The means to safely, chronically stimulate the vagus nerve in humans is already available. Demonstrated efficacy of the vagus nerve stimulator (VNS) for refractory partial epilepsy, although by mechanisms unproven, suggests VNS can alter cortical excitability in humans. Much remains to be determined, however, before VNS is proven as a clinical treatment for tinnitus or chronic pain. Future studies will need to address not only clinical efficacy, but also appropriate patient selection, treatment paradigm, and cost effectiveness. Nevertheless, the study conducted by Dr. Engineer and his associates offers early promise for a potentially novel intervention for these disabling conditions that often elude our current best efforts at management.
KATHERINE H. NOE, M.D., PH.D., is a consultant in the division of epilepsy at the Mayo Clinic in Phoenix. She has no relevant financial disclosures.
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