Vagus nerve stimulation for reactive attachment disorder.

摘要

Reactive Attachment Disorder (RAD) is a potential consequence of pervasive neglectful and unpredictable caregiving behaviors, and has extensive psychological and daunting consequences on the vulnerable and developing young brain. Current treatment strategies for RAD are conspicuously lacking, relying on indiscriminately targeted psychopharmacological therapies with pharmacokinetic and pharmacodynamic complications due to developmental vulnerabilities, and the unavailability of evidence based psychotherapeutic interventions. At present, there is an acute demand for innovative research into more developmentally sensitive and neurobiologically targeted treatment strategies for this population, and as a result, Vagus Nerve Stimulation (VNS) is being proposed as a potentially efficacious treatment for children with RAD due to the targeted effects on limbic system structures and neurotransmitter systems that are directly implicated in the neurobiology of RAD. Rationale for the use of VNS in the pediatric RAD population is based upon evidence from the safety and efficacy of VNS in the pediatric epileptic population, in conjunction with the fairly consistent observed anxiolytic and mood stabilizing effects reported in multiple clinical studies.