title: High strength stimulation of the vagus nerve in awake humans: a lack of cardiorespiratory effects.
abstract: Vagus nerve stimulation is used to reduce the frequency and intensity of seizures in patients with epilepsy. In the present study four such patients were studied while awake. We analyzed the physiological responses to vagus nerve stimulation over a broad range of tolerable stimulus parameters to identify vagal A-fiber threshold and to induce respiratory responses typical of C-fiber activation. A-fiber threshold was determined by increasing stimulation current until laryngeal motor A-fibers were excited (frequency=30 Hz). With A-fiber threshold established, C-fiber excitation was attempted with physiologically appropriate stimulus parameters (low frequency and high amplitude).
  
  
  RESULTS
  A-fiber thresholds were established in all patients, threshold currents ranged between 0.5 and 1.5 mA. Stimulation at lower frequency (2-10 Hz) and higher amplitudes (2.75-3.75 mA) did not produce cardiorespiratory effects consistent with C-fiber activation. It is possible that such effects were not observed because vagal C-fibers were not excited, because C-fiber effects were masked by the 'wakeful drive' to breathe, or because epilepsy or the associated therapy had altered central processing of the vagal afferent inputs.
authors.affiliation: Physiology Program, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. abinks@hsph.harvard.edu
authors.forename: A P
authors.initials: AP
authors.lastname: Binks
authors.forename: D
authors.initials: D
authors.lastname: Paydarfar
authors.forename: S C
authors.initials: SC
authors.lastname: Schachter
authors.forename: A
authors.initials: A
authors.lastname: Guz
authors.forename: R B
authors.initials: RB
authors.lastname: Banzett
mesh_terms: D000328:Adult; D001364:Awareness; D001794:Blood Pressure; D004599:Electric Stimulation Therapy; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000502:physiology; D009413:Nerve Fibers, Myelinated / Q000502:physiology; D012119:Respiration; D012684:Sensory Thresholds / Q000502:physiology; D014630:Vagus Nerve / Q000166:cytology / Q000502:physiology*