Vagus Nerve Stimulation (VNS) and Treatment of Depression: To the Brainstem and Beyond

 Neuromodulation appears to be emerging gradually as a new therapeutic
field in psychiatric treatment. It encompasses neuropsychiatric medical
devices, such as vagus nerve stimulation (VNS), transcranial magnetic
stimulation (TMS), deep brain stimulation (DBS), and electroconvulsive
therapy (ECT). As a therapeutic approach to affective disorders,
neuromodulation shifts the focus from the monoamine synapse to neural
circuitry of the brain, which is dysregulated in depression. This neural
circuitry has been elaborated on over the course of 15 years of
neuroimaging research in mood disorders and is now believed to encompass
disturbances in a frontolimbic network. These include reduced
metabolism and blood flow in the prefrontal cortex and anterior
cingulate and pathologically increased activity in the subgenual
cingulate and amygdala.VNS is an implanted device that has established
efficacy in pharmaco-resistant epilepsy. It was approved by the FDA for
the treatment of severe, recurrent unipolar and bipolar depression in
July of 2005. VNS adopts a bottom-up approach to modulating the neural
circuitry of depression by stimulating vagal afferent fibers in the neck
, which carry impulses to the brain stem to target there the locus
ceruleus and dorsal raphe nucleus. Now that VNS has moved beyond the
experimental phase and into the clinic, psychiatrists are faced with
deciding who is an appropriate patient for this surgical implant and how
to integrate VNS into existing treatment in order to optimize both
efficacy and safety.This review of VNS will assess the efficacy and
safety data that led to the FDA approval. We will also review for the
busy clinician how VNS is likely to translate into clinical practice as
a treatment option for patients in need who are suffering from severe
depression.

MIGRAIN HEADACHE

Migraine can be defined as a paroxysmal affection, accompanied by severe headache, generally on one side of the head and associated with disorders of the digestion, the liver and the vision. It usually occurs when a person is under great mental tension or has suddenly got over that state.

Migraine is also known as "sick headache" because nausea and vomiting occasionally
accompany the excruciating pain which lasts for as long as three days.

Migraine usually gives warning before it strikes : black spots or a brilliant zig-zag line appears before the eyes or the patient has blurring of vision or has part of his vision blanked out. When the headache occurs, the patient may feel tingling, numbness, or weakness in an arm or leg.

Migraine sufferers have what is known as a "migrainous personality ". They are compulsive
workers and perfectionists, who feel that they have to do everything right away. When they complete a task, they are suddenly laid down from a state of temporary tension to a feeling of utmost relief. Then comes the migraine. It is a purely physiological process. The head and neck muscles, reacting to continuous stress, become overworked. The tightened muscles squeeze the arteries and reduce blood flow. When a person relaxes suddenly, the constricted muscles expand, stretching the walls of the blood-vessel. With every heart beat, the blood being pushed through this vessels expands them further and causes incredible pain.

When a headache strikes, one should stay on one’s feet in the daytime and do simple chores which do not require too much concentration or walk, move around and get some fresh air. The best remedy to prevent headaches is to build up physical resistance through proper nutrition, exercise and constructive thinking. As a first step, the patient should undertake a short fast.


During the fast, citrus fruit juices, diluted with water may be taken six times daily. By taking the load of digestion, the patient will at once save nervous energy which can be utilised for more important purposes. The blood and lymph will also be relieved of a great burden. After a short fast, the diet should be fixed in such a way as to put the least possible strain on the digestion.

Breakfast should consist of fruits, both fresh and dried. Lunch should consist largely of protein foods. Starchy foods such as whole wheat bread, cereals, rice or potatoes should be taken at dinner along with raw salads. Spices, tomatoes, sour buttermilk and oily foodstuffs SHOULD BE AVOIDED!!!. Drinking a glass of water ( warm water in winter and cool water in summer) mixed with a teaspoonful of honey the first thing in the morning, is also a good remedy.

Water Treatment
There are certain water applications which help relieve headaches. Copious drinking of water
can help , as do the cleansing enema with water temperature at 98.6 o F, the hot foot bath, a
cold throat pack, frequent applications of towels wrung out from very hot water to the back of the neck, a cold compress at 40 o to 60o F applied to the head and face or an alternate spinal
compress. Hot fomentations over the abdominal region just before retiring relieve headaches
due to stomach and liver upsets.

Yogic kriyas like jalneti and kunjal, pranayamas like anuloma-viloma, shitali and sitkari and
asanas such as uttanapadasana, sarvangasana, paschimottanasana, halasana and shavasana
are useful in the treatment of headaches.

CONCLUSIONS

DO some fasting (JUICE FAST)
Spices, tomatoes, sour buttermilk and oily foodstuffs SHOULD BE AVOIDED!!!

The New Aneurysm Clip System for Particularly Complex Aneurysm Surgery: Technical Note

Currently, there is an ongoing debate regarding the best treatment option for ruptured aneurysms. The International Subarachnoid Aneurysm Trial study suggests that an endovascular procedure is the best treatment. In some complex cases, or in patients with an additional large intracerebral hemorrhage, aneurysms require further microsurgical clipping.

OBJECTIVE:We introduce a new clip system to improve clipping procedures in especially complex aneurysms.

METHODS: The inverted opening mechanism of the clip in combination with the special clip applier provides the surgeon with a good overview in the operating field. The new design also enables a wider opening of the clip jaws in contrast to all other well-known titanium aneurysm clips. This should provide a better and safer application and decrease the danger of premature rupture.

RESULTS: From January 2006 to July 2008, 55 aneurysms were clipped in 45 patients. The most common aneurysm location was the anterior communicating artery (20 patients) followed by the M1 segment of the middle cerebral artery (16 patients). Four patients had 2, one had 3, and one had 5 aneurysms. Two clipping procedures were performed for an ateriovenous malformation-associated aneurysm. All aneurysms were clipped without any technical complication.

CONCLUSION: The use of the new clip system, especially in complex aneurysm surgery, has potential benefits because of the better surgical vision during clip application and the wider opening of the clip jaws. It is easy to handle and compatible with magnetic resonance imaging.