment-resistant anxiety disorders generally tolerated VNS treatment, and there was evidence of acute and long-term improvement in some patients. These open data suggest that further double-blind studies assessing the VNS role in treating anxiety disorders, particularly OCD, may be warranted. |
topic |
vagus nerve stimulation (VNS) anxiety disorder obsessive compulsive disorder panic disorder posttraumatic stress disorder clinical trial |
url |
http://www.sciencedirect.com/science/article/pii/S1935861X0800003X |
work_keys_str_mv |
AT marksgeorgemd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT herbertewardjrmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT philiptninanmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT markpollackmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT ziadnahasmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT berryandersonrn apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT sametkosemd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT roberthhowlandmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT waynekgoodmanmd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT jamescballengermd apilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT marksgeorgemd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT herbertewardjrmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT philiptninanmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT markpollackmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT ziadnahasmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT berryandersonrn pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT sametkosemd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT roberthhowlandmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT waynekgoodmanmd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders AT jamescballengermd pilotstudyofvagusnervestimulationvnsfortreatmentresistantanxietydisorders |
_version_ |
1724217587229786112 |
spelling |
doaj-1233e4a2eec041ab92724666f50aa9392021-03-18T04:32:42ZengElsevierBrain Stimulation1935-861X2008-04-0112112121A pilot study of vagus nerve stimulation (VNS) for treatment-resistant anxiety disordersMark S. George, MD0Herbert E. Ward, Jr., MD1Philip T. Ninan, MD2Mark Pollack, MD3Ziad Nahas, MD4Berry Anderson, RN5Samet Kose, MD6Robert H. Howland, MD7Wayne K. Goodman, MD8James C. Ballenger, MD9Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Address reprints requests to: Dr. Mark S. George, 502N, IOP, Medical University of South Carolina, 67 President Street, Charleston, SC 29425.Department of Psychiatry, University of Florida School of Medicine, Gainesville, FloridaDepartment of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GeorgiaDepartment of Psychiatry, Massachusetts General Hospital, Boston, MassachusettsDepartment of Psychiatry, Medical University of South Carolina, Charleston, South CarolinaDepartment of Psychiatry, Medical University of South Carolina, Charleston, South CarolinaDepartment of Psychiatry, Medical University of South Carolina, Charleston, South CarolinaWestern Psychiatric Institute, Pittsburgh, PennsylvaniaDepartment of Psychiatry, University of Florida School of Medicine, Gainesville, FloridaDepartment of Psychiatry, Medical University of South Carolina, Charleston, South CarolinaBackground: Vagus nerve stimulation (VNS) is an effective anticonvulsant device and has shown antidepressant effects in chronic treatment resistant depression. Because the vagus nerve sends information to brain regions important in anxiety regulation (locus coeruleus, orbitofrontal cortex, insula, hippocampus and amygdala), this pathway might be involved in perceiving or manifesting various somatic and cognitive symptoms that characterize anxiety disorders. On the basis of this reasoning and reports of anxiolytic effects of VNS in patients treated for epilepsy and depression, we organized an open-label pilot acute trial of adjunctive VNS on top of stable medications, followed by long-term follow-up, to assess the safety and potential efficacy of VNS for patients with treatment resistant anxiety disorders. Methods: Eleven adult outpatients with treatment resistant obsessive-compulsive disorder (OCD), panic disorder (PD), or posttraumatic stress disorder (PTSD) were recruited. Patients had failed several medication trials as well as cognitive behavioral therapy (CBT). All patients were rated with the Hamilton Anxiety Scale (HAM-A) and the clinical global impressions improvement scale (CGI-I). Patients with OCD were also rated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Patients were maintained on their current psychotropic medications at fixed doses during the acute 12-week phase. Changes in medications and VNS stimulus parameters were allowed during the long-term follow-up. Response was defined as a 50% or greater improvement on the HAM-A for all patients and a 25% or greater improvement on the Y-BOCS for patients with OCD. Results: Eleven patients were recruited. Seven patients had a primary diagnosis of OCD, two had PTSD, and one had PD. One OCD patient changed their mind and was never implanted. One patient with OCD withdrew consent before the end of the acute phase, so long-term results were available for nine patients. Three patients were acute responders, based on the HAM-A, and there was some improvement in anxiety ratings over time (with statistically significant improvements at 14 of 18 quarters during long-term follow-up). Of the seven patients with OCD who received stimulation, three were acute responders, based on the Y-BOCS, and there was some improvement in Y-BOCS scores over time (with statistically significant improvements at 7 of 18 quarters during long-term follow-up). VNS was relatively well tolerated. Four years after implantation, four patients (diagnoses two OCD, one PD, one PTSD) were still receiving VNS with continued and sustained improvement in anxiety scores compared with their baseline scores. Conclusions: These patients with treatment-resistant anxiety disorders generally tolerated VNS treatment, and there was evidence of acute and long-term improvement in some patients. These open data suggest that further double-blind studies assessing the VNS role in treating anxiety disorders, particularly OCD, may be warranted.http://www.sciencedirect.com/science/article/pii/S1935861X0800003Xvagus nerve stimulation (VNS)anxiety disorderobsessive compulsive disorderpanic disorderposttraumatic stress disorderclinical trial |