Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.

J.J. Ardesch, J.R. Sikken, Petrus H. Veltink, H.E. van der Aa, G. Hageman, H.P.J. Buschman

    Research output: Contribution to journalArticleAcademicpeer-review

    16 Citations (Scopus)

    Abstract

    Purpose Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric alterations on the vocal folds during VNS. Methods Vocal fold EMG experiments were conducted intra-operatively during the implantation of a VNS system. During surgery the VNS pulse generator was programmed to stimulate at different pulse durations. At each pulse width the EMG-threshold current was determined by electrical stimulation of the vagus nerve with increasing stimulation currents. Laryngostroboscopic examination was performed after surgery to analyze the effects of spontaneous stimulation on the larynx. Results The vocal fold EMG and morphodynamic changes in the larynx have been analyzed in eight patients. In all patients left vocal fold EMG-threshold was between 0.25 and 0.50 mA. Pulse duration had little influence on the EMG-threshold level. Vocal fold EMG saturation levels were reached between 0.75 and 1.00 mA. Video stroboscopic monitoring showed that stimulation induced an adductory spasm of either the ipsilateral vocal fold or the vestibular fold, and was present remarkably irrespective of the presence of hoarseness. Conclusions VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness.
    Original languageUndefined
    Article number10.1016/j.eplepsyres.2010.01.005
    Pages (from-to)227-231
    Number of pages5
    JournalEpilepsy research
    Volume89
    Issue number2-3
    DOIs
    Publication statusPublished - May 2010

    Keywords

    • EWI-18248
    • BSS-Electrical Neurostimulation
    • Hoarseness
    • Epilepsy
    • IR-72489
    • EMG
    • Vocal fold
    • Laryngoscopy
    • METIS-277419
    • Vagus nerve stimulation

    Cite this

    Ardesch, J. J., Sikken, J. R., Veltink, P. H., van der Aa, H. E., Hageman, G., & Buschman, H. P. J. (2010). Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels. Epilepsy research, 89(2-3), 227-231. [10.1016/j.eplepsyres.2010.01.005]. https://doi.org/10.1016/j.eplepsyres.2010.01.005
    Ardesch, J.J. ; Sikken, J.R. ; Veltink, Petrus H. ; van der Aa, H.E. ; Hageman, G. ; Buschman, H.P.J. / Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels. In: Epilepsy research. 2010 ; Vol. 89, No. 2-3. pp. 227-231.
    @article{d2f7907f63d5407aa752e1cb25668f5f,
    title = "Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.",
    abstract = "Purpose Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric alterations on the vocal folds during VNS. Methods Vocal fold EMG experiments were conducted intra-operatively during the implantation of a VNS system. During surgery the VNS pulse generator was programmed to stimulate at different pulse durations. At each pulse width the EMG-threshold current was determined by electrical stimulation of the vagus nerve with increasing stimulation currents. Laryngostroboscopic examination was performed after surgery to analyze the effects of spontaneous stimulation on the larynx. Results The vocal fold EMG and morphodynamic changes in the larynx have been analyzed in eight patients. In all patients left vocal fold EMG-threshold was between 0.25 and 0.50 mA. Pulse duration had little influence on the EMG-threshold level. Vocal fold EMG saturation levels were reached between 0.75 and 1.00 mA. Video stroboscopic monitoring showed that stimulation induced an adductory spasm of either the ipsilateral vocal fold or the vestibular fold, and was present remarkably irrespective of the presence of hoarseness. Conclusions VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness.",
    keywords = "EWI-18248, BSS-Electrical Neurostimulation, Hoarseness, Epilepsy, IR-72489, EMG, Vocal fold, Laryngoscopy, METIS-277419, Vagus nerve stimulation",
    author = "J.J. Ardesch and J.R. Sikken and Veltink, {Petrus H.} and {van der Aa}, H.E. and G. Hageman and H.P.J. Buschman",
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    Ardesch, JJ, Sikken, JR, Veltink, PH, van der Aa, HE, Hageman, G & Buschman, HPJ 2010, 'Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.', Epilepsy research, vol. 89, no. 2-3, 10.1016/j.eplepsyres.2010.01.005, pp. 227-231. https://doi.org/10.1016/j.eplepsyres.2010.01.005

    Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels. / Ardesch, J.J.; Sikken, J.R.; Veltink, Petrus H.; van der Aa, H.E.; Hageman, G.; Buschman, H.P.J.

