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Lee TW, Li CSR, Tramontano G. Tripod transcranial alternating current stimulation at 5-Hz to alleviate anxiety symptoms: A preliminary report. J Affect Disord 2024; 360:156-162. [PMID: 38821364 DOI: 10.1016/j.jad.2024.05.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION One of the most common applications of transcranial electrical stimulation (tES) at low current intensity is to induce a relaxed state or reduce anxiety. With technical advancement, different waveforms, montages, and parameters can be incorporated into the treatment regimen. We developed a novel protocol to treat individuals with anxiety disorders by transcranial alternating current stimulation (tACS). METHODS A total of 27 individuals with anxiety disorders underwent tACS treatment for 12 sessions, with each session lasting 25 min. tACS at 5 Hz was applied to F4 (1.0 mA), P4 (1.0 mA), and T8 (2.0 mA) EEG lead positions (tripod), with sinewave oscillation between T8 and F4/P4. We evaluated the primary and secondary outcomes using the Beck Anxiety Inventory (BAI) and neuropsychological assessments. RESULTS Of the 27 patients, 19 (70.4 %) experienced a reduction in symptom severity >50 %, with an average reduction of BAI 58.5 %. All reported side effects were mild, with itching or tingling being the most common complaint. No significant differences were noted in attention, linguistic working memory, visuospatial working memory, or long-term memory in neuropsychological assessments. CONCLUSION The results suggest the potential of this novel tripod tACS design as a rapid anxiety alleviator and the importance of a clinical trial to verify its efficacy.
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Affiliation(s)
- Tien-Wen Lee
- The NeuroCognitive Institute (NCI) Clinical Research Foundation, NJ 07856, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, USA; Wu Tsai Institute, Yale University, New Haven, CT 06520, USA.
| | - Gerald Tramontano
- The NeuroCognitive Institute (NCI) Clinical Research Foundation, NJ 07856, USA.
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Kent RD. The Feel of Speech: Multisystem and Polymodal Somatosensation in Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1424-1460. [PMID: 38593006 DOI: 10.1044/2024_jslhr-23-00575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE The oral structures such as the tongue and lips have remarkable somatosensory capacities, but understanding the roles of somatosensation in speech production requires a more comprehensive knowledge of somatosensation in the speech production system in its entirety, including the respiratory, laryngeal, and supralaryngeal subsystems. This review was conducted to summarize the system-wide somatosensory information available for speech production. METHOD The search was conducted with PubMed/Medline and Google Scholar for articles published until November 2023. Numerous search terms were used in conducting the review, which covered the topics of psychophysics, basic and clinical behavioral research, neuroanatomy, and neuroscience. RESULTS AND CONCLUSIONS The current understanding of speech somatosensation rests primarily on the two pillars of psychophysics and neuroscience. The confluence of polymodal afferent streams supports the development, maintenance, and refinement of speech production. Receptors are both canonical and noncanonical, with the latter occurring especially in the muscles innervated by the facial nerve. Somatosensory representation in the cortex is disproportionately large and provides for sensory interactions. Speech somatosensory function is robust over the lifespan, with possible declines in advanced aging. The understanding of somatosensation in speech disorders is largely disconnected from research and theory on speech production. A speech somatoscape is proposed as the generalized, system-wide sensation of speech production, with implications for speech development, speech motor control, and speech disorders.
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Yue M, Peng X, Chunlei G, Yi L, Shanshan G, Jifei S, Qingyan C, Bai Z, Yong L, Zhangjin Z, Peijing R, Jiliang F. Modulating the default mode network: Antidepressant efficacy of transcutaneous electrical cranial-auricular acupoints stimulation targeting the insula. Psychiatry Res Neuroimaging 2024; 339:111787. [PMID: 38295529 DOI: 10.1016/j.pscychresns.2024.111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/22/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is a novel non-invasive therapy for major depressive disorder (MDD) that stimulates acupoints innervated by the trigeminal and auricular vagus nerves. However, there are few neuroimaging studies involving the TECAS for the treatment of MDD. Therefore, this study aimed to investigate the treatment response and neurological effects of TECAS using resting-state functional magnetic resonance imaging (rs-fMRI). METHOD A total of 34 patients with mild-to-moderate MDD and 34 demographically matched healthy controls (HCs) were recruited. After an eight-week treatment the primary outcome was clinical response, defined as a baseline-to-endpoint ≥ 50 % reduction in the 17-item Hamilton Depression Rating Scale (HAMD-17). The low-frequency fluctuations (ALFF) method were used to investigate the brain abnormalities of MDD patients and HCs, and altered brain networks were analyzed between pre- and post-treatment using seed-based functional connectivity (FC) analysis. RESULTS We found no significant differences in terms of gender, age, and years of education between the two groups. After treatment, the response rate was 58.82 %. Compared to HCs, MDD patients showed lower ALFF values in the left insula(t = -4.298,P < 0.005), the insula-based FC revealed in the right middle frontal gyrus (MFG)/ right superior frontal gyrus, orbital part (ORBsupmed) (t = -5.29,P < 0.005) and the right anterior cingulate gyrus (ACC)were decreased (t = -6.08,P < 0.005). Furthermore, Compared to pre-treatment, abnormal FC values in the ACC /orbital superior frontal gyrus (SFG) (t = 3.42,P < 0.005) and left superior frontal gyrus (SFG)/ supplement motor area (SMA) were enhanced (t = 3.34,P < 0.005). CONCLUSION TECAS exhibits antidepressant efficacy, particularly influencing the insula-based functional connections within the Default Mode Network (DMN) related to emotion processing in individuals with MDD.
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Affiliation(s)
- Ma Yue
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xu Peng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China
| | - Guo Chunlei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Luo Yi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Gao Shanshan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Sun Jifei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Chen Qingyan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Zhenjun Bai
- College of Traditional Chinese Medicine Health Service, Shanxi Datong University, Datong, 037009, Shanxi Province, China
| | - Liu Yong
- Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, 646000, Luzhou, China
| | - Zhang Zhangjin
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Rong Peijing
- Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Fang Jiliang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China.
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Jigo M, Carmel JB, Wang Q, Rodenkirch C. Transcutaneous cervical vagus nerve stimulation improves sensory performance in humans: a randomized controlled crossover pilot study. Sci Rep 2024; 14:3975. [PMID: 38368486 PMCID: PMC10874458 DOI: 10.1038/s41598-024-54026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/07/2024] [Indexed: 02/19/2024] Open
Abstract
Accurate senses depend on high-fidelity encoding by sensory receptors and error-free processing in the brain. Progress has been made towards restoring damaged sensory receptors. However, methods for on-demand treatment of impaired central sensory processing are scarce. Prior invasive studies demonstrated that continuous vagus nerve stimulation (VNS) in rodents can activate the locus coeruleus-norepinephrine system to rapidly improve central sensory processing. Here, we investigated whether transcutaneous VNS improves sensory performance in humans. We conducted three sham-controlled experiments, each with 12 neurotypical adults, that measured the effects of transcutaneous VNS on metrics of auditory and visual performance, and heart rate variability (HRV). Continuous stimulation was delivered to cervical (tcVNS) or auricular (taVNS) branches of the vagus nerve while participants performed psychophysics tasks or passively viewed a display. Relative to sham stimulation, tcVNS improved auditory performance by 37% (p = 0.00052) and visual performance by 23% (p = 0.038). Participants with lower performance during sham conditions experienced larger tcVNS-evoked improvements (p = 0.0040). Lastly, tcVNS increased HRV during passive viewing, corroborating vagal engagement. No evidence for an effect of taVNS was observed. These findings validate the effectiveness of tcVNS in humans and position it as a method for on-demand interventions of impairments associated with central sensory processing dysfunction.
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Affiliation(s)
| | - Jason B Carmel
- Sharper Sense, Inc., New York, NY, USA
- Department of Neurology and Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Qi Wang
- Sharper Sense, Inc., New York, NY, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Charles Rodenkirch
- Sharper Sense, Inc., New York, NY, USA.
- The Jacobs Technion-Cornell Institute at Cornell Tech, New York, NY, USA.
