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Nerve: Vagus nerve
Gray791
Plan of upper portions of glossopharyngeal, vagus, and accessory nerves.
Gray793
Course and distribution of the glossopharyngeal, vagus, and accessory nerves.
Latin nervus vagus
Gray's subject #205 910
Innervates Levator veli palatini, Salpingopharyngeus, Palatoglossus, Palatopharyngeus, Superior pharyngeal constrictor, Middle pharyngeal constrictor, Inferior pharyngeal constrictor
From
To
MeSH A08.800.800.120.900

The vagus nerve (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired cranial nerves, and is the only nerve that starts in the brainstem (within the medulla oblongata) and extends, through the jugular foramen, down below the head, to the abdomen.

The medieval Latin word vagus means literally "Wandering" (the words vagrant, vagabond, and vague come from the same root). It is also called the pneumogastric nerve since it innervates both the lungs and the stomach.

Innervation

The vagus descends from the spinal cord in the carotid sheath, lateral to the carotid artery. It carries on past the aortic arch to dip inferiorly behind the left bronchus. Here it forms the pulmonary plexus, after giving rise to the recurrent laryngeal nerve.

The vagus nerve supplies motor parasympathetic fibers to all the organs except the suprarenal (adrenal) glands, from the neck down to the second segment of the transverse colon. The vagus also controls a few skeletal muscles, namely:

This means that the vagus nerve is responsible for such varied tasks as heart rate, gastrointestinal peristalsis, sweating, and quite a few muscle movements in the mouth, including speech (via the recurrent laryngeal nerve) and keeping the larynx open for breathing. It also receives some sensation from the outer ear, via the Auricular branch (also known as Alderman's nerve) and part of the meninges.

The vagus nerve and the heart

Parasympathetic innervation of the heart is mediated by the vagus nerve. The right vagus innervates the Sinoatrial node. Parasympathetic hyperstimulation predisposes those affected to bradyarrhythmias. The left vagus when hyperstimulated predisposes the heart to Atrioventricular (AV) blocks.

At this location Otto Loewi first proved that nerves secrete substances called neurotransmitters which have effects on receptors in target tissues. Loewi described the substance released by the vagus nerve as vagusstoff, which was later found to be acetylcholine.

The vagus nerve has three associated nuclei, the dorsal motor nucleus, the nucleus ambiguus and the solitary nucleus.

Drugs that inhibit the muscarinic cholinergic receptor (anticholinergics) such as atropine and scopolamine are called vagolytic because they inhibit the action of the vagus nerve on the heart, gastrointestinal tract and other organs. Anticholinergic drugs increase heart rate and are used to treat bradycardia(slow heart rate) and asystole, which is when the heart has no electrical activity. Anticholinergic drugs relax the detrusor muscle and cause constipation which again involves the vagus nerve.

Bulimics and anorexics have high vagal activity which is associated with the arrhythmias seen in these patients.

Medical treatment involving the vagus nerve

Treatment of epilepsy

Vagus nerve stimulation (VNS) therapy using a pacemaker-like device implanted in the chest is a treatment used since 1997 to control seizures in epilepsy patients.

Drug resistant or refractory seizures, myoclonic seizures and Lennox-Gastaut syndrome treated by VNS have all been recorded with neurovisceral (neuropsychiatric) porphyrias (acute intermittent porphyria, hereditary coproporphyria, variegate porphyria). These highly drug and environmentally induced genetic disorders can cause seizures, chronic epilepsy and significant damage to the neuroendocrine and peripheral nervous systems including marked vagal nerve dysfunction. Before implantation of VNS these genetic disorders should be investigated in patients with epilepsy since most antiseizure drugs are porphyrinogenic and aggravate porphyrias. Children require enzyme or DNA testing since significant porphyrin production and excretion may not occur prepuberty.

A degree of intermittent VNS can be achieved by daily breathing exercises (for example, Pranayama) over a period of several weeks. In some patients, such proactive relaxation exercises have been found to correlate with lower blood pressure and lower heart rate and more stable moods.[How to reference and link to summary or text] The Valsalva maneuver may activate the vagus nerve and is a "natural" way to achieve the same effect in some patients. Patients with atrial fibrillation, supraventricular tachycardia and other illnesses may be trained to perform the valsalva maneuver (or find it for themselves).

