char = C;code = 67 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = r;code = 114 char = t;code = 116 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = y;code = 121 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = f;code = 102 char = r;code = 114 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = e;code = 101 char = p;code = 112 char = i;code = 105 char = l;code = 108 char = e;code = 101 char = p;code = 112 char = s;code = 115 char = y;code = 121 char = .;code = 46 result sql = Chronic vagus nerve stimulation improves alertness and reduces rapid eye movement sleep in patients affected by refractory epilepsy.
Chronic vagus nerve stimulation improves alertness and reduces rapid eye movement sleep in patients affected by refractory epilepsy.char = <;code = 60 char = b;code = 98 char = >;code = 62 char = O;code = 79 char = B;code = 66 char = J;code = 74 char = E;code = 69 char = C;code = 67 char = T;code = 84 char = I;code = 73 char = V;code = 86 char = E;code = 69 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = O;code = 79 char = u;code = 117 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = u;code = 117 char = d;code = 100 char = y;code = 121 char = ;code = 32 char = a;code = 97 char = i;code = 105 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = c;code = 99 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = u;code = 117 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = l;code = 108 char = l;code = 108 char = o;code = 111 char = w;code = 119 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = f;code = 102 char = r;code = 114 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = e;code = 101 char = p;code = 112 char = i;code = 105 char = l;code = 108 char = e;code = 101 char = p;code = 112 char = s;code = 115 char = y;code = 121 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = M;code = 77 char = E;code = 69 char = T;code = 84 char = H;code = 72 char = O;code = 79 char = D;code = 68 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = A;code = 65 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = l;code = 108 char = y;code = 121 char = s;code = 115 char = o;code = 111 char = m;code = 109 char = n;code = 110 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = u;code = 117 char = d;code = 100 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = 1;code = 49 char = 0;code = 48 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = b;code = 98 char = j;code = 106 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = f;code = 102 char = r;code = 114 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = o;code = 111 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = e;code = 101 char = p;code = 112 char = i;code = 105 char = l;code = 108 char = e;code = 101 char = p;code = 112 char = s;code = 115 char = y;code = 121 char = .;code = 46 char = ;code = 32 char = S;code = 83 char = u;code = 117 char = b;code = 98 char = j;code = 106 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = r;code = 114 char = d;code = 100 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = o;code = 111 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = d;code = 100 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = h;code = 104 char = r;code = 114 char = o;code = 111 char = n;code = 110 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = S;code = 83 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = a;code = 97 char = m;code = 109 char = e;code = 101 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = i;code = 105 char = g;code = 103 char = h;code = 104 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = M;code = 77 char = e;code = 101 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = o;code = 111 char = w;code = 119 char = -;code = 45 char = w;code = 119 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = i;code = 105 char = r;code = 114 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = -;code = 45 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = c;code = 99 char = y;code = 121 char = c;code = 99 char = l;code = 108 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = A;code = 65 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = r;code = 114 char = y;code = 121 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = b;code = 98 char = o;code = 111 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ,;code = 44 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = i;code = 105 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = v;code = 118 char = i;code = 105 char = s;code = 115 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = -;code = 45 char = a;code = 97 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = ;code = 32 char = s;code = 115 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = t;code = 116 char = w;code = 119 char = e;code = 101 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = 2;code = 50 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = d;code = 100 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = w;code = 119 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = a;code = 97 char = m;code = 109 char = e;code = 101 char = t;code = 116 char = r;code = 114 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = a;code = 97 char = m;code = 109 char = e;code = 101 char = t;code = 116 char = r;code = 114 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = R;code = 82 char = E;code = 69 char = S;code = 83 char = U;code = 85 char = L;code = 76 char = T;code = 84 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = V;code = 86 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = s;code = 115 char = i;code = 105 char = g;code = 103 char = n;code = 110 char = i;code = 105 char = f;code = 102 