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Yan L, Wu L, Li H, Qian Y, Wang M, Wang Y, Dou B, Yu T. Effect of non-invasive neuromodulation techniques on vascular cognitive impairment: A Bayesian network meta-analysis protocol. PLoS One 2024; 19:e0284447. [PMID: 38175852 PMCID: PMC10766188 DOI: 10.1371/journal.pone.0284447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND VCI is a severe public health problem facing the world today. In addition to pharmacological treatment, non-invasive neuromodulation techniques have also been effective. At this stage, non-invasive neuromodulation techniques combined with pharmacological treatment are the mainstay of clinical treatment, and clinical trials are continuing to be conducted, which is becoming the direction of treatment for VCI. Therefore, we outline this systematic review and network meta-analysis protocol to evaluate and rank clinical data in future studies which can develop optimal protocols for the clinical treatment of VCI with non-invasive neuromodulation techniques in combination with drugs. METHODS The network meta-analysis will search eight databases, including PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Infrastructure Library (CNKI), China Biology Medicine disc (CBM)), Wanfang Data Knowledge Service Platform and Vipshop Journal Service Platform (VIP), for a period of from the establishment of the library to January 30 2022. The quality of the studies will be evaluated using the Cochrane Review's Handbook 5.1 and the PEDro scale to assess the evidence and quality of the included randomised controlled trials. Risk of bias assessment and heterogeneity tests will be performed using the Review Manager 5.4 program, and Bayesian network meta-analysis will be performed using the Stata 16.0 and WinBUGS 1.4.3 program. RESULTS The results of the network meta-analysis will be published in a peer-reviewed journal. CONCLUSIONS Our study is expected to provide high quality evidence-based medical evidence for the treatment of VCI by clinicians. TRIAL REGISTRATION PROSPERO: CRD42022308580.
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Affiliation(s)
- Long Yan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, P. R. China
| | - Linna Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, P. R. China
| | - Hong Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, P. R. China
| | - Yulin Qian
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Meng Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Yu Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Baomin Dou
- Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
| | - Tao Yu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, P. R. China
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Jigo M, Carmel JB, Wang Q, Rodenkirch C. Transcutaneous cervical vagus nerve stimulation improves sensory performance in humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.08.08.552508. [PMID: 37609169 PMCID: PMC10441305 DOI: 10.1101/2023.08.08.552508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Accurate senses depend on high-fidelity encoding by sensory receptors and error-free processing in the brain. Progress has been made towards restoring damaged sensory receptors. However, methods for on-demand treatment of impaired central sensory processing are scarce. Prior invasive studies demonstrated that continuous vagus nerve stimulation (VNS) in rodents can activate the locus coeruleus-norepinephrine system to rapidly improve central sensory processing. Here, we investigated whether transcutaneous VNS improves sensory performance in humans. We conducted three sham-controlled experiments, each with 12 neurotypical adults, that measured the effects of transcutaneous VNS on metrics of auditory and visual performance, and heart rate variability (HRV). Continuous stimulation was delivered to cervical (tcVNS) or auricular (taVNS) branches of the vagus nerve while participants performed psychophysics tasks or passively viewed a display. Relative to sham stimulation, tcVNS improved auditory performance by 37% (p=0.00052) and visual performance by 23% (p=0.038). Participants with lower performance during sham conditions experienced larger tcVNS-evoked improvements (p=0.0040). Lastly, tcVNS increased HRV during passive viewing, corroborating vagal engagement. No evidence for an effect of taVNS was observed. These findings validate the effectiveness of tcVNS in humans and position it as a method for on-demand interventions of impairments associated with central sensory processing dysfunction.
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Affiliation(s)
| | - Jason B. Carmel
- Sharper Sense, Inc., New York, NY
- Department of Neurology and Orthopedics, Columbia University Medical Center, New York, NY
| | - Qi Wang
- Sharper Sense, Inc., New York, NY
- Department of Biomedical Engineering, Columbia University, New York, NY
| | - Charles Rodenkirch
- Sharper Sense, Inc., New York, NY
- The Jacobs Technion-Cornell Institute at Cornell Tech, New York, NY
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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8
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Moazzami K, Pearce BD, Gurel NZ, Wittbrodt MT, Levantsevych OM, Huang M, Shandhi MMH, Herring I, Murrah N, Driggers E, Alkhalaf ML, Soudan M, Shallenberger L, Hankus AN, Nye JA, Vaccarino V, Shah AJ, Inan OT, Bremner JD. Transcutaneous vagal nerve stimulation modulates stress-induced plasma ghrelin levels: A double-blind, randomized, sham-controlled trial. J Affect Disord 2023; 342:85-90. [PMID: 37714385 PMCID: PMC10698687 DOI: 10.1016/j.jad.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Transcutaneous cervical vagus nerve stimulation (tcVNS) has emerged as a potential treatment strategy for patients with stress-related psychiatric disorders. Ghrelin is a hormone that has been postulated to be a biomarker of stress. While the mechanisms of action of tcVNS are unclear, we hypothesized that tcVNS reduces the levels of ghrelin in response to stress. METHODS Using a randomized double-blind approach, we studied the effects of tcVNS on ghrelin levels in individuals with a history of exposure to traumatic stress. Participants received either sham (n = 29) or active tcVNS (n = 26) after exposure to acute personalized traumatic script stress and mental stress challenges (public speech, mental arithmetic) over a three day period. RESULTS There were no significant differences in the levels of ghrelin between the tcVNS and sham stimulation groups at either baseline or in the absence of trauma scripts. However, tcVNS in conjunction with personalized traumatic scripts resulted in lower ghrelin levels compared to the sham stimulation group (265.2 ± 143.6 pg/ml vs 478.7 ± 349.2 pg/ml, P = 0.01). Additionally, after completing the public speaking and mental arithmetic tests, ghrelin levels were found to be lower in the group receiving tcVNS compared to the sham group (293.3 ± 102.4 pg/ml vs 540.3 ± 203.9 pg/ml, P = 0.009). LIMITATIONS Timing of ghrelin measurements, and stimulation of only left vagus nerve. CONCLUSION tcVNS decreases ghrelin levels in response to various stressful stimuli. These findings are consistent with a growing literature that tcVNS modulates hormonal and autonomic responses to stress.
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Affiliation(s)
- Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Bradley D Pearce
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Nil Z Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - Matthew T Wittbrodt
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Md Mobashir H Shandhi
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Isaias Herring
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America; Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - MhmtJamil L Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Majd Soudan
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Allison N Hankus
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America; Atlanta VA Medical Center, Decatur, GA, United States of America
| | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America; Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Atlanta VA Medical Center, Decatur, GA, United States of America
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Monaco A, Cattaneo R, Di Nicolantonio S, Strada M, Altamura S, Ortu E. Central effects of trigeminal electrical stimulation. Cranio 2023:1-24. [PMID: 38032105 DOI: 10.1080/08869634.2023.2280153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This is a review of the literature on the main neuromodulation techniques, focusing on the possibility of introducing sensory threshold ULFTENS into them. Electro neuromodulation techniques have been in use for many years as promising methods of therapy for cognitive and emotional disorders. One of the most widely used forms of stimulation for orofacial pain is transcutaneous trigeminal stimulation on three levels: supraorbital area, dorsal surface of the tongue, and anterior skin area of the tragus. The purpose of this review is to trigger interest on using dental ULFTENS as an additional trigeminal neurostimulation and neuromodulation technique in the context of TMD. In particular, we point out the possibility of using ULFTENS at a lower activation level than that required to trigger a muscle contraction that is capable of triggering effects at the level of the autonomic nervous system, with extreme ease of execution and few side effects.
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Affiliation(s)
- Annalisa Monaco
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Ruggero Cattaneo
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | | | - Marco Strada
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Serena Altamura
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Ortu
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
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Macionis V. Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review. Curr Pain Headache Rep 2023; 27:775-791. [PMID: 37837483 DOI: 10.1007/s11916-023-01174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Surgical deactivation of migraine trigger sites by extracranial neurovascular decompression has produced encouraging results and challenged previous understanding of primary headaches. However, there is a lack of in-depth discussions on the pathophysiological basis of migraine surgery. This narrative review provides interpretation of relevant literature from the perspective of compressive neuropathic etiology, pathogenesis, and pathophysiology of migraine. RECENT FINDINGS Vasodilation, which can be asymptomatic in healthy subjects, may produce compression of cranial nerves in migraineurs at both extracranial and intracranial entrapment-prone sites. This may be predetermined by inherited and acquired anatomical factors and may include double crush-type lesions. Neurovascular compression can lead to sensitization of the trigeminal pathways and resultant cephalic hypersensitivity. While descending (central) trigeminal activation is possible, symptomatic intracranial sensitization can probably only occur in subjects who develop neurovascular entrapment of cranial nerves, which can explain why migraine does not invariably afflict everyone. Nerve compression-induced focal neuroinflammation and sensitization of any cranial nerve may neurogenically spread to other cranial nerves, which can explain the clinical complexity of migraine. Trigger dose-dependent alternating intensity of sensitization and its synchrony with cyclic central neural activities, including asymmetric nasal vasomotor oscillations, may explain the laterality and phasic nature of migraine pain. Intracranial allodynia, i.e., pain sensation upon non-painful stimulation, may better explain migraine pain than merely nociceptive mechanisms, because migraine cannot be associated with considerable intracranial structural changes and consequent painful stimuli. Understanding migraine as an intracranial allodynia could stimulate research aimed at elucidating the possible neuropathic compressive etiology of migraine and other primary headaches.