Treatment of depression

Main article: Depression - Vagus nerve stimulation

Vagus nerve stimulation (VNS) has recently been approved for treating drug-resistant cases of clinical depression.[1] A convenient, non-invasive VNS device that stimulates an afferent branch of the vagus nerve is also being developed and will soon undergo trials.


Vagotomy (cutting of the vagus nerve) is a now-obsolete therapy that was performed for peptic ulcer disease.

Physical and emotional effects

Activation of the vagus nerve typically leads to a reduction in heart rate, blood pressure, or both. This occurs commonly in the setting of gastrointestinal illness such as viral gastroenteritis or acute cholecystitis, or in response to other stimuli, including carotid sinus massage, Valsalva maneuver, or pain from any cause, particularly having blood drawn. When the circulatory changes are great enough, vasovagal syncope results. Relative dehydration tends to amplify these responses.

Excessive activation of the vagal nerve during emotional stress, which is a parasympathetic overcompensation of a strong sympathetic nervous system response associated with stress, can also cause vasovagal syncope because of a sudden drop in blood pressure and heart rate. Vasovagal syncope affects young children and women more often. It can also lead to temporary loss of bladder control under moments of extreme fear.

Effects of vagus nerve lesions

The patient complains of hoarse voice, difficulty in swallowing and choking when drinking fluid.

Additional images


See also

References & Bibliography

  1. Nemeroff C, Mayberg H, Krahl S, McNamara J, Frazer A, Henry T, George M, Charney D, Brannan S (2006). VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms.. Neuropsychopharmacology 31 (7): 1345-55. PMID 16641939. link

