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FIGURE 27–3. Vagus nerve anatomy.Drawing depicts the brain split sagittally. Note that vagus nerve afferents enter the brain stem and then travel to the locus coeruleus, as well as to other important mood- and anxiety-regulating regions.Source. Reprinted from George MS, Sackeim HA, Rush AJ, et al.: "Vagus Nerve Stimulation: A New Tool for Brain Research and Therapy." Biological Psychiatry 47:287–295, 2000. Copyright 2000, Society of Biological Psychiatry. Used with permission.

FIGURE 27–4. Dosing and delivery of vagus nerve stimulation (VNS).Nurse Berry Anderson, left, holds the programming PDA, which is connected to an infrared wand positioned over the left chest wall of research assistant Lauren Forster (not an actual VNS patient). The VNS patient holds the wand over the generator, which is typically implanted in the left chest wall and connected by a wire to the lead wrapped under the vagus nerve in the left neck. The treating clinician can then adjust the VNS device stimulation parameters.Source. Photo courtesy of Dr. Mark George, Medical University of South Carolina (MUSC) Brain Stimulation Laboratory.

FIGURE 27–5. Vagus nerve stimulation (VNS) efferents in the brain.Shown are images from representative slices of a common brain, where results from nine depressed patients have been pooled. Top row: The activated areas (displayed in color) are regions showing increased blood flow while the device was actively delivering stimulation, compared with the few seconds before, when it was silent. Note the activation in the hypothalamus, orbitofrontal and prefrontal cortex, and insula. Bottom row: The colored areas are the brain regions activated when subjects heard a tone (largely auditory cortex). VNS activates the "gut-sensory" system.Source. Reprinted from Lomarev M, Denslow S, Nahas Z, et al: "Vagus Nerve Stimulation (VNS) Synchronized BOLD fMRI Suggests That VNS in Depressed Adults Has Frequency/Dose Dependent Effects." Journal of Psychiatric Research 36:219–227, 2002. Copyright 2002, Elsevier LTD. Used with permission.

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