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Li J, Wu C, Zeng M, Zhang Y, Wei D, Sun J, Fan H. Functional material-mediated wireless physical stimulation for neuro-modulation and regeneration. J Mater Chem B 2023; 11:9056-9083. [PMID: 37649427 DOI: 10.1039/d3tb01354e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Nerve injuries and neurological diseases remain intractable clinical challenges. Despite the advantages of stem cell therapy in treating neurological disorders, uncontrollable cell fates and loss of cell function in vivo are still challenging. Recently, increasing attention has been given to the roles of external physical signals, such as electricity and ultrasound, in regulating stem cell fate as well as activating or inhibiting neuronal activity, which provides new insights for the treatment of neurological disorders. However, direct physical stimulations in vivo are short in accuracy and safety. Functional materials that can absorb energy from a specific physical field exerted in a wireless way and then release another localized physical signal hold great advantages in mediating noninvasive or minimally invasive accurate indirect physical stimulations to promote the therapeutic effect on neurological disorders. In this review, the mechanism by which various physical signals regulate stem cell fate and neuronal activity is summarized. Based on these concepts, the approaches of using functional materials to mediate indirect wireless physical stimulation for neuro-modulation and regeneration are systematically reviewed. We expect that this review will contribute to developing wireless platforms for neural stimulation as an assistance for the treatment of neurological diseases and injuries.
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Affiliation(s)
- Jialu Li
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
| | - Chengheng Wu
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
- Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu 610065, Sichuan, China
| | - Mingze Zeng
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
| | - Yusheng Zhang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
| | - Dan Wei
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
| | - Jing Sun
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
| | - Hongsong Fan
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, Sichuan, China.
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Westwood SJ, Conti AA, Tang W, Xue S, Cortese S, Rubia K. Clinical and cognitive effects of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders: a systematic review and meta-analysis. Mol Psychiatry 2023; 28:4025-4043. [PMID: 37674019 PMCID: PMC10827664 DOI: 10.1038/s41380-023-02227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
This pre-registered (CRD42022322038) systematic review and meta-analysis investigated clinical and cognitive outcomes of external trigeminal nerve stimulation (eTNS) in neurological and psychiatric disorders. PubMed, OVID, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP database for Chinese technical periodicals were searched (until 16/03/2022) to identify trials investigating cognitive and clinical outcomes of eTNS in neurological or psychiatric disorders. The Cochrane Risk of Bias 2.0 tool assessed randomized controlled trials (RCTs), while the Risk of Bias of Non-Randomized Studies (ROBINS-I) assessed single-arm trials. Fifty-five peer-reviewed articles based on 48 (27 RCTs; 21 single-arm) trials were included, of which 12 trials were meta-analyzed (N participants = 1048; of which ~3% ADHD, ~3% Epilepsy, ~94% Migraine; age range: 10-49 years). The meta-analyses showed that migraine pain intensity (K trials = 4, N = 485; SMD = 1.03, 95% CI[0.84-1.23]) and quality of life (K = 2, N = 304; SMD = 1.88, 95% CI[1.22-2.53]) significantly improved with eTNS combined with anti-migraine medication. Dimensional measures of depression improved with eTNS across 3 different disorders (K = 3, N = 111; SMD = 0.45, 95% CI[0.01-0.88]). eTNS was well-tolerated, with a good adverse event profile across disorders. eTNS is potentially clinically relevant in other disorders, but well-blinded, adequately powered RCTs must replicate findings and support optimal dosage guidance.
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Affiliation(s)
- Samuel J Westwood
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK.
- Department of Psychology, School of Social Science, University of Westminster, London, UK.
| | - Aldo Alberto Conti
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wanjie Tang
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Xue
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Technical University Dresden, Dresden, Germany
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Abyzova E, Dogadina E, Rodriguez RD, Petrov I, Kolesnikova Y, Zhou M, Liu C, Sheremet E. Beyond Tissue replacement: The Emerging role of smart implants in healthcare. Mater Today Bio 2023; 22:100784. [PMID: 37731959 PMCID: PMC10507164 DOI: 10.1016/j.mtbio.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
Smart implants are increasingly used to treat various diseases, track patient status, and restore tissue and organ function. These devices support internal organs, actively stimulate nerves, and monitor essential functions. With continuous monitoring or stimulation, patient observation quality and subsequent treatment can be improved. Additionally, using biodegradable and entirely excreted implant materials eliminates the need for surgical removal, providing a patient-friendly solution. In this review, we classify smart implants and discuss the latest prototypes, materials, and technologies employed in their creation. Our focus lies in exploring medical devices beyond replacing an organ or tissue and incorporating new functionality through sensors and electronic circuits. We also examine the advantages, opportunities, and challenges of creating implantable devices that preserve all critical functions. By presenting an in-depth overview of the current state-of-the-art smart implants, we shed light on persistent issues and limitations while discussing potential avenues for future advancements in materials used for these devices.
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Affiliation(s)
- Elena Abyzova
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | - Elizaveta Dogadina
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | | | - Ilia Petrov
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | | | - Mo Zhou
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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14
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Sharif NA. Electrical, Electromagnetic, Ultrasound Wave Therapies, and Electronic Implants for Neuronal Rejuvenation, Neuroprotection, Axonal Regeneration, and IOP Reduction. J Ocul Pharmacol Ther 2023; 39:477-498. [PMID: 36126293 DOI: 10.1089/jop.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The peripheral nervous system (PNS) of mammals and nervous systems of lower organisms possess significant regenerative potential. In contrast, although neural plasticity can provide some compensation, the central nervous system (CNS) neurons and nerves of adult mammals generally fail to regenerate after an injury or damage. However, use of diverse electrical, electromagnetic and sonographic energy waves are illuminating novel ways to stimulate neuronal differentiation, proliferation, neurite growth, and axonal elongation/regeneration leading to various levels of functional recovery in animals and humans afflicted with disorders of the CNS, PNS, retina, and optic nerve. Tools such as acupuncture, electroacupuncture, electroshock therapy, electrical stimulation, transcranial magnetic stimulation, red light therapy, and low-intensity pulsed ultrasound therapy are demonstrating efficacy in treating many different maladies. These include wound healing, partial recovery from motor dysfunctions, recovery from ischemic/reperfusion insults and CNS and ocular remyelination, retinal ganglion cell (RGC) rejuvenation, and RGC axonal regeneration. Neural rejuvenation and axonal growth/regeneration processes involve activation or intensifying of the intrinsic bioelectric waves (action potentials) that exist in every neuronal circuit of the body. In addition, reparative factors released at the nerve terminals and via neuronal dendrites (transmitter substances), extracellular vesicles containing microRNAs and neurotrophins, and intercellular communication occurring via nanotubes aid in reestablishing lost or damaged connections between the traumatized tissues and the PNS and CNS. Many other beneficial effects of the aforementioned treatment paradigms are mediated via gene expression alterations such as downregulation of inflammatory and death-signal genes and upregulation of neuroprotective and cytoprotective genes. These varied techniques and technologies will be described and discussed covering cell-based and animal model-based studies. Data from clinical applications and linkage to human ocular diseases will also be discussed where relevant translational research has been reported.
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Affiliation(s)
- Najam A Sharif
- Global Alliances and External Research, Ophthalmology Innovation Center, Santen Inc., Emeryville, California, USA
- Singapore Eye Research Institute (SERI), Singapore
- SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore
- Department of Surgery and Cancer, Imperial College of Science and Technology, London, United Kingdom
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, Texas, USA
- Department of Pharmacy Sciences, Creighton University, Omaha, Nebraska, USA
- Insitute of Ophthalmology, University College London (UCL), London, United Kingdom
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15
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Mercante B, Enrico P, Deriu F. Cognitive Functions following Trigeminal Neuromodulation. Biomedicines 2023; 11:2392. [PMID: 37760833 PMCID: PMC10525298 DOI: 10.3390/biomedicines11092392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Vast scientific effort in recent years have been focused on the search for effective and safe treatments for cognitive decline. In this regard, non-invasive neuromodulation has gained increasing attention for its reported effectiveness in promoting the recovery of multiple cognitive domains after central nervous system damage. In this short review, we discuss the available evidence supporting a possible cognitive effect of trigeminal nerve stimulation (TNS). In particular, we ask that, while TNS has been widely and successfully used in the treatment of various neuropsychiatric conditions, as far as research in the cognitive field is concerned, where does TNS stand? The trigeminal nerve is the largest cranial nerve, conveying the sensory information from the face to the trigeminal sensory nuclei, and from there to the thalamus and up to the somatosensory cortex. On these bases, a bottom-up mechanism has been proposed, positing that TNS-induced modulation of the brainstem noradrenergic system may affect the function of the brain networks involved in cognition. Nevertheless, despite the promising theories, to date, the use of TNS for cognitive empowering and/or cognitive decline treatment has several challenges ahead of it, mainly due to little uniformity of the stimulation protocols. However, as the field continues to grow, standardization of practice will allow for data comparisons across studies, leading to optimized protocols targeting specific brain circuitries, which may, in turn, influence cognition in a designed manner.