Key texts

Books

Papers

  • Adan, J., Escosa, M., & Ayuso-Mateos, J. L. (2005). Vagus nerve stimulation and psychosis. A single case report. Actas Espanolas de Psiquiatria, 33(2), 130-134.
  • Aldenkamp, A. P., Majoie, H. J. M., Berfelo, M. W., Evers, S. M. A. A., Kessels, A. G. H., Renier, W. O., et al. (2002). Long-term effects of 24-month treatment with vagus nerve stimulation on behaviour in children with Lennox-Gastaut syndrome. Epilepsy & Behavior, 3(5,Pt1), 475-479.
  • Aldenkamp, A. P., Van de Veerdonk, S. H. A., Majoie, H. J. M., Berfelo, M. W., Evers, S. M. A. A., Kessels, A. G. H., et al. (2001). Effects of 6 months of treatment with vagus nerve stimulation on behavior in children with Lennox-Gastaut syndrome in an open clinical and nonrandomized study. Epilepsy & Behavior, 2(4,Part1), 343-350.
  • Ali, I. I., Pirzada, N. A., Kanjwal, Y., Wannamaker, B., Medhkour, A., Koltz, M. T., et al. (2004). Complete heart block with ventricular asystole during left vagus nerve stimulation for epilepsy. Epilepsy & Behavior, 5(5), 768-771.
  • Allen, W. F. (1929). Effect on respiration, blood pressure, and carotid pulse of various inhaled and insufflated vapors when stimulating one cranial nerve and various combinations of cranial nerves. II. Vagus and vagotomy experiments. American Journal of Physiology, 87, 558-565.
  • Alsaadi, T. M., Laxer, K. D., Barbaro, N. M., Marks, W. J., Jr., & Garcia, P. (2001). Vagus nerve stimulation for the treatment of bilateral independent temporal lobe epilepsy. Epilepsia, 42(7), 954-956.
  • Andrade, D. M., Velazquez, J. L. P., & Wennberg, R. (2004). On the need for battery replacement before end of service in vagus nerve stimulation for epilepsy. Epilepsy & Behavior, 5(4), 612-613.
  • Andrews, R. J. (2003). Neuroprotection trek--The next generation: Neuromodulation I. Techniques--Deep brain stimulation, vagus nerve stimulation, and transcranial magnetic stimulation. Neuroprotective agents: Sixth International Conference., 1-13.
  • Andriola, M. R., & Vitale, S. A. (2001). Vagus nerve stimulation in the developmentally disabled. Epilepsy & Behavior, 2(2), 129-134.
  • Arnedo, M. L., & Puerto, A. (1986). The functions of the vagus nerve in interoceptive learning. Revista de Psicologia General y Aplicada, 41(3), 487-494.
  • Aubert, M., & Legros, J. (1963). Projections of the vagus nerve on the neocortex of the cat. Journal de Physiologie, 55, 109-110.
  • Bailey, P., & Bremer, F. (1938). A sensory cortical representation of the vagus nerve (with a note on the effects of low blood pressure on the cortical electrograms). Journal of Neurophysiology, 1, 405-412.
  • Bajbouj, M., Danker-Hopfe, H., Heuser, I., & Anghelescu, I. (2006). Long-Term Outcome of Vagus Nerve Stimulation in Rapid-Cycling Bipolar Disorder. Journal of Clinical Psychiatry, 67(5), 837-838.
  • Berger, E. N., & Bolyarskaya, V. A. (1968). Changes in the cardio-inhibitory effect of stimulation of the vagus nerve on experimental disruption of adrenal function. Byulleten' Eksperimental'Noi Biologii i Meditsiny, 65(6), 41-42.
  • Bernstein, A. L., Barkan, H., & Hess, T. (2007). Vagus nerve stimulation therapy for pharmacoresistant epilepsy: Effect on health care utilization. Epilepsy & Behavior, 10(1), 134-137.
  • Bishop, G. H., Heinbecker, P., & O'Leary, J. (1934). The significance of frequency, number of impulses and fiber size in vasomotor responses to vagus and depressor nerve stimulation in the rabbit. American Journal of Physiology, 109, 409-421.
  • Blumer, D., Davies, K., Alexander, A., & Morgan, S. (2001). Major psychiatric disorders subsequent to treating epilepsy by vagus nerve stimulation. Epilepsy & Behavior, 2(5), 466-472.
  • Bobkov, Y. G. (1966). The influence of aconitine on the conduction of excitation through the nodular ganglia of the vagus nerve. Farmakologiya i Toksikologiya, 29(4), 450-453.
  • Bodenlos, J. S., Borckardt, J. J., & George, M. S. (2008). Vagus nerve stimulation and food cravings: A response to Gibson and Mohiyeddini. Appetite, 51(1), 226-228.
  • Bohotin, C., Scholsem, M., Multon, S., Martin, D., Bohotin, V., & Schoenen, J. (2003). Vagus nerve stimulation in awake rats reduces formalin-induced nociceptive behaviour and fos-immunoreactivity in trigeminal nucleus caudalis. Pain, 101(1-2), 3-12.
