Talk:Vagus nerve stimulation/Archive 1

Archive 1

References

I'm a little concerned about the lack of proper references in this article. I'd like to learn more about the topic, but the reference notations throughout the article don't point to any actual references, as there is no references/citations section for the article. Can anyone help to fix this? 'Kash 06:58, 5 May 2007 (UTC)

The references got lost in some vandalism that wasn't fully reverted. I've restored the text. However, this article isn't in good shape at the moment and I keep thinking about giving it an overhaul. Colin°^Talk 09:05, 5 May 2007 (UTC)

Thanks. At least it's much better with the references present. I'm trying to search the "FDA Summary of VNS Data" document for where it states that "VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on." I've been digging around and finding articles which discuss adverse effects of the device or negligible long-term results, but wanted to find something specific. I haven't read the entire 76-page document yet, but haven't noticed anything to the effect of that phrase in the article. 'Kash 02:27, 8 May 2007 (UTC)

Side Effects

The VNS nearly took my life due to the cardiac side effects. My story was told in Reader's Digest and mentioned in BMJ.

Reader's Digest "Medical devices that can kill" http://www.newamerica.net/node/35911

BMJ "Why the FDA can't protect the public" http://www.bmj.com/content/341/bmj.c4753.full (subscription required)

Below are examples of the cardiac side effects that I dug up from the FDA's adverse events databank (MAUDE).

Asystole http://www.vnsmessageboard.com/index.php/topic,3832.0.html

Bradycardia & Hypotension http://www.vnsmessageboard.com/index.php/topic,3850.0.html

Tachycardia & Hypertension http://www.vnsmessageboard.com/index.php/topic,3862.0.html

Chest pain/Shortness of breath http://www.vnsmessageboard.com/index.php/topic,3911.0.html

Heart Block http://www.vnsmessageboard.com/index.php/topic,3851.0.html

Misc. Cardiac http://www.vnsmessageboard.com/index.php/topic,4008.0.html

Chest pain/Shortness of breath http://www.vnsmessageboard.com/index.php/topic,3911.0.html

Other interesting reports:

Increase in seizures http://www.vnsmessageboard.com/index.php/topic,3864.0.html

Lead Failure http://www.vnsmessageboard.com/index.php/topic,3950.0.html

Programming Malfunctions http://www.vnsmessageboard.com/index.php/topic,3975.0.html

Vocal Cord Paralysis http://www.vnsmessageboard.com/index.php/topic,3863.0.html

Unexplained deaths http://www.vnsmessageboard.com/index.php/topic,3840.0.html

SUDEP http://www.vnsmessageboard.com/index.php/topic,3833.0.html

FDA warning letters http://www.vnsmessageboard.com/index.php/topic,3967.0.html

Dmf58 (talk) 16:32, 30 July 2011 (UTC)

VNS for suppression of tinnitus

In January, 2011, researchers at the University of Texas, Dallas published a study showing that VNS when paired with tones suppressed tonal tinnitus in rats. VNS human trials for the treatment of tonal tinnitus are now underway in Antwerp, Belgium. I see no mention of tinnitus and VNS in this article. I would update it myself, but I fear I would mess up the article/ sourcing, so I'll leave it to others to do as is deemed appropriate. I do know that the UT-Dallas study became a big news event in the tinnitus community, so I believe a tinnitus reference may have a place in this article. Thanks. — Preceding unsigned comment added by Norlns22 (talk • contribs) 08:30, 21 August 2011 (UTC)

Plain English

This article doesdn't explain what vagus nerve stimulation is. It would benefit from a lay summary. — Preceding unsigned comment added by 86.163.87.51 (talk) 07:32, 6 June 2012 (UTC)

added citation for tVNS

found the journal article, added a citation for it, and cleaned up the "citation needed" flags. :) — Preceding unsigned comment added by 184.3.119.158 (talk) 03:29, 13 December 2015 (UTC)

External links modified

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Non-Medical Applications of VNS

Enhanced recognition memory following vagus nerve stimulation in human subjects.