    In: Epilepsy research, Vol. 89, No. 2-3, 10.1016/j.eplepsyres.2010.01.005, 05.2010, p. 227-231.

    Research output: Contribution to journalArticleAcademicpeer-review

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    T1 - Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.

    AU - Ardesch, J.J.

    AU - Sikken, J.R.

    AU - Veltink, Petrus H.

    AU - van der Aa, H.E.

    AU - Hageman, G.

    AU - Buschman, H.P.J.

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    N2 - Purpose Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric alterations on the vocal folds during VNS. Methods Vocal fold EMG experiments were conducted intra-operatively during the implantation of a VNS system. During surgery the VNS pulse generator was programmed to stimulate at different pulse durations. At each pulse width the EMG-threshold current was determined by electrical stimulation of the vagus nerve with increasing stimulation currents. Laryngostroboscopic examination was performed after surgery to analyze the effects of spontaneous stimulation on the larynx. Results The vocal fold EMG and morphodynamic changes in the larynx have been analyzed in eight patients. In all patients left vocal fold EMG-threshold was between 0.25 and 0.50 mA. Pulse duration had little influence on the EMG-threshold level. Vocal fold EMG saturation levels were reached between 0.75 and 1.00 mA. Video stroboscopic monitoring showed that stimulation induced an adductory spasm of either the ipsilateral vocal fold or the vestibular fold, and was present remarkably irrespective of the presence of hoarseness. Conclusions VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness.

    AB - Purpose Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric alterations on the vocal folds during VNS. Methods Vocal fold EMG experiments were conducted intra-operatively during the implantation of a VNS system. During surgery the VNS pulse generator was programmed to stimulate at different pulse durations. At each pulse width the EMG-threshold current was determined by electrical stimulation of the vagus nerve with increasing stimulation currents. Laryngostroboscopic examination was performed after surgery to analyze the effects of spontaneous stimulation on the larynx. Results The vocal fold EMG and morphodynamic changes in the larynx have been analyzed in eight patients. In all patients left vocal fold EMG-threshold was between 0.25 and 0.50 mA. Pulse duration had little influence on the EMG-threshold level. Vocal fold EMG saturation levels were reached between 0.75 and 1.00 mA. Video stroboscopic monitoring showed that stimulation induced an adductory spasm of either the ipsilateral vocal fold or the vestibular fold, and was present remarkably irrespective of the presence of hoarseness. Conclusions VNS causes pronounced effects on the vocal folds even at low stimulation amplitudes. At therapeutic levels even at the lowest stimulation pulse durations, the vocal fold contract, however, this does not necessarily give hoarseness.

    KW - EWI-18248

    KW - BSS-Electrical Neurostimulation

    KW - Hoarseness

    KW - Epilepsy

    KW - IR-72489

    KW - EMG

    KW - Vocal fold

    KW - Laryngoscopy

    KW - METIS-277419

    KW - Vagus nerve stimulation

    U2 - 10.1016/j.eplepsyres.2010.01.005

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    M3 - Article

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    JF - Epilepsy research

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    Ardesch JJ, Sikken JR, Veltink PH, van der Aa HE, Hageman G, Buschman HPJ. Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels. Epilepsy research. 2010 May;89(2-3):227-231. 10.1016/j.eplepsyres.2010.01.005. https://doi.org/10.1016/j.eplepsyres.2010.01.005