  • Boon, P., Moors, I., De Herdt, V., & Vonck, K. (2006). Vagus nerve stimulation and cognition. Seizure, 15(4), 259-263.
  • Boothby, W. M., & Shamoff, V. N. (1915). A Study of the Late Effects of Division of the Pulmonary Branches of the Vagus Nerve on the Gaseous Metabolism, Gas Exchange, and Respiratory Mechanism in Dogs. American Journal of Physiology, 37, 418-432.
  • Borckardt, J. J., Kozel, F. A., Anderson, B., Walker, A., & George, M. S. (2005). Vagus nerve stimulation affects pain perception in depressed adults. Pain Research & Management, 10(1), 9-14.
  • Bunch, S., DeGiorgio, C. M., Krahl, S., Britton, J., Green, P., Lancman, M., et al. (2007). Vagus nerve stimulation for epilepsy: Is output current correlated with acute response? Acta Neurologica Scandinavica, 116(4), 217-220.
  • Buoni, S., Mariottini, A., Pieri, S., Zalaffi, A., Farnetani, M. A., Strambi, M., et al. (2004). Vagus nerve stimulation for drug-resistant epilepsy in children and young adults. Brain & Development, 26(3), 158-163.
  • Burlage, S. R. (1922). A study of the regeneration of the autonomic fibres in the vagus nerve of the sheep. American Journal of Physiology, 60, 350-356.
  • Carius, A., & Schulze-Bonhage, A. (2005). Trigeminal pain under vagus nerve stimulation. Pain, 118(1-2), 271-273.
  • Carpenter, L. L., Moreno, F. A., Kling, M. A., Anderson, G. M., Regenold, W. T., Labiner, D. M., et al. (2004). Effect of Vagus Nerve Stimulation on Cerebrospinal Fluid Monoamine Metabolites, Norepinephrine, and Gamma-Aminobutyric Acid Concentrations in Depressed Patients. Biological Psychiatry, 56(6), 418-426.
  • Ceskova, E. (2002). Vagus nerve stimulation. Ceska a Slovenska Psychiatrie, 98(5), 283-286.
  • Chae, J.-H., Nahas, Z., Lomarev, M., Denslow, S., Lorderbaum, J. P., Bohning, D. E., et al. (2003). A review of functional neuroimaging studies of vagus nerve stimulation (VNS). Journal of Psychiatric Research, 37(6), 443-455.
  • Chang, H. C., Chia, K. F., Hse, C. H., & Lim, R. K. S. (1937). Humoral transmission of nerve impulses at central synapses. I. Sinus and vagus afferent nerves. Chinese Journal of Physiology, 12, 1-36.
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  • Chernyshova, G. V., & Pogosova, A. V. (1969). On the influence of the right and left vagus nerve on protein metabolism of the different regions of dog myocardium. Byulleten' Eksperimental'Noi Biologii i Meditsiny, 68(8), 51-53.
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  • Crawley, J. N. (1985). Neurochemical investigation of the afferent pathway from the vagus nerve to the nucleus tractus solitarius in mediating the "satiety syndrome" induced by systemic cholecystokinin. Peptides, 6(Suppl 1), 133-137.
  • Danielsson, S., Viggedal, G., Gillberg, C., & Olsson, I. (2008). Lack of effects of vagus nerve stimulation on drug-resistant epilepsy in eight pediatric patients with autism spectrum disorders: A prospective 2-year follow-up study. Epilepsy & Behavior, 12(2), 298-304.
  • de Alcantara, A. C. L., Salgado, H. C., & Fazan, V. P. S. (2008). Morphology and morphometry of the vagus nerve in male and female spontaneously hypertensive rats. Brain Research, 1197, 170-180.
  • De Herdt, V., Boon, P., Vonck, K., Goossens, L., Nieuwenhuis, L., Paemeleire, K., et al. (2003). Are psychotic symptoms related to vagus nerve stimulation in epilepsy patients? Acta Neurologica Belgica, 103(3), 170-175.
  • Dedeurwaerdere, S., Vonck, K., De Herdt, V., Waterschoot, L., De Smedt, T., Raedt, R., et al. (2006). Neuromodulation with levetiracetam and vagus nerve stimulation in experimental animal models of epilepsy. Acta Neurologica Belgica, 106(2), 91-97.
  • Dorr, A. E., & Debonnel, G. (2006). Effect of Vagus Nerve Stimulation on Serotonergic and Noradrenergic Transmission. Journal of Pharmacology and Experimental Therapeutics, 318(2), 890-898.
  • Elger, C. E., & Hoppe, C. (2002). Vagus nerve stimulation and mood. The neuropsychiatry of epilepsy., 283-295.
  • Ergene, E., Behr, P. K., & Shih, J. J. (2001). Quality-of-life assessment in patients treated with vagus nerve stimulation. Epilepsy & Behavior, 2(3,Part1), 284-287.
  • Erlanger, J. (1905). On the Union of a Spinal Nerve with the Vagus Nerve. American Journal of Physiology(XIII), 372-395.
  • Fallgatter, A. J., Ehlis, A.-C., Ringel, T. M., & Herrmann, M. J. (2005). Age effect on far field potentials from the brain stem after transcutaneous vagus nerve stimulation. International Journal of Psychophysiology, 56(1), 37-43.