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Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
| | - Paolo Enrico
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
- AOU Sassari, Unit of Endocrinology, Nutritional and Metabolic Disorders, 07100 Sassari, Italy
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Tramonti Fantozzi MP, De Cicco V, d’Ascanio P, Cataldo E, De Cicco D, Bruschini L, Barresi M, Faraguna U, Manzoni D. Trigeminal Stimulation and Visuospatial Performance: The Struggle between Chewing and Trigeminal Asymmetries. Biomedicines 2023; 11:2307. [PMID: 37626803 PMCID: PMC10452603 DOI: 10.3390/biomedicines11082307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/31/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Chewing improves visuospatial performance through locus coeruleus (LC) activation. The effects of bilateral and unilateral mastication were investigated in subjects showing different degrees of asymmetry in masseter electromyographic (EMG) activity during clenching and in pupil size at rest (anisocoria), which is a proxy of LC imbalance. Correlations between performance changes and asymmetry values were found in males, but not in females. Among males, subjects with low asymmetry values (balanced-BAL) were more sensitive than those with high asymmetry values (imbalanced-IMB) to bilateral and unilateral chewing on the side with higher EMG activity (hypertonic). The opposite was true for hypotonic side chewing. BAL subjects were sensitive to unilateral chewing on both sides, while in IMB subjects, hypertonic side chewing did not influence performance in either males or females. Bilateral chewing elicited larger effects in BAL subjects than in IMB subjects, exceeding the values predicted from unilateral chewing in both groups. Finally, pupil size and anisocoria changes elicited by chewing were correlated with asymmetry values, independent of sex. Data confirmed the facilitation of visuospatial performance exerted by chewing. Trigeminal asymmetries modulate the chewing effects, making occlusal rebalancing an appropriate strategy to improve performance.
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Affiliation(s)
- Maria Paola Tramonti Fantozzi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
| | - Vincenzo De Cicco
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
| | - Paola d’Ascanio
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
| | - Enrico Cataldo
- Department of Physics, University of Pisa, 56127 Pisa, Italy
| | - Davide De Cicco
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
| | - Luca Bruschini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Massimo Barresi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
| | - Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Diego Manzoni
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56123 Pisa, Italy
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17
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Bremner JD, Gazi AH, Lambert TP, Nawar A, Harrison AB, Welsh JW, Vaccarino V, Walton KM, Jaquemet N, Mermin-Bunnell K, Mesfin H, Gray TA, Ross K, Saks G, Tomic N, Affadzi D, Bikson M, Shah AJ, Dunn KE, Giordano NA, Inan OT. Noninvasive Vagal Nerve Stimulation for Opioid Use Disorder. ANNALS OF DEPRESSION AND ANXIETY 2023; 10:1117. [PMID: 38074313 PMCID: PMC10699253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Background Opioid Use Disorder (OUD) is an escalating public health problem with over 100,000 drug overdose-related deaths last year most of them related to opioid overdose, yet treatment options remain limited. Non-invasive Vagal Nerve Stimulation (nVNS) can be delivered via the ear or the neck and is a non-medication alternative to treatment of opioid withdrawal and OUD with potentially widespread applications. Methods This paper reviews the neurobiology of opioid withdrawal and OUD and the emerging literature of nVNS for the application of OUD. Literature databases for Pubmed, Psychinfo, and Medline were queried for these topics for 1982-present. Results Opioid withdrawal in the context of OUD is associated with activation of peripheral sympathetic and inflammatory systems as well as alterations in central brain regions including anterior cingulate, basal ganglia, and amygdala. NVNS has the potential to reduce sympathetic and inflammatory activation and counter the effects of opioid withdrawal in initial pilot studies. Preliminary studies show that it is potentially effective at acting through sympathetic pathways to reduce the effects of opioid withdrawal, in addition to reducing pain and distress. Conclusions NVNS shows promise as a non-medication approach to OUD, both in terms of its known effect on neurobiology as well as pilot data showing a reduction in withdrawal symptoms as well as physiological manifestations of opioid withdrawal.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
- Atlanta Veterans Affairs Healthcare System, Decatur GA
| | - Asim H Gazi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Tamara P Lambert
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Afra Nawar
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Anna B Harrison
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Justine W Welsh
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta GA
| | - Kevin M Walton
- Clinical Research Grants Branch, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD
| | - Nora Jaquemet
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Kellen Mermin-Bunnell
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Hewitt Mesfin
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Trinity A Gray
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Keyatta Ross
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Georgia Saks
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Nikolina Tomic
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Danner Affadzi
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY
| | - Amit J Shah
- Atlanta Veterans Affairs Healthcare System, Decatur GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta GA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
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18
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Song CB, Lim C, Lee J, Kim D, Seo H. The effect of deep brain structure modeling on transcranial direct current stimulation-induced electric fields: An in-silico study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082988 DOI: 10.1109/embc40787.2023.10339959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
To study transcranial direct current stimulation (tDCS) and its effect on the brain, it could be useful to predict the distribution of the electric field induced in the brain with given tDCS parameters. As a solution, simulation with realistic computational models using magnetic resonance images (MRIs) have been widely used in the fields. With the recent advance of deep learning-based segmentation techniques of the brain, questions have been raised about if tDCS-induced electric field is affected by the deep brain structures. This study aimed to investigate the effect of the deep brain structure modeling on the induced electric field. To this end, we generated models with and without the deep brain structures by using an open MRI dataset comprising tDCS parameters, electric field simulation results and in-vivo intracranial recordings in the deep brain structures. We investigated the difference between the simulation results of the two models with a statistical analysis. Our results indicated that tDCS-induced electric fields and current flow in the brain are significantly different when the deep brain structures are considered.
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Peng X, Baker-Vogel B, Sarhan M, Short EB, Zhu W, Liu H, Kautz S, Badran BW. Left or right ear? A neuroimaging study using combined taVNS/fMRI to understand the interaction between ear stimulation target and lesion location in chronic stroke. Brain Stimul 2023; 16:1144-1153. [PMID: 37517466 DOI: 10.1016/j.brs.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Implanted vagus nerve stimulation (VNS) and transcutaneous auricular VNS (taVNS) have been primarily administered clinically to the unilateral-left vagus nerve. This left-only convention has proved clinically beneficial in brain disorders. However, in stroke survivors, the presence of a lesion in the brain may complicate VNS-mediated signaling, and it is important to understand the laterality effects of VNS in stroke survivors to optimize the intervention. OBJECTIVE To understand whether taVNS delivered to different ear targets relative to the lesion (ipsilesional vs contralesional vs bilateral vs sham) impacts blood oxygenation level dependent (BOLD) signal propagation in stroke survivors. METHODS We enrolled 20 adults with a prior history of stroke. Each participant underwent a single visit, during which taVNS was delivered concurrently during functional magnetic resonance imaging (fMRI) acquisition. Each participant received three discrete active stimulation conditions (ipsilesional, contralesional, bilateral) and one sham condition in a randomized order. Stimulation-related BOLD signal changes in the active conditions were compared to sham conditions to understand the interaction taVNS and laterality effects. RESULTS All active taVNS conditions deactivated the contralesional default mode network related regions compared to sham, however only ipsilesional taVNS enhanced the activations in the ipsilesional visuomotor and secondary visual cortex. Furthermore, we reveal an interaction in task activations between taVNS and cortical visuomotor areas, where ipsilesional taVNS significantly increased ipsilesional visuomotor activity and decreased contralesional visuomotor activity compared to sham. CONCLUSION Laterality of taVNS relative to the lesion is a critical factor in optimizing taVNS in a stroke population, with ipsilesional stimulation providing largest direct brain activation and should be explored further when designing taVNS studies in neurorehabilitation.
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Affiliation(s)
- Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Brenna Baker-Vogel
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Mutaz Sarhan
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Edward B Short
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesheng Liu
- Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Changping Laboratory, Beijing, China
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, USA; Deparment of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.