• http://www.ncbi.nlm.nih.gov/pubmed/10195186

Transcutaneous Vagal Nerve Stimulation (tVNS): a new neuromodulation tool in healthy humans

• http://journal.frontiersin.org/article/10.3389/fpsyg.2015.00102/full

"Headphones that stimulate the release of dopamine in your brain and reportedly make you feel high as hell have been invented by Florida-based tech company, Nervana, and are set to go on sale as early as next month. The headphones will pump music into your ears as normal, but at the same time, an integrated device will deliver a low-power electrical signal through your ear canal to stimulate the Vagus nerve - a nerve that runs from the brainstem to the abdomen and plays a role in the release of dopamine, a neurotransmitter that helps control the brain’s reward and pleasure centres."

• http://www.sciencealert.com/headphones-that-get-you-high-are-tipped-to-go-on-sale-next-month

118.148.83.29 (talk) 04:06, 25 February 2016 (UTC)

Thanks for replying, but those are not actual uses - they are things being researched. They are also not currently discussed in the body of the article, so they don't go in the lead. I undoing your change until there is well-sourced support in the body. Jytdog (talk) 04:20, 25 February 2016 (UTC)

It seems logically inconsistent to classify VNS as just a medical tool, since there are many ways of inducing physiological and consciousness changes that are not intended or done for therapeutic benefit, but which may nonetheless have some therapeutic value (e.g., surfing, dancing, or transcranial direct-current stimulation for cognitive enhancement). The way i'm looking at it is that all forms of electromagnetism are primarily energy stimulus, whether or not they have medical or therapeutic utility (which is really just one kind of application). So wouldn't it make more sense to class VNS as primarily an electric form of stimulus, rather than as a medical tool? Also, there is a strong body of research which shows that electrical stimulation of human biology/brain can produce cognitive enhancement for learning and work performance, among other things; significant non-medical applications. (see for example http://www.bbc.com/future/story/20140603-brain-zapping-the-future-of-war and http://www.bbc.com/future/story/20140603-brain-zapping-the-future-of-war). 118.148.80.26 (talk) 07:11, 26 February 2016 (UTC)

I understand your logic but you don't seem to understand Wikipedia. We don't change content without sourcing in the article. Please see WP:VERIFY. We don't change the lead without changing the body first. Please see WP:LRAD. And if you are Bold and make a change to an article (which is great), and then someone Reverts the change, you Discuss. We call that "WP:BRD. You don't edit war. Please leave the article alone until we figure this out. Jytdog (talk) 17:23, 26 February 2016 (UTC)

Okay. Who are you going to figure it out with? And how will it be figured out? I strongly feel-think that this issue ought to be dealt with immediately, because classifying electromagnetic energies primarily as medical or therapeutic interventions is misleading and inconsistent with the facts. The fact is that electrically stimulating the brain or any aspect of biology does not imply medical intent, purpose, or benefit. Just because an electromagnetic stimulus has medical-therapetutic benefit does not mean that it has non-medical applications/uses/or benefits. We should determine this first before we classify either way. Thoughts? Thanks. 118.148.80.26 (talk) 08:06, 27 February 2016 (UTC)

I've left a note on your Talk page, as this is going off the topic of addressing content in this article. (see WP:TPG) Jytdog (talk) 19:16, 27 February 2016 (UTC)

References for Adverse Reactions Section

Hello,

I've been researching VNS and something about the page that I noticed is that some of the claims in the Averse Reaction section are supported by a reference that is no longer available. Specifically:

In the treatment of epilepsy, randomized control trials conducted in the United States indicated that one-third of the patients had some type of an increase in seizures, with 17 percent having greater than a 25 percent increase. In each of the studies, there were patients who had greater than a 100 percent increase. In the E05 study, the range went up to a 234 percent increase, while in the E04 study, it went even higher, to a 680 percent maximum range.[4]

The reference is a link to the FDA site that says "Page Not Found". A link I found to an active FDA page for this treatment (https://www.accessdata.fda.gov/cdrh_docs/pdf/p970003s207b.pdf), shows very different adverse event data: -Increased seizures - Ages 4-11 (1.46%) Ages 12+ (1.38%)

What's usually the procedure for editing something like this? I would have replaced the reference, but was unable to find the a source that has those events listed. Does it make more sense to remove this section for the time being?

