BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation
Volume 2, Issue 1 , Pages 41-49 , January 2009

A pilot study of the teratogenicity of vagus nerve stimulation in a rabbit model

  • Ingela Danielsson, MD, PhD

      Affiliations

    • Cyberonics, Inc, Houston, Texas
    • Corresponding Author InformationCorrespondence: Dr. Ingela Danielsson, 100 Cyberonics Blvd., Houston, TX 77058.
  • ,
  • Laurence Lister, BS

      Affiliations

    • Toxikon, Inc, Bedford, Massachusetts

Received 26 October 2007 ,Revised 11 June 2008 ,Accepted 12 June 2008.

References 

  1. A North American Registry for Epilepsy and Pregnancy, a unique public/private partnership of health surveillance. Epilepsia. 1998;39:793–798
  2. Kanner AM. Depression in epilepsy: a frequently neglected multifaceted disorder. Epilepsy Behav. 2003;4(Suppl4):S11–S19
  3. Wrench J, Wilson SJ, Bladin PF. Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections. Epilepsia. 2004;45:534–543
  4. Gilliam FG, Mendiratta A, Pack AM, Bazil CW. Epilepsy and common comorbidities: improving the outpatient epilepsy encounter. Epileptic Disord. 2005;7(Suppl1):S27–S33
  5. Ornoy A. Neuroteratogens in man: an overview with special emphasis on the teratogenicity of antiepileptic drugs in pregnancy. Reprod Toxicol. 2006;22:214–226
  6. Lateef TM, Nelson KB. In utero exposure to antiepileptic drugs: teratogenicity and neonatal morbidity. Curr Neurol Neurosci Rep. 2007;7:133–138
  7. Marchi NS, Azoubel R, Tognola WA. Teratogenic effects of lamotrigine on rat fetal brain: a morphometric study. Arq Neuropsiquiatr. 2001;59:362–364
  8. ten Berg K, Samrén EB, van Oppen AC, Engelsman M, Lindhout D. Levetiracetam use and pregnancy outcome. Reprod Toxicol. 2005;20:175–178
  9. Louik C, Lin AE, Werler MM, Hernández-Díaz S, Mitchell AA. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 2007;356:2675–2683
  10. Way CM. Safety of newer antidepressants in pregnancy. Pharmacotherapy. 2007;27:546–552
  11. Suri R, Altshuler L, Hellemann G, et al. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry. 2007;164:1206–1213
  12. DeBattista C, Cochran M, Barry JJ, Brock-Utne JG. Fetal heart rate decelerations during ECT-induced seizures: is it important?. Acta Anaesthesiol Scand. 2003;47:101–103
  13. Physician'sManual, VNS Therapy Pulse Model 102 Generator and VNS Therapy Pulse Duo Model 102R Generator. Available at: http://www.vnstherapy.com/manuals/index.asp?type=vns-hcp%2fep. Accessed on: March 12, 2008.
  14. Henry TR. Therapeutic mechanisms of vagus nerve stimulation. Neurology. 2002;59(Suppl. 4):S3–S14
  15. Morris GL, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01-E05. Neurology. 1999;53:1731–1735
  16. In:  Richardson V editors. Rabbbits Health Husbandry & Diseases. Malden, MA: Blackwell Science Ltd; 2000;
  17. Harcourt-Brown F. Textbook of Rabbit Medicine. Woburn, MA:Butterworth Heinemann. 2002;
  18. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89:2745–2749
  19. Morrell MJ. Reproductive and metabolic disorders in women with epilepsy. Epilepsia. 2003;44(Suppl.4):S11–S20
  20. Lossius MI, Taubøll E, Mowinckel P, Mørkrid L, Gjerstad L. Reversible effects of antiepileptic drugs on reproductive endocrine function in men and women with epilepsy—a prospective randomized double-blind withdrawal study. Epilepsia. 2007;48:1875–1882
  21. Harden CL, Leppik I. Optimizing therapy of seizures in women who use oral contraceptives. Neurology. 2006;67(12 Suppl. 4):S56–S58
  22. Holmes LB, Wyszynski DF, Lieberman E. The AED (antiepileptic drug) pregnancy registry: a 6-year experience. Arch Neurol. 2004;61:673–678