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Xu J, Wu S, Huo L, Zhang Q, Liu L, Ye Z, Cao J, Ma H, Shang C, Ma C. Trigeminal nerve stimulation restores hippocampal dopamine deficiency to promote cognitive recovery in traumatic brain injury. Prog Neurobiol 2023:102477. [PMID: 37270025 DOI: 10.1016/j.pneurobio.2023.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
Cognitive impairment (CI) is a common neurological disease resulting from traumatic brain injury (TBI). Trigeminal nerve stimulation (TNS) is an emerging, non-invasive, and effective neuromodulation therapy especially for patients suffering from brain function disorders. However, the treatment and recovery mechanisms of TNS remain poorly understood. By using combined advanced technologies, we revealed here that the neuroprotective potential of TNS to improve CI caused by TBI. The study results found that 40Hz TNS treatment has the ability to improve CI in TBI mice and communicates with central nervous system via the trigeminal ganglion (TG). Transsynaptic virus experiments revealed that TG is connected to the hippocampus (HPC) through the corticotropin-releasing hormone (CRH) neurons of paraventricular hypothalamic nucleus (PVN) and the dopamine transporter (DAT) neurons of substantia nigra pars compacta/ventral tegmental area (SNc/VTA). Mechanistically, the data showed that TNS can increase the release of dopamine in the HPC by activating the following neural circuit: TG→CRH+ PVN→DAT+ SNc/VTA → HPC. Bulk RNA sequencing confirmed changes in the expression of dopamine-related genes in the HPC. This work preliminarily explains the efficacy and mechanism of TNS and adds to the increasing evidence demonstrating that nerve stimulation is an effective method to treat neurological diseases. DATA AVAILABILITY: The data that support the findings of this study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Jing Xu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China
| | - Shaoling Wu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China
| | - Lifang Huo
- Guangzhou Laboratory, Guangzhou, 510005, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, 510005, China
| | - Qian Zhang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China
| | - Lijiaqi Liu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China
| | - Zhimin Ye
- Guangzhou Laboratory, Guangzhou, 510005, China
| | - Jie Cao
- Guangzhou Laboratory, Guangzhou, 510005, China
| | - Haiyun Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China
| | - Congping Shang
- Guangzhou Laboratory, Guangzhou, 510005, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, 510005, China; School of Basic Medical Sciences, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510005, China.
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, China.
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21
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Luckey AM, McLeod LS, Huang Y, Mohan A, Vanneste S. Making memories last using the peripheral effect of direct current stimulation. eLife 2023; 12:e75586. [PMID: 37204308 PMCID: PMC10241520 DOI: 10.7554/elife.75586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/18/2023] [Indexed: 05/20/2023] Open
Abstract
Most memories that are formed are forgotten, while others are retained longer and are subject to memory stabilization. We show that non-invasive transcutaneous electrical stimulation of the greater occipital nerve (NITESGON) using direct current during learning elicited a long-term memory effect. However, it did not trigger an immediate effect on learning. A neurobiological model of long-term memory proposes a mechanism by which memories that are initially unstable can be strengthened through subsequent novel experiences. In a series of studies, we demonstrate NITESGON's capability to boost the retention of memories when applied shortly before, during, or shortly after the time of learning by enhancing memory consolidation via activation and communication in and between the locus coeruleus pathway and hippocampus by plausibly modulating dopaminergic input. These findings may have a significant impact for neurocognitive disorders that inhibit memory consolidation such as Alzheimer's disease.
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Affiliation(s)
- Alison M Luckey
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Lauren S McLeod
- School of Medicine, Texas Tech School of MedicineLubbockUnited States
| | - Yuefeng Huang
- Department of Psychiatry, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Anusha Mohan
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Sven Vanneste
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
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22
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Luckey AM, Adcock K, Vanneste S. Peripheral nerve stimulation: A neuromodulation-based approach. Neurosci Biobehav Rev 2023; 149:105180. [PMID: 37059406 DOI: 10.1016/j.neubiorev.2023.105180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
Recent technological improvements have positioned us at the threshold of innovative discoveries that will assist in new perspectives and avenues of research. Increased attention has been directed towards peripheral nerve stimulation, particularly of the vagus, trigeminal, or greater occipital nerve, due to their unique pathway that engages neural circuits within networks involved in higher cognitive processes. Here, we question whether the effects of transcutaneous electrical stimulation are mediated by synergistic interactions of multiple neuromodulatory networks, considering this pathway is shared by more than one neuromodulatory system. By spotlighting this attractive transcutaneous pathway, this opinion piece aims to acknowledge the contributions of four vital neuromodulators and prompt researchers to consider them in future investigations or explanations.
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Affiliation(s)
- Alison M Luckey
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Katherine Adcock
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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23
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Byczynski G, Vanneste S. Modulating motor learning with brain stimulation: Stage-specific perspectives for transcranial and transcutaneous delivery. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110766. [PMID: 37044280 DOI: 10.1016/j.pnpbp.2023.110766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 04/14/2023]
Abstract
Brain stimulation has been used in motor learning studies with success in improving aspects of task learning, retention, and consolidation. Using a variety of motor tasks and stimulus parameters, researchers have produced an array of literature supporting the efficacy of brain stimulation to modulate motor task learning. We discuss the use of transcranial direct current stimulation, transcranial alternating current stimulation, and peripheral nerve stimulation to modulate motor learning. In a novel approach, we review literature of motor learning modulation in terms of learning stage, categorizing learning into acquisition, consolidation, and retention. We endeavour to provide a current perspective on the stage-specific mechanism behind modulation of motor task learning, to give insight into how electrical stimulation improves or hinders motor learning, and how mechanisms differ depending on learning stage. Offering a look into the effectiveness of peripheral nerve stimulation for motor learning, we include potential mechanisms and overlapping features with transcranial stimulation. We conclude by exploring how peripheral stimulation may contribute to the results of studies that employed brain stimulation intracranially.
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Affiliation(s)
- Gabriel Byczynski
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, D02 PN40, Ireland; Global Brain Health Institute, Trinity College Dublin, D02 PN40, Ireland
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, D02 PN40, Ireland; School of Psychology, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, D02 PN40, Ireland; Global Brain Health Institute, Trinity College Dublin, D02 PN40, Ireland.
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24
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Menzel S, Konstantinidis I, Valentini M, Battaglia P, Turri-Zanoni M, Sileo G, Monti G, Castelnuovo PGM, Hummel T, Macchi A. Surgical Approaches for Possible Positions of an Olfactory Implant to Stimulate the Olfactory Bulb. ORL J Otorhinolaryngol Relat Spec 2023; 85:253-263. [PMID: 36996786 PMCID: PMC10627492 DOI: 10.1159/000529563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/29/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Current scientific developments seem to allow for an "olfactory implant" in analogy to cochlear implants. However, the position and surgical approaches for electrical stimulation of the olfactory system are unclear. METHODS In a human anatomic cadaver study, we investigated different endoscopic approaches to electrically stimulate the olfactory bulb (OB) based on the following considerations: (1) the stimulating electrode should be close to the OB. (2) The surgical procedure should be as non-invasive and safe as possible and (3) as easy as possible for an experienced ENT surgeon. RESULTS In summary, the endoscopic intracranial positioning of the electrode via a widened ostium of the fila olfactoria or a frontal sinus surgery like a Draf IIb procedure is a good option in terms of patients' risk, degree of difficulty for ENT surgeons, and position to the OB. Endoscopic intranasal positioning appeared to be the best option in terms of patient risk and the degree of difficulty for ENT surgeons. Although a bigger approach to the OB using a drill and the combined intranasal endoscopic and external approach enabled a close placement of the electrode to the OB, they do not seem relevant in practice due to their higher invasiveness. CONCLUSION The study suggested that an intranasal positioning of a stimulating electrode is possible, with placements beneath the cribriform plate, extra- or intracranially, applying elegant surgical techniques with low or medium risk to the patient and a close placement to OB.
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Affiliation(s)
- Susanne Menzel
- Smell and Taste Clinic, Department of Otorhinolaryngology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Iordanis Konstantinidis
- Smell and Taste Clinic, 2nd ORL Academic Department, Aristotle University, Thessaloniki, Greece
| | - Marco Valentini
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giulia Monti
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alberto Macchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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25
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Tian QQ, Cheng C, Liu PH, Yin ZX, Zhang MK, Cui YP, Zhao R, Deng H, Lu LM, Tang CZ, Xu NG, Yang XJ, Sun JB, Qin W. Combined effect of transcutaneous auricular vagus nerve stimulation and 0.1 Hz slow-paced breathing on working memory. Front Neurosci 2023; 17:1133964. [PMID: 36968483 PMCID: PMC10034029 DOI: 10.3389/fnins.2023.1133964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundPrevious research has found that transcutaneous auricular vagus nerve stimulation (taVNS) can improve working memory (WM) performance. It has also been shown that 0.1 Hz slow-paced breathing (SPB, i.e., breathing at a rate of approximately 6 breaths/min) can significantly influence physical state and cognitive function via changes in autonomic afferent activity. In the present study, we investigated the synergistic effects of taVNS and SPB on WM performance.MethodsA total of 96 healthy people participated in this within-subjects experiment involving four conditions, namely taVNS, SPB, combined taVNS with SPB (taVNS + SPB), and sham. Each participant underwent each intervention for 30 min and WM was compared pre- and post-intervention using the spatial and digit n-back tasks in a random order four times. Permutation-based analysis of variance was used to assess the interaction between time and intervention.ResultsFor the spatial 3-back task, a significant interaction between time and intervention was found for the accuracy rate of matching trials (mACC, p = 0.03). Post hoc analysis suggested that both taVNS and taVNS + SPB improved WM performance, however, no significant difference was found in the SPB or sham groups.ConclusionThis study has replicated the effects of taVNS on WM performance reported in previous studies. However, the synergistic effects of combined taVNS and SPB warrant further research.