Thanks for guidance on this — Preceding unsigned comment added by CMILNEditor (talk • contribs) 14:49, 6 June 2018 (UTC)

Thanks for raising this issue. The FDA moves pages around a lot. You can often find a now-dead page in the Internet Archive, which I did, and then fixed the ref in this diff. Who ever cited that before didn't provide the date. The meeting was in 1997 and that source is horribly out of date. Yes we should update with more current information. The ref you brought is good; while it focuses on the expanded (pediatric) age group it does have information about all populations, and is recent (June 23, 2017). If you want to update the section based on this that would be great. I can do it if you like. Jytdog (talk) 15:07, 6 June 2018 (UTC)

Hey Jytdog. I can definitely take care of updating some of the data, citing the source provided. In fact, I'm going to be reviewing some of the other information from this page just to ensure the most recent references are being used and the claims being made are up to date. Thank you so much for your help with this process. — Preceding unsigned comment added by CMILNEditor (talk • contribs) 16:09, 6 June 2018 (UTC)

OK, I'll put a welcome notice on your page ((User talk:CMILNEditor) , which provides guidance for editing content about health. Please make sure you review that before you start. I'll also leave you a note there about logistics of using talk pages. Jytdog (talk) 16:13, 6 June 2018 (UTC)

Edits

About these edits:

• As noted in WP:MEDMOS (and specifically pointed out in the welcome message on your talk page), we don't use the word "patient".
• The "medical use" section, is meant to describe medical uses. Content about regulatory approvals can go in "History" or perhaps in "society and culture" but does not belong in medical use. This section just describes uses.
• In the adverse events section, again this is written like "news"; we just describe adverse effects here. Also we write in prose as much as possible.

I will a shot at revising. But please do take time and read the welcome message at your talk page and the links there. The three key documents briefly described and linked there are WP:MEDMOS, WP:MEDHOW, and WP:MEDRS. Thanks. Jytdog (talk) 17:03, 6 June 2018 (UTC)

Thank you so much for your help with this. I really appreciate the support. — Preceding unsigned comment added by CMILNEditor (talk • contribs) 17:35, 6 June 2018 (UTC)

This is more complicated than i thought. the initial devices were implanted; the new one is a handheld device. A bunch of changes are needed. Jytdog (talk) 18:57, 6 June 2018 (UTC)

I have came across the same issue with a lot of the info with this type of treatment. Not only is there a variety of indications it can be used for, but there are different means for how the treatment is applied, which makes it tricky. When you combine that with outdated references and you have yourself quite a mess. I would love to help you with revising this, and providing any needed research. It seems like this page spins off in a lot of directions so anything we can do to clarify the content and provide a solid reference would be great. — Preceding unsigned comment added by CMILNEditor (talk • contribs) 20:46, 6 June 2018 (UTC)

Sorry I have gotten distracted with other things. I will come back this weekend! :) Jytdog (talk) 07:44, 8 June 2018 (UTC)

No worries, I really appreciate your guidance with this. Please let me know if there's anything I can provide to support. I have some pretty extensive information sources, as I've been researching this treatment pretty intensely recently. 12:54, 14 June 2018 (UTC) — Preceding unsigned comment added by 162.213.114.226 (talk) 14:17, 8 June 2018 (UTC)

I wanted to check progress for the changes for this page. The more I review this page an other resources, the more it becomes apparent that a lot of this information needs to be reformed. If you're too busy to make changes, do you recommend another editor I could potentially partner with? Thanks in advance! 162.213.114.226 (talk) 12:54, 14 June 2018 (UTC) — Preceding unsigned comment added by 162.213.114.226 (talk) 14:18, 12 June 2018 (UTC)

