J.L. Corning and vagal nerve stimulation for seizures in the 1880s

Abstract

Beginning in the late 18th century, facial flushing and bounding carotid artery pulses during seizures were seen as evidence that seizures resulted from “venous hyperaemia” of the CNS. Consequently, physicians used digital compression of the carotid artery, and later carotid ligation, to abort seizures. In the early 1880s, New York neurologist James Leonard Corning (1855–1923) developed several instruments for carotid artery compression in the treatment of seizures. These devices included a two-pronged, fork-like instrument (the “carotid fork”) for temporary compression as an abortive treatment and an adjustable belt-like instrument to encircle the neck (the “carotid truss”) for chronic compression as a prophylactic treatment. Corning’s uncontrolled observations suggested that the abortive treatment decreased the duration of seizures and that the prophylactic treatment decreased the frequency of seizures. Corning later combined instrumented carotid artery compression with other devices to decrease cerebral blood flow, including transcutaneous electrical vagal nerve and cervical sympathetic stimulation. Observed side effects of treatment included bradycardia, dizziness, and syncope. Corning’s use of instrumented carotid compression and his precocious application of transcutaneous electrical vagal nerve stimulation were not widely adopted by neurologists, and these techniques and devices ultimately were abandoned in the late 19th century.