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Affiliation(s)
- Qian-Qian Tian
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Chen Cheng
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Peng-Hui Liu
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Zi-Xin Yin
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Meng-Kai Zhang
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Ya-Peng Cui
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Rui Zhao
- School of Electronics and Information, Xi’an Polytechnic University, Xi’an, Shaanxi, China
| | - Hui Deng
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
- Guangzhou Institute of Technology, Xidian University, Xi’an, Shaanxi, China
| | - Li-Ming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chun-Zhi Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Neng-Gui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xue-Juan Yang
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
- Guangzhou Institute of Technology, Xidian University, Xi’an, Shaanxi, China
- Xue-Juan Yang,
| | - Jin-Bo Sun
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
- Guangzhou Institute of Technology, Xidian University, Xi’an, Shaanxi, China
- *Correspondence: Jin-Bo Sun,
| | - Wei Qin
- Intelligent Non-Invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi’an, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
- Guangzhou Institute of Technology, Xidian University, Xi’an, Shaanxi, China
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26
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Murphy AJ, O'Neal AG, Cohen RA, Lamb DG, Porges EC, Bottari SA, Ho B, Trifilio E, DeKosky ST, Heilman KM, Williamson JB. The Effects of Transcutaneous Vagus Nerve Stimulation on Functional Connectivity Within Semantic and Hippocampal Networks in Mild Cognitive Impairment. Neurotherapeutics 2023; 20:419-430. [PMID: 36477709 PMCID: PMC10121945 DOI: 10.1007/s13311-022-01318-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 12/12/2022] Open
Abstract
Better treatments are needed to improve cognition and brain health in people with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Transcutaneous vagus nerve stimulation (tVNS) may impact brain networks relevant to AD through multiple mechanisms including, but not limited to, projection to the locus coeruleus, the brain's primary source of norepinephrine, and reduction in inflammation. Neuropathological data suggest that the locus coeruleus may be an early site of tau pathology in AD. Thus, tVNS may modify the activity of networks that are impaired and progressively deteriorate in patients with MCI and AD. Fifty patients with MCI (28 women) confirmed via diagnostic consensus conference prior to MRI (sources of info: Montreal Cognitive Assessment Test (MOCA), Clinical Dementia Rating scale (CDR), Functional Activities Questionnaire (FAQ), Hopkins Verbal Learning Test - Revised (HVLT-R) and medical record review) underwent resting state functional magnetic resonance imaging (fMRI) on a Siemens 3 T scanner during tVNS (left tragus, n = 25) or sham control conditions (left ear lobe, n = 25). During unilateral left tVNS, compared with ear lobe stimulation, patients with MCI showed alterations in functional connectivity between regions of the brain that are important in semantic and salience functions including regions of the temporal and parietal lobes. Furthermore, connectivity from hippocampi to several cortical and subcortical clusters of ROIs also demonstrated change with tVNS compared with ear lobe stimulation. In conclusion, tVNS modified the activity of brain networks in which disruption correlates with deterioration in AD. These findings suggest afferent target engagement of tVNS, which carries implications for the development of noninvasive therapeutic intervention in the MCI population.
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Affiliation(s)
- Aidan J Murphy
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Alexandria G O'Neal
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ronald A Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Damon G Lamb
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
| | - Eric C Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Sarah A Bottari
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Brian Ho
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Erin Trifilio
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kenneth M Heilman
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - John B Williamson
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, College of Medicine, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, USA.
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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27
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Zhang ZJ, Zhang SY, Yang XJ, Qin ZS, Xu FQ, Jin GX, Hou XB, Liu Y, Cai JF, Xiao HB, Wong YK, Zheng Y, Shi L, Zhang JN, Zhao YY, Xiao X, Zhang LL, Jiao Y, Wang Y, He JK, Chen GB, Rong PJ. Transcutaneous electrical cranial-auricular acupoint stimulation versus escitalopram for mild-to-moderate depression: An assessor-blinded, randomized, non-inferiority trial. Psychiatry Clin Neurosci 2023; 77:168-177. [PMID: 36445151 DOI: 10.1111/pcn.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AIM Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is a novel non-invasive therapy that stimulates acupoints innervated by the trigeminal and auricular vagus nerves. An assessor-blinded, randomized, non-inferiority trial was designed to compare the efficacy of TECAS and escitalopram in mild-to-moderate major depressive disorder. METHODS 468 participants received two TECAS sessions per day at home (n = 233) or approximately 10-13 mg/day escitalopram (n = 235) for 8 weeks plus 4-week follow-up. The primary outcome was clinical response, defined as a baseline-to-endpoint ≥50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score. Secondary outcomes included remission rate, changes in the severity of depression, anxiety, sleep and life quality. RESULTS The response rate was 66.4% on TECAS and 63.2% on escitalopram with a 3.2% difference (95% confidence interval [CI], -5.9% to 12.9%) in intention-to-treat analysis, and 68.5% versus 66.2% with a 2.3% difference (95% CI, -6.9% to 11.4%) in per-protocol analysis. The lower limit of 95% CI of the differences fell within the prespecified non-inferiority margin of -10% (P ≤ 0.004 for non-inferiority). Most secondary outcomes did not differ between the two groups. TECAS-treated participants who experienced psychological trauma displayed a markedly greater response than those without traumatic experience (81.3% vs 62.1%, P = 0.013). TECAS caused much fewer adverse events than escitalopram. CONCLUSIONS TECAS was comparable to escitalopram in improving depression and related symptoms, with high acceptability, better safety profile, and particular efficacy in reducing trauma-associated depression. It could serve an effective portable therapy for mild-to-moderate depression.
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Affiliation(s)
- Zhang-Jin Zhang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Shui-Yan Zhang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Xin-Jing Yang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Zong-Shi Qin
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Feng-Quan Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Gui-Xing Jin
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Bing Hou
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Yong Liu
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ji-Fu Cai
- Department of Neurology, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Hai-Bing Xiao
- Department of Neurology, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Yat Kwan Wong
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Yu Zheng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Lei Shi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Jin-Niu Zhang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan-Yuan Zhao
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Liu-Lu Zhang
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Jiao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China.,Department of TCM, Tsinghua University Hospital Beijing, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Jia-Kai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Guo-Bing Chen
- Department of Microbiology and Immunology, School of Medicine; Institute of Geriatric Immunology, School of Medicine, Jinan University, Guangzhou, China
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
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28
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Transcutaneous auricular vagus stimulation (taVNS) improves human working memory performance under sleep deprivation stress. Behav Brain Res 2023; 439:114247. [PMID: 36473677 DOI: 10.1016/j.bbr.2022.114247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Many human activities require high cognitive performance over long periods, while impairments induced by sleep deprivation influence various aspects of cognitive abilities, including working memory (WM), attention, and processing speed. Based on previous research, vagal nerve stimulation can modulate cognitive abilities, attention, and arousal. Two experiments were conducted to assess the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) to relieve the deleterious effects of sleep deprivation. In the first experiment, 35 participants completed N-back tasks at 8:00 a.m. for two consecutive days in a within-subject study. Then, the participants received either taVNS or earlobe stimulation (active control) intervention in two sessions at random orders after 24 h of sustained wakefulness. Then, they completed the N-back tasks again. In the second experiment, 30 participants completed the psychomotor vigilance task (PVT), and 32 completed the N-back tasks at 8:00 a.m. on the first and second days. Then, they received either taVNS or earlobe stimulation at random orders and finished the N-back and PVT tasks immediately after one hour. In Experiment 1, taVNS could significantly improve the accuracy rate of participants in spatial 3-back tasks compared to active control, which was consistent with experiment 2. However, taVNS did not specifically enhance PVT performance. Therefore, taVNS could be a powerful intervention for acute sleep deprivation as it can improve performance on high cognitive load tasks and is easy to administer.
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29
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Acute TMS/fMRI response explains offline TMS network effects - An interleaved TMS-fMRI study. Neuroimage 2023; 267:119833. [PMID: 36572133 DOI: 10.1016/j.neuroimage.2022.119833] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an FDA-approved therapeutic option for treatment resistant depression. However, exact mechanisms-of-action are not fully understood and individual responses are variable. Moreover, although previously suggested, the exact network effects underlying TMS' efficacy are poorly understood as of today. Although, it is supposed that DLPFC stimulation indirectly modulates the sgACC, recent evidence is sparse. METHODS Here, we used concurrent interleaved TMS/fMRI and state-of-the-science purpose-designed MRI head coils to delineate networks and downstream regions activated by DLPFC-TMS. RESULTS We show that regions of increased acute BOLD signal activation during TMS resemble a resting-state brain network previously shown to be modulated by offline TMS. There was a topographical overlap in wide spread cortical and sub-cortical areas within this specific RSN#17 derived from the 1000 functional connectomes project. CONCLUSION These data imply a causal relation between DLPFC-TMS and activation of the ACC and a broader network that has been implicated in MDD. In the broader context of our recent work, these data imply a direct relation between initial changes in BOLD activity mediated by connectivity to the DLPFC target site, and later consolidation of connectivity between these regions. These insights advance our understanding of the mechanistic targets of DLPFC-TMS and may provide novel opportunities to characterize and optimize TMS therapy in other neurological and psychiatric disorders.
