Стимуляция блуждающего нерва (VNS) при лечении резистентной депрессии

Depression is one of the most prevalent diseases worldwide. It is counted among the mood disorders.
Similar to back pain, about 70% of people go through a depressive episode during their lifetime. The causes can be manifold; Common reasons include the death of life partners, separations, professional setbacks such as dismissal, abandonment of the business, etc. The depressive illness can express itself, for example in general pain, withdrawal from the social environment, sleep and eating disorders. In severe cases, suicidal thoughts can also be added. The feeling of “vainness” is also typical of a depressive illness. Psychotherapeutic approaches and drug therapies can help to overcome the depression with a high success rate. But in 10% of all patients, you can not improve in the long term despite intensive psychotherapy and drug therapy. One speaks then of therapy resistance.

VNS therapy is an established procedure for the treatment of certain forms of epilepsy. However, in the mid-90s of the last century, it was found that in many patients treated with VNS therapy, the existing depression could be significantly improved. Since 2001, VNS therapy has been approved in Europe and, since 2005, by the Food and Drug Administration (FDA), the highest regulatory agency in the United States, for the treatment of treatment-resistant depression.

In the US and Europe, leading psychiatrists are increasingly using this opportunity to help their patients.

The numbers are encouraging and, according to recent studies, improvements have been made in about 50% of all patients globally. VNS therapy has resulted in a substantial and lasting improvement in the quality of life, and in part a complete decrease in depression

The stimulation electrodes are implanted in an approximately 1-2 hour procedure performed on the left anterior cervical side, ie, they are gently microsurgically implanted on the left side by a neuro-neurologist experienced around the vagus nerve (10th cranial nerve). The nerve is not injured. A cable connects the electrodes to a small, programmable generator. This generator is implanted under the skin in the left breast area (similar to a pacemaker).

By gentle current stimuli, the vagus nerve is continuously stimulated (stimulated) at fixed intervals. The choice of appropriate stimulation parameters and programming is made by the physician. The battery life of the generator is between 6 and 11 years, depending on the stimulation parameters. To change the battery only a small intervention is necessary, which may possibly be carried out in local anesthesia. The operation is performed under general anesthesia; the patient usually stays in the clinic for 2 nights for observation. The risks of implantation are minimal in the hands of an experienced neurosurgeon.

I am an experienced contact person for interested patients and referring colleagues.

The decision as to whether a patient is suitable for implantation always applies to a psychiatric colleague. For the preliminary talk at least 2-3 hours are necessary. The patient should first send in existing clinical and medical reports.

If the decision is then made that the VNS therapy makes sense, an OP appointment can be arranged for the patient.
As a rule, the operations are performed on a Friday or Saturday, so that the patient can be released on Monday at the latest in the aftercare.

Since I’ve been involved in neuromodulation for a long time, I’m one of the most experienced neurosurgeons in Germany in this area. As early as 2003, I successfully set up deep brain stimulation in Parkinson’s disease and tremor at my former site, the Rechts der Isar Hospital of the Technical University of Munich, and successfully applied spinal cord stimulation to otherwise untreatable pain in the spinal area.

Also, I offer Occipital Nerve Nerve Stimulation (ONS) for patients with chronic migraine and / or cluster headache. The collaboration is now first in the context of a data collection, which cares the Pain Clinic Kiel.

The vagus nerve stimulation is carried out in collaboration with renowned and leading psychiatrists in Germany. Whether a patient is suitable for implantation (VNS), the psychiatric colleague decides together with his patient. He therefore also takes over the follow-up and adjustment of the pacemaker.

The side effects of the therapy are minimized by optimizing pacing parameters that are individually tailored to each patient. The most common side effects triggered by the stimulation are hoarseness, change in voice pitch, tingling skin sensation, very rarely temporary respiratory distress, and increased coughing. The side effects are generally described by the patients as non-irritating and often disappear after some time on their own.

In addition to patients who are not eligible due to psychiatric evaluation, patients should not be implanted in the stomach after previous vagotomy. In patients with problems with swallowing, heart and respiratory symptoms and sleep apnea, the indication must be examined with particular care. Certain cardiac pre-existing conditions can also lead to the exclusion of therapy. During the initial examination, the exclusion criteria are carefully checked.

Like any neuromodulative procedure, the engineering effort for the pulser and the electrodes made of special platinum threads is great. The system costs about 12,000 €.
The costs for implantation including stay, surgery and anesthesia are about 10,000 €.
The costs of VNS therapy are currently not reimbursed by all health insurance companies. In any case, a reasoned request for reimbursement makes sense, which you can obtain during the preliminary investigations. The inpatient and outpatient treatment is usually taken over by the health insurances as part of the treatment of the underlying disease.