  • Flo, G., Van Boven, M., Vermaut, S., Daenens, P., Decuypere, E., & Cokelaere, M. (2000). The vagus nerve is involved in the anorexigenic effect of simmondsin in the rat. Appetite, 34(2), 147-151.
  • Flood, J. F., Smith, G. E., & Morley, J. E. (1987). Modulation of memory processing by cholecystokinin: Dependence on the vagus nerve. Science, 236(4803), 832-834.
  • Foley, J. O., & Dubois, F. S. (1933). Experimental and anatomical studies on the vagus nerve of the cat. Proceedings of the Society for Experimental Biology & Medicine, 30, 571-572.
  • Follesa, P., Biggio, F., Gorini, G., Caria, S., Talani, G., Dazzi, L., et al. (2007). Vagus nerve stimulation increases norepinephrine concentration and the gene expression of BDNF and bFGF in the rat brain. Brain Research, 1179, 28-34.
  • Frick, C., Kosel, M., Schlaepfer, T. E., Stanga, Z., & Hasdemir, M. G. (2005). Incident Mania During Therapy With Vagus Nerve Stimulation. Journal of ECT, 21(3).
  • Galli, R., Bonanni, E., Pizzanelli, C., Maestri, M., Lutzemberger, L., Giorgi, F. S., et al. (2003). Daytime vigilance and quality of life in epileptic patients treated with vagus nerve stimulation. Epilepsy & Behavior, 4(2), 185-191.
  • Garcia-Diaz, D. E., Aguilar-Baturoni, H. U., Guevara-Aguilar, R., & Wayner, M. J. (1984). Vagus nerve stimulation modifies the electrical activity of the olfactory bulb. Brain Research Bulletin, 12(5), 529-537.
  • Gates, J., Huf, R., & Frost, M. (2001). Vagus nerve stimulation for patients in residential treatment facilities. Epilepsy & Behavior, 2(6,Part1), 563-567.
  • George, M. S., Nahas, Z., Bohning, D. E., Kozel, F. A., Anderson, B., Mu, C., et al. (2006). Vagus Nerve Stimulation and Deep Brain Stimulation. The American Psychiatric Publishing textbook of mood disorders., 337-349.
  • Gesell, R. A. (1916). Cardiodynamics in heart block as affected by auricular systole, auricular fibrillation and stimulation of the vagus nerve. American Journal of Physiology, 40, 267-313.
  • Ghacibeh, G. A., Shenker, J. I., Shenal, B., Uthman, B. M., & Heilman, K. M. (2006). Effect of vagus nerve stimulation on creativity and cognitive flexibility. Epilepsy & Behavior, 8(4), 720-725.
  • Ghacibeh, G. A., Shenker, J. I., Shenal, B., Uthman, B. M., & Heilman, K. M. (2006). The Influence of Vagus Nerve Stimulation on Memory. Cognitive and Behavioral Neurology, 19(3), 119-122.
  • Gibson, A. (1915). Bilateral Abnormal Relationship of the Vagus Nerve in its Cervical Portion. J. of Anat. & Physiol, 49, 243-273.
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Additional material

Books

Papers

Dissertations

  • Bell, T. P. (2007). A study of the effects of vagus nerve stimulation on anxiety in laboratory rats. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(5-B).
  • Clark, K. B. (1999). Studies investigating the role played by vagus nerve stimulation in the modulation of memory formation. (verbal recognition tasks, learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 60(4-B).
  • Markus, T. M. (2003). An investigation into the modulatory effects of vagus nerve stimulation on emotional expression in laboratory rats. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(9-B).
  • Krahl, S. E. (1995). Vagus nerve stimulation for the control of seizures: Possible modulatory role of the locus coeruleus. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(1-B).
  • Starbuck, E. M. (2001). The subfornical organ and vagus nerve: A similar role in hypernatremic thirst demonstrated by hypothalamic fos-immunoreactivity. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62(5-B).
  • Talley, C. E. P. (1999). Peripheral nervous system influences on spontaneous alternation behavior: A role for the vagus nerve. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60(1-B).
  • Tan, A. A. (2007). Effects of vagus nerve stimulation on recovery of function following controlled cortical impact brain injury. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67(8-B).
  • Zuo, Y. (2006). An investigation of the modulatory effect of vagus nerve stimulation on hippocampal LTP in freely moving rats. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66(11-B).

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