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = R;code = 82 char = E;code = 69 char = M;code = 77 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = (;code = 40 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = b;code = 98 char = j;code = 106 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = g;code = 103 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = 1;code = 49 char = .;code = 46 char = 5;code = 53 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = l;code = 108 char = l;code = 108 char = i;code = 105 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = b;code = 98 char = u;code = 117 char = t;code = 116 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = t;code = 116 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = 1;code = 49 char = .;code = 46 char = 5;code = 53 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = l;code = 108 char = l;code = 108 char = i;code = 105 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = );code = 41 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = o;code = 111 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = u;code = 117 char = m;code = 109 char = b;code = 98 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = a;code = 97 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = n;code = 110 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = c;code = 99 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = e;code = 101 char = t;code = 116 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = ;code = 32 char = 1;code = 49 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = .;code = 46 char = ;code = 32 char = D;code = 68 char = a;code = 97 char = t;code = 116 char = a;code = 97 char = ;code = 32 char = f;code = 102 char = r;code = 114 char = o;code = 111 char = m;code = 109 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = n;code = 110 char = a;code = 97 char = i;code = 105 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = h;code = 104 char = o;code = 111 char = w;code = 119 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = o;code = 111 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = n;code = 110 char = a;code = 97 char = p;code = 112 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = r;code = 114 char = t;code = 116 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = i;code = 105 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = q;code = 113 char = u;code = 117 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = f;code = 102 char = u;code = 117 char = l;code = 108 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = g;code = 103 char = l;code = 108 char = o;code = 111 char = b;code = 98 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = S;code = 83 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = y;code = 121 char = s;code = 115 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = s;code = 115 char = h;code = 104 char = o;code = 111 char = w;code = 119 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = l;code = 108 char = t;code = 116 char = a;code = 97 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = d;code = 100 char = u;code = 117 char = r;code = 114 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = -;code = 45 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = C;code = 67 char = O;code = 79 char = N;code = 78 char = C;code = 67 char = L;code = 76 char = U;code = 85 char = S;code = 83 char = I;code = 73 char = O;code = 79 char = N;code = 78 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = O;code = 79 char = u;code = 117 char = r;code = 114 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = t;code = 116 char = a;code = 97 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = m;code = 109 char = o;code = 111 char = n;code = 110 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = j;code = 106 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = e;code = 101 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = o;code = 111 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = y;code = 121 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = r;code = 114 char = t;code = 116 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;code = 32 char = (;code = 40 char = w;code = 119 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = h;code = 104 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = d;code = 100 char = );code = 41 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = (;code = 40 char = w;code = 119 char = h;code = 104 char = i;code = 105 char = c;code = 99 char = h;code = 104 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = );code = 41 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = u;code = 117 char = l;code = 108 char = d;code = 100 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = u;code = 117 char = l;code = 108 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = b;code = 98 char = i;code = 105 char = l;code = 108 char = i;code = 105 char = z;code = 122 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = u;code = 117 char = r;code = 114 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = u;code = 117 char = c;code = 99 char = t;code = 116 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = g;code = 103 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = w;code = 119 char = a;code = 97 char = k;code = 107 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = /;code = 47 char = n;code = 110 char = o;code = 111 char = n;code = 110 char = -;code = 45 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = ;code = 32 char = c;code = 99 char = y;code = 121 char = c;code = 99 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = .;code = 46 char = ;code = 32 char = L;code = 76 char = o;code = 111 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = e;code = 101 char = m;code = 109 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = n;code = 110 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = i;code = 105 char = m;code = 109 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = e;code = 101 char = r;code = 114 char = t;code = 116 char = n;code = 110 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = ;;code = 59 char = ;code = 32 char = h;code = 104 char = i;code = 105 char = g;code = 103 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = g;code = 103 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = r;code = 114 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = e;code = 101 char = m;code = 109 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = l;code = 108 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = e;code = 101 char = r;code = 114 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = j;code = 106 char = u;code = 117 char = n;code = 110 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = i;code = 105 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = y;code = 121 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = l;code = 108 char = e;code = 101 char = e;code = 101 char = p;code = 112 char = -;code = 45 char = a;code = 97 char = t;code = 116 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = e;code = 101 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = .;code = 46 result sql = OBJECTIVE : Our study aimed to evaluate the existence and entity of changes in sleep structure following vagus nerve stimulation in patients with refractory epilepsy.METHOD : A polysomnographic study was performed on the nocturnal sleep of 10 subjects with refractory epilepsy. Subjects were recorded both in baseline conditions and after chronic vagus nerve stimulation. Sleep parameters of the entire night were evaluated. Mean power value of slow-wave activity was computed in the first non-rapid eye movement sleep cycle. A sleep-wake diary evaluated quantity of both nocturnal and daytime sleep, while visual-analog scales assessed quality of sleep and wake. The differences between the 2 conditions underwent parametric and nonparametric statistical evaluation.RESULTS : Vagus nerve stimulation produced a significant reduction in REM sleep (in all subjects with vagus nerve stimulus intensity greater than 1.5 milliampere, but not in the only patient with a stimulus intensity less than 1.5 milliampere), along with an increase in the number of awakenings, percentage of wake after sleep onset, and stage 1 sleep. Data from a sleep-wake questionnaire show a decrease in both nocturnal sleep and daytime naps and an increased daytime alertness, while the quality of wakefulness is globally improved. Spectral analysis shows an enhancement of delta power during non-rapid eye movement sleep.CONCLUSIONS : Our data demonstrate major effects of vagus nerve stimulation on both daytime alertness (which is improved) and nocturnal rapid eye movement sleep (which is reduced). These effects could be interpreted as the result of a destabilizing action of vagus nerve stimulation on neural structures regulating sleep-wake and rapid eye movement/non-rapid eye movement sleep cycles. Lower intensity vagus nerve stimulation seems only to improve alertness; higher intensity vagus nerve stimulation seems able to exert an adjunctive rapid eye movement sleep-attenuating effect.
Publication: Sleep 2003 Aug 1 ;26(5)::607-11.
Publication Date: 2003 Aug 1
Study Author(s): Rizzo, Pierpaolo;Beelke, Manolo;De Carli, Fabrizio;Canovaro, Paola;Nobili, Lino;Robert, Alice;Tanganelli, Paolo;Regesta, Giovanni;Ferrillo, Franco;
Institution: Sleep Medicine Center, DISMR, University of Genova, Italy.
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OBJECTIVE : Our study aimed to evaluate the existence and entity of changes in sleep structure following vagus nerve stimulation in patients with refractory epilepsy.METHOD : A polysomnographic study was performed on the nocturnal sleep of 10 subjects with refractory epilepsy. Subjects were recorded both in baseline conditions and after chronic vagus nerve stimulation. Sleep parameters of the entire night were evaluated. Mean power value of slow-wave activity was computed in the first non-rapid eye movement sleep cycle. A sleep-wake diary evaluated quantity of both nocturnal and daytime sleep, while visual-analog scales assessed quality of sleep and wake. The differences between the 2 conditions underwent parametric and nonparametric statistical evaluation.RESULTS : Vagus nerve stimulation produced a significant reduction in REM sleep (in all subjects with vagus nerve stimulus intensity greater than 1.5 milliampere, but not in the only patient with a stimulus intensity less than 1.5 milliampere), along with an increase in the number of awakenings, percentage of wake after sleep onset, and stage 1 sleep. Data from a sleep-wake questionnaire show a decrease in both nocturnal sleep and daytime naps and an increased daytime alertness, while the quality of wakefulness is globally improved. Spectral analysis shows an enhancement of delta power during non-rapid eye movement sleep.CONCLUSIONS : Our data demonstrate major effects of vagus nerve stimulation on both daytime alertness (which is improved) and nocturnal rapid eye movement sleep (which is reduced). These effects could be interpreted as the result of a destabilizing action of vagus nerve stimulation on neural structures regulating sleep-wake and rapid eye movement/non-rapid eye movement sleep cycles. Lower intensity vagus nerve stimulation seems only to improve alertness; higher intensity vagus nerve stimulation seems able to exert an adjunctive rapid eye movement sleep-attenuating effect.
PMID: 12938816