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Short-term transcutaneous trigeminal nerve stimulation does not affect visual oddball task and paired-click paradigm ERP responses in healthy volunteers. Exp Brain Res 2023; 241:327-339. [PMID: 36515720 DOI: 10.1007/s00221-022-06525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Recent research suggests that transcutaneous trigeminal nerve stimulation (TNS) may positively affect cognitive function. However, no clear-cut evidence is available yet, since the majority of it derives from clinical studies, and the few data on healthy subjects show inconsistent results. In this study, we report the effects of short-term TNS on event-related potentials (ERP) recorded during the administration of a simple visual oddball task and a paired-click paradigm, both considered useful for studying brain information processing functions. Thirty-two healthy subjects underwent EEG recording before and after 20 min of sham- or real-TNS, delivered bilaterally to the infraorbital nerve. The amplitude and latency of P200 and P300 waves in the simple visual oddball task and P50, N100 and P200 waves in the paired-click paradigm were measured before and after treatment. Our results show that short-term TNS did not alter any of the ERP parameters measured, suggesting that in healthy subjects, short-term TNS may not affect brain processes involved in cognitive functions such as pre-attentional processes, early allocation of attention and immediate memory. The perspective of having an effective, non-pharmacological, non-invasive, and safe treatment option for cognitive decline is particularly appealing; therefore, more research on the positive effects on cognition of TNS is definitely needed.
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Kryukov AI, Kunel'skaya NL, Zaoeva ZO, Bajbakova EV, Chugunova MA, Vasilchenko NO, Panasov SA, Panova TN. [Involvement of the trigeminal nerve system in the sense of smell]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:7-12. [PMID: 38147376 DOI: 10.17116/jnevro20231231217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
A systematic review of literature on the issue of involvement in the sense of smell, as well as the interaction between the trigeminal and olfactory nerves, was carried out. The article discusses the features of the chemical perception systems, as well as the treatment of olfactory disorders using transcranial electrical stimulation of the trigeminal nerve.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N L Kunel'skaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Z O Zaoeva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Bajbakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - N O Vasilchenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S A Panasov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - T N Panova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Benali A, Tsutsui KI, Sekino M, Pfeiffer F. Editorial: Brain stimulation: From basic research to clinical use. Front Hum Neurosci 2022; 16:1092165. [DOI: 10.3389/fnhum.2022.1092165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
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Pavlov VA, Tracey KJ. Bioelectronic medicine: Preclinical insights and clinical advances. Neuron 2022; 110:3627-3644. [PMID: 36174571 PMCID: PMC10155266 DOI: 10.1016/j.neuron.2022.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/28/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
The nervous system maintains homeostasis and health. Homeostatic disruptions underlying the pathobiology of many diseases can be controlled by bioelectronic devices targeting CNS and peripheral neural circuits. New insights into the regulatory functions of the nervous system and technological developments in bioelectronics drive progress in the emerging field of bioelectronic medicine. Here, we provide an overview of key aspects of preclinical research, translation, and clinical advances in bioelectronic medicine.
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Affiliation(s)
- Valentin A Pavlov
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Wu M, Luo B, Yu Y, Li X, Gao J, Li J, Sorger B, Riecke L. Rhythmic musical-electrical trigeminal nerve stimulation improves impaired consciousness. Neuroimage Clin 2022; 36:103170. [PMID: 36063757 PMCID: PMC9460811 DOI: 10.1016/j.nicl.2022.103170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/27/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
Accumulating evidence shows that consciousness is linked to neural oscillations in the thalamocortical system, suggesting that deficits in these oscillations may underlie disorders of consciousness (DOC). However, patient-friendly non-invasive treatments targeting this functional anomaly are still missing and the therapeutic value of oscillation restoration has remained unclear. We propose a novel approach that aims to restore DOC patients' thalamocortical oscillations by combining rhythmic trigeminal-nerve stimulation with comodulated musical stimulation ("musical-electrical TNS"). In a double-blind, placebo-controlled, parallel-group study, we recruited 63 patients with DOC and randomly assigned them to groups receiving gamma, beta, or sham musical-electrical TNS. The stimulation was applied for 40 min on five consecutive days. We measured patients' consciousness before and after the stimulation using behavioral indicators and neural responses to rhythmic auditory speech. We further assessed their outcomes one year later. We found that musical-electrical TNS reliably lead to improvements in consciousness and oscillatory brain activity at the stimulation frequency: 43.5 % of patients in the gamma group and 25 % of patients in the beta group showed an improvement of their diagnosis after being treated with the stimulation. This group of benefitting patients still showed more positive outcomes one year later. Moreover, patients with stronger behavioral benefits showed stronger improvements in oscillatory brain activity. These findings suggest that brain oscillations contribute to consciousness and that musical-electrical TNS may serve as a promising approach to improve consciousness and predict long-term outcomes in patients with DOC.
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Affiliation(s)
- Min Wu
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Benyan Luo
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Corresponding author.
| | - Yamei Yu
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoxia Li
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, China
| | - Jingqi Li
- Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, China
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Lars Riecke
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Badran BW, Huffman SM, Dancy M, Austelle CW, Bikson M, Kautz SA, George MS. A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms. Bioelectron Med 2022; 8:13. [PMID: 36002874 PMCID: PMC9402278 DOI: 10.1186/s42234-022-00094-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Although the coronavirus disease 19 (COVID-19) pandemic has now impacted the world for over two years, the persistent secondary neuropsychiatric effects are still not fully understood. These “long COVID” symptoms, also referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), can persist for months after infection without any effective treatments. Long COVID involves a complex heterogenous symptomology and can lead to disability and limit work. Long COVID symptoms may be due to sustained inflammatory responses and prolonged immune response after infection. Interestingly, vagus nerve stimulation (VNS) may have anti-inflammatory effects, however, until recently, VNS could not be self-administered, at-home, noninvasively. Methods We created a double-blind, noninvasive transcutaneous auricular VNS (taVNS) system that can be self-administered at home with simultaneous remote monitoring of physiological biomarkers and video supervision by study staff. Subsequently, we carried out a pilot (n = 13) randomized, sham-controlled, trial with this system for four weeks to treat nine predefined long covid symptoms (anxiety, depression, vertigo, anosmia, ageusia, headaches, fatigue, irritability, brain fog). No in-person patient contact was needed, with informed consent, trainings, ratings, and all procedures being conducted remotely during the pandemic (2020–2021) and equipment being shipped to individuals’ homes. This trial was registered on ClinicalTrials.gov under the identifier: NCT04638673 registered November 20, 2020. Results Four-weeks of at-home self-administered taVNS (two, one-hour sessions daily, delivered at suprathreshold intensities) was feasible and safe. Although our trial was not powered to determine efficacy as an intervention in a heterogenous population, the trends in the data suggest taVNS may have a mild to moderate effect in reducing mental fatigue symptoms in a subset of individuals. Conclusions This innovative study demonstrates the safety and feasibility of supervised self-administered taVNS under a fully contactless protocol and suggests that future studies can safely investigate this novel form of brain stimulation at-home for a variety of neuropsychiatric and motor recovery applications.
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Affiliation(s)
- Bashar W Badran
- Neuro-X Lab, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Sarah M Huffman
- Brain Stimulation Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Morgan Dancy
- Brain Stimulation Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher W Austelle
- Brain Stimulation Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | - Steven A Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA.,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Zhao R, He ZY, Cheng C, Tian QQ, Cui YP, Chang MY, Wang FM, Kong Y, Deng H, Yang XJ, Sun JB. Assessing the Effect of Simultaneous Combining of Transcranial Direct Current Stimulation and Transcutaneous Auricular Vagus Nerve Stimulation on the Improvement of Working Memory Performance in Healthy Individuals. Front Neurosci 2022; 16:947236. [PMID: 35928012 PMCID: PMC9344917 DOI: 10.3389/fnins.2022.947236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
A previous study found that combining transcranial direct current stimulation (tDCS) and transcutaneous auricular vagus nerve stimulation (taVNS) could evoke significantly larger activation on a range of cortical and subcortical brain regions than the numerical summation of tDCS and taVNS effects. In this study, two within-subject experiments were employed to investigate its effects on working memory (WM). In experiment 1, the WM modulatory effects of tDCS over the left dorsolateral prefrontal cortex (DLPFC), taVNS, and simultaneous joint simulation of tDCS over the left DLPFC and taVNS (SJS-L) were compared among 60 healthy subjects. They received these three interventions between the baseline test and post-test in a random manner three times. In spatial 3-back task, there was a significant interaction between time and stimulations in the accuracy rate of matching trials (mACC, p=0.018). MACCs were significantly improved by SJS (p = 0.001) and taVNS (p = 0.045), but not by tDCS (p = 0.495). Moreover, 41 subjects in the SJS group showed improvement, which was significantly larger than that in the taVNS group (29 subjects) and tDCS group (26 subjects). To further investigate the generalization effects of SJS, 72 students were recruited in experiment 2. They received tDCS over the right DLPFC, taVNS, simultaneous joint simulation of tDCS over the right DLPFC and taVNS (SJS-R), and sham stimulation in a random manner four times. No significant results were found, but there was a tendency similar to experiment 1 in the spatial 3-back task. In conclusion, combining tDCS and taVNS might be a potential non-invasive neuromodulation technique which is worthy of study in future.