  23. Wyszynski DF, Nambisan M, Surve T, et al. Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology. 2005;22:961–965
  24. Wide K, Winbladh B, Källén B. Major malformations in infants exposed to antiepileptic drugs in utero, with emphasis on carbamazepine and valproic acid: a nation-wide, population-based register study. Acta Paediatr. 2004;93:174–176
  25. Morrow J, Russell A, Guthrie E, et al. Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry. 2006;77:193–198
  26. Meador KJ, Baker GA, Finnell RH, et al. In utero antiepileptic drug exposure: fetal death and malformations. Neurology. 2006;67:407–412
  27. Oyen N, Vollset SE, Eide MG, Bjerkedal T, Skjaerven R. Maternal epilepsy and offsprings' adult intelligence: a population-based study from Norway. Epilepsia. 2007;48:1731–1738
  28. Yerby M, Koepsell T, Daling J. Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia. 1985;26:631–635
  29. Information for healthcare professionals Lamotrigene (marketed as Lamictal). FDA Alert [9/2006]. US Food and Drug Administration Center for Drug Evaluation and Research. Available at: http://www.fda.gov/CDER/drug/InfoSheets/HCP/lamotrigineHCP.htm. Last accessed: March 12, 2008.
  30. Hirschfeld RM, Calabrese JR, Weissman MM, et al. Screening for bipolar disorder in the community. J Clin Psychiatry. 2003;64:53–59
  31. Runnström J. An analysis of the action of lithium on sea urchin development. Biolog Bull. 1935;68:378–384
  32. Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161:608–620
  33. Newport DJ, Calamaras MR, DeVane CL, et al. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J. Psychiatry. 2007;164:1214–1220
  34. Eberhard-Gran M, Eskild A, Opjordsmoen S. Use of psychotropic medications in treating mood disorders during lactation: practical recommendations. CNS Drugs. 2006;187–198
  35. Alwan S, Reefhuis J, Rasmussen SA, et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007;28:2684–2692
  36. Pinette MG, Santarpio C, Wax JR, Blackstone J. Electroconvulsive therapy in pregnancy. Obstet Gynecol. 2007;110:465–466
  37. Husain MM, Stegman D, Trevino K. Pregnancy and delivery while receiving vagus nerve stimulation for the treatment of major depression: a case report. Ann Gen Psychiatry. 2005;4:16
  38. Brent RL. Utilization of animal studies to determine the effects and human risks of environmental toxicants (drugs, chemicals, and physical agents). Pediatrics. 2004;113:984–995
  39. Rush AJ, Sackeim HA, Marangell LB, et al. Effects of 12 months of vagus nerve stimulation in treatment-resistant depression: a naturalistic study. Biol Psychiatry. 2005;58:355–363

 The results of the teratogenicity study were presented in poster form at the 57th meeting of the American Epilepsy Society, December 5-10, 2003, in Boston, Massachusetts, Harden, CL (Comprehensive Epilepsy Center, Weill Medical College of Cornell University, New York, NY) High-dose vagus nerve stimulation does not cause teratogenicity in animals.

 Cyberonics, Inc, manufacturer of the VNS Therapy System, compensated Toxikon, Corporation of Bedford, Massachusetts, for performing this reproductive and developmental toxicity screening test. Mr. Laurence Lister, an author of this article, is an employee of Toxikon Corporation, which was contracted to perform the Reproductive Screening study; Mr. Lister received no direct compensation from Cyberonics for directing the study. Ingela Danielsson, MD, PhD, an author of this article, is a stockholder of Cyberonics, Inc.

PII: S1935-861X(08)00043-0

doi: 10.1016/j.brs.2008.06.008

BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation
Volume 2, Issue 1 , Pages 41-49 , January 2009