Mechanism of Action

The intro line to the Mechanism of Action section seems very vague, subjective and potentially misleading "As of 2017 little was understood about exactly how vagal nerve stimulation modulates mood and seizure control." and the reference cited does not support the statement made. Whilst researching, I found a resource from the Epilepsy Society that uses specific details to describe theories of how the treatment is used to reduce severity and frequency of epileptic seizures (https://www.epilepsysociety.org.uk/sites/default/files/attachments/Chapter48Sen2015.pdf). I am looking to incorporate some of this information to the current section but am very new to the wiki editing process and don't want to disrupt the editing process. Would any seasoned editors be able to help me make the necessary changes to this section? CMILNEditor (talk) 19:30, 14 June 2018 (UTC) 13:06, 14 June 2018 (UTC) — Preceding unsigned comment added by CMILNEditor (talk • contribs)

"VNS message board"

User:Dennismfegan -- the content you added here and here is not acceptable in Wikipedia. The VNS message board you cited in your edit note is not what we call a "reliable source" for any kind of content in Wikipedia. (see WP:USERGENERATED.) And content about health needs to be sourced per the WP:MEDRS guideline -- basically recent literature reviews in good quality journals or statements by major medical or scientific bodies. If you don't understand, please ask. Jytdog (talk) 00:08, 6 July 2018 (UTC)

Source

Would the journal Epilepsia (peer reviewed) be an acceptable source for my edits to vagus nerve stimulation? (Dennismfegan (talk) 15:36, 19 July 2018 (UTC))

That is a fine journal; the actual piece from the journal that you would like to cite matters as does the kind of content you want to generate. If the content is WP:Biomedical information then the piece should be a literature review or a clinical guideine. Not a research article, letter to the editor, editorial, commentary, etc. If you want to post the citation here and say the kind of content you want to generate from it, I can help you. Jytdog (talk) 15:45, 19 July 2018 (UTC)

So in this diff the following refs were added"

1. Andriola mr, rosenweig t, vlay s. "vagus nerve stimulation (vns): induction of asystole during implantations with subsequent successful stimulation. " epilepsia 2000;41(suppl. 7):223
2. long-henson tj, o'donovan ca et al. "bradycardia occurring during vns therapy for intractable epilepsy. " epilepsi. 2003;44(suppl 9):324.
3. Han p, frei mg, osorio i. Probable mechanisms of action of vagus nerve stimulation in humans with epilepsy: is a window into the brain [abstract]? epilepsia 1996;37 (5suppl):83s
4. US National Library of Medicine National Institutes of Health: Vagus Nerve Stimulation – Robert H. Howland, M.D.
5. Ardesch jj, et al. , "cardiac responses of vagus nerve stimulation: intraoperative bradycardia and subsequent chronic stimulation", clin neurol neurosurg (2007), doi: 10. 1016/j. Clineuro. 2007. 07. 024.

looking at these

1. This is not indexed in pubmed. The reason, is that this is a conference abstract-- here is the actual source. These are proceedings from an American Epilepsy Society meeting in 2000. This is way too old, and we do not cite conference abstracts; they fail MEDRS.
2. Same as #1, but from the meeting in 2003. The actual sources is here. So not MEDRS. Also 2003 is too old.
3. Same as #1 but from the meeting in 1996. The actual source is here. So not MEDRS and 1996 is way too old.
4. I think this is PMID 24834378 (also PMC 4017164). If so this is a good source per MEDRS. It is a literature review and is recent enough. It differentiates between adverse affects of left mid-cervical VNS and right mid-cervical VNS.
5. This is PMID 17825483 and is a primary source, so fauls MEDRS. It is from 2007 and too old.

I have reverted and added back content using the one good ref here. Jytdog (talk) 03:46, 21 July 2018 (UTC)

Medical Uses Section

JYtDOG, thanks for helping me with the edits on medical use. I was tried to model the content to be reflective of some of the other medical wiki pages I saw for treatments that handled multiple medical issues Example: https://en.wikipedia.org/wiki/Adalimumab or https://en.wikipedia.org/wiki/Amoxicillin). Granted this is a procedure; not a treatment. The majority of the medical issues in these pages were written in the same style, and used .gov resources, similar to the content that I added for the vagus nerve stimulation page. Can you help me to understand why these edits are acceptable, but what I added was not? I am really trying to improve my ability to edit pages effectively and would love your help. Thank you in advance CMILNEditor (talk) 14:55, 15 August 2018 (UTC)

Thanks for your note. I have explained MEDRS to you already I believe. Please do see WP:MEDHOW if you would like more guidance.

There is a difference between medical use and clinical research. "Medical use" is what happens in doctor's offices and hospitals and is offered to anybody with a given condition, in order to treat them; "research" is scientific experiments, done in a controlled way, in order to learn things (not to treat anybody). Clinical research is still research; it is not medical use. See clinical trial if this is not clear to you.

Please also see Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs,_treatments,_and_devices - the "medical use" bit says "Medical uses (how the intervention is used, along with evaluations of efficacy if available)"

Those other pages are messed up and need to be fixed. People add bad content to Wikipedia all the time.

Thanks. Jytdog (talk) 15:15, 15 August 2018 (UTC)

Thank you so much for the guidance on the sources and formatting. I really appreciate the input and am trying very hard with trying to get better at this. Is there anyway we can work together on trying to expand the content on this page? I have come across a lot of information that is available on this treatment that I think would really help people who are looking to learn more about it, but it is becoming pretty clear that I might not be the best editor to make changes. I really would love to count on your expertise, rather than me having to spend time creating and sourcing content that does not fit the requirements. Please let me know if you are available. Thanks CMILNEditor (talk) 15:47, 15 August 2018 (UTC)

Thanks for being gracious.

Everything in Wikipedia starts with sources. Then it is a matter of generating appropriate content and putting it in the right place.

If you want, while you are learning you could post sources here that you would like to use, and I can let you know if they are OK, and we can work on generating content from them, and where to put it... Jytdog (talk) 15:57, 15 August 2018 (UTC)

That would AWESOME. I would be undeniably grateful for your help with this.

CMILNEditor (talk) 16:00, 15 August 2018 (UTC)

Candidates for VNS Therapy

Hello Wiki World, I wanted to add some information to the Vagus Nerve Stimulation that talks about the FDA requirements for approval when it comes to people who are able to receive this type of treatment. This is the content I would like to include:

The Food and Drug Administration (FDA) has approved vagus nerve stimulation for people who:

• Are at least 12 years old and older
• Suffer from focal (partial) epilepsy
• Experience seizures that can’t be properly controlled with medications

The FDA has also approved vagus nerve stimulation for treating depression in adults who:

• Suffer from treatment resistant depression and have tried at least four medications to treat depression
• Have tried electroconvulsive therapy (ECT), four medications that treat depression or both
• Continue standard treatments for depression in addition to vagus nerve stimulation

This is the source I used: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961632/

My question is, would it be better as it's own section, or would this information be better added to one of the existing sections of the page. Any feedback would be greatly appreciated. CMILNEditor (talk) 14:30, 5 September 2018 (UTC)

We already cover this... Doc James (talk · contribs · email) 18:05, 9 September 2018 (UTC)

Pregnancy Safety

Hello, I was looking to expand the content of the page to include some information on how vagus nerve stimulation is a safe treatment for depression and epilepsy. I created content and pulled some sources, but I wanted to get feedback before creating a subsection and posting it to the main page. Please review both my content and sources and let me know if I'm headed in the right direction! Thanks!

Content: Receiving vagus nerve stimulation while pregnant has been deemed safe for women, whether they are receiving it for treatment resistant depression, or as an adjunctive treatment of medically refractory seizures caused by epilepsy.

Sources: https://www.ncbi.nlm.nih.gov/pubmed/26350804 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242217/ https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/1744-859X-4-16 https://www.ncbi.nlm.nih.gov/pubmed/29054513 https://www.ncbi.nlm.nih.gov/pubmed/20093864

CMILNEditor (talk) 14:03, 20 August 2018 (UTC)

Please read WP:MEDRS. Have removed the content in question as it was based on primary sources. Doc James (talk · contribs · email) 18:07, 9 September 2018 (UTC)

Proposed merge of Transcutaneous vagus nerve stimulation into Vagus nerve stimulation

This article is just a subtopic of the other page. This stub would have better sources if it was moved as a section of the the more general Vagus nerve stimulation article Akrasia25 (talk) 12:48, 1 December 2019 (UTC)

User:Akrasia25 agree and merged. Doc James (talk · contribs · email) 00:39, 2 December 2019 (UTC)