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Affiliation(s)
- Rui Zhao
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Zhao-Yang He
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Chen Cheng
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
| | - Qian-Qian Tian
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Ya-Peng Cui
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Meng-Ying Chang
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Fu-Min Wang
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Yao Kong
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, China
| | - Hui Deng
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
- Guangzhou Institute of Technology, Xidian University, Xi'an, China
| | - Xue-Juan Yang
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
- Guangzhou Institute of Technology, Xidian University, Xi'an, China
| | - Jin-Bo Sun
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, China
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
- Guangzhou Institute of Technology, Xidian University, Xi'an, China
- *Correspondence: Jin-Bo Sun
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Czura CJ, Bikson M, Charvet L, Chen JDZ, Franke M, Fudim M, Grigsby E, Hamner S, Huston JM, Khodaparast N, Krames E, Simon BJ, Staats P, Vonck K. Neuromodulation Strategies to Reduce Inflammation and Improve Lung Complications in COVID-19 Patients. Front Neurol 2022; 13:897124. [PMID: 35911909 PMCID: PMC9329660 DOI: 10.3389/fneur.2022.897124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiated to identify and develop disease modifying or preventative therapeutic strategies has been initiated. The primary focus has been on pharmacological treatment of the immune and respiratory system and the development of a vaccine. The hyperinflammatory state (“cytokine storm”) observed in many cases of COVID-19 indicates a prognostically negative disease progression that may lead to respiratory distress, multiple organ failure, shock, and death. Many critically ill patients continue to be at risk for significant, long-lasting morbidity or mortality. The human immune and respiratory systems are heavily regulated by the central nervous system, and intervention in the signaling of these neural pathways may permit targeted therapeutic control of excessive inflammation and pulmonary bronchoconstriction. Several technologies, both invasive and non-invasive, are available and approved for clinical use, but have not been extensively studied in treatment of the cytokine storm in COVID-19 patients. This manuscript provides an overview of the role of the nervous system in inflammation and respiration, the current understanding of neuromodulatory techniques from preclinical and clinical studies and provides a rationale for testing non-invasive neuromodulation to modulate acute systemic inflammation and respiratory dysfunction caused by SARS-CoV-2 and potentially other pathogens. The authors of this manuscript have co-founded the International Consortium on Neuromodulation for COVID-19 to advocate for and support studies of these technologies in the current coronavirus pandemic.
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Affiliation(s)
- Christopher J. Czura
- Convergent Medical Technologies, Inc., Oyster Bay, NY, United States
- *Correspondence: Christopher J. Czura
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Jiande D. Z. Chen
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | | | - Marat Fudim
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | | | - Sam Hamner
- Cala Health, Burlingame, CA, United States
| | - Jared M. Huston
- Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | | | - Elliot Krames
- Pacific Pain Treatment Center, Napa, CA, United States
| | | | - Peter Staats
- National Spine and Pain, ElectroCore, Inc., Jacksonville, FL, United States
| | - Kristl Vonck
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Arias DE, Buneo CA. Effects of Kilohertz Electrical Stimulation of the Trigeminal Nerve on Motor Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:5103-5106. [PMID: 36085879 DOI: 10.1109/embc48229.2022.9871095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurological disorders such as stroke remain leading causes of disability worldwide. A current thrust in the neurorehabilitation of such disorders involves exogenous neuromodulation of cranial nerves in order to enhance neuro-plasticity and maximize recovery of function. Here we present preliminary results on the effects of kilohertz range electrical stimulation of the trigeminal nerve (TNS) on motor learning, using an upper extremity visuomotor adaptation paradigm. Twenty-five (25) healthy adult subjects were randomly assigned to 2 groups: 3kHz stimulation ( n=13) and sham ( n=12). Participants performed a visuomotor rotation task that involved center-out reaching movements to eight vertically arranged targets. Four blocks of trials were performed: two baseline blocks with veridical visual feedback, one adaptation block involving a 30° CCW rotation of hand visual feedback, and one washout block with no rotation. TNS was applied for 20 minutes before the 2nd baseline block using two electrodes targeting the ophthalmic branches of the trigeminal nerve. Early in the rotation block, learning rates were similar between the 3kHz and sham groups but gradually diverged, with the 3kHz group demonstrating slightly faster rates than sham later in the rotation block. The results provide new information on the potential use of TNS in neurorehabilitation.
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Assessing the structural and functional changes in vagus nerve in multiple sclerosis. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Badran BW, Huffman SM, Dancy M, Austelle CW, Bikson M, Kautz SA, George MS. A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms. RESEARCH SQUARE 2022:rs.3.rs-1716096. [PMID: 35765566 PMCID: PMC9238186 DOI: 10.21203/rs.3.rs-1716096/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Background Although the coronavirus disease 19 (COVID-19) pandemic has now impacted the world for over two years, the persistent secondary neuropsychiatric effects are still not fully understood. These "long COVID" symptoms, also referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), can persist for months after infection without any effective treatments. Long COVID involves a complex heterogenous symptomology and can lead to disability and limit work. Long COVID symptoms may be due to sustained inflammatory responses and prolonged immune response after infection. Interestingly, vagus nerve stimulation (VNS) may have anti-inflammatory effects, however, until recently, VNS could not be self-administered, at-home, noninvasively. Methods We created a double-blind, noninvasive transcutaneous auricular VNS (taVNS) system that can be self-administered at home with simultaneous remote monitoring of physiological biomarkers and video supervision by study staff. Subsequently, we carried out a pilot (n = 13) randomized, sham-controlled, trial with this system for four weeks to treat nine predefined long covid symptoms (anxiety, depression, vertigo, anosmia, ageusia, headaches, fatigue, irritability, brain fog). No in-person patient contact was needed, with informed consent, trainings, ratings, and all procedures being conducted remotely during the pandemic (2020-2021) and equipment being shipped to individuals' homes. This trial was registered onClinicalTrials.gov under the identifier: NCT04638673. Results Four-weeks of at-home self-administered taVNS (two, one-hour sessions daily, delivered at suprathreshold intensities) was feasible and safe. Although our trial was not powered to determine efficacy as an intervention in a heterogenous population, the trends in the data suggest taVNS may have a mild to moderate effect in reducing mental fatigue symptoms in a subset of individuals. This innovative study demonstrates the safety and feasibility of supervised self-administered taVNS under a fully contactless protocol and suggests that future studies can safely investigate this novel form of brain stimulation at-home for a variety of neuropsychiatric and motor recovery applications.
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Affiliation(s)
| | | | | | | | - Marom Bikson
- City College of the City University of New York: The City College of New York
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Majdi A, van Boekholdt L, Sadigh-Eteghad S, Mc Laughlin M. A systematic review and meta-analysis of transcranial direct-current stimulation effects on cognitive function in patients with Alzheimer's disease. Mol Psychiatry 2022; 27:2000-2009. [PMID: 35115703 DOI: 10.1038/s41380-022-01444-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 01/25/2023]
Abstract
Transcranial direct-current stimulation (tDCS) appears to enhance cognitive function in Alzheimer's disease (AD). Accordingly, over the last two decades, the number of studies using tDCS for AD has grown. This study aimed to provide a quantitative assessment of the efficacy of tDCS in improving cognitive function in patients with AD. We systematically searched the literature until May 2021 to identify relevant publications for inclusion in our systematic review and meta-analysis. Eligible studies were sham-controlled trials assessing the impacts of anodal or cathodal tDCS on cognitive function in patients with AD. The outcome measure of this study was the effects of tDCS on distinct cognitive domains including memory, attention, and global cognitive function. The initial search yielded a total of 323 records. Five other articles were found using manual search of the databases. Of these, 13 publications (14 different studies) with a total of 211 patients of various degrees of AD severity underwent meta-analysis. Meta-analysis revealed the non-significant effects of tDCS on attention (0.425 SMD, 95% CI, -0.254 to 1.104, p = 0.220), and significant positive impacts on the amelioration of general cognitive measures (1.640 SMD, 95% CI, 0.782 to 2.498, p < 0.000), and memory (1.031 SMD, 95% CI, 0.688 to 1.373, p < 0.000) dysfunction in patients with AD. However, the heterogeneity of the studies were high in all subdomains of cognition (ϰ2 = 22.810, T2 = 0.552, d.f. = 5, I2 = 78.80%, p < 0.000 for attention, ϰ2 = 96.29, T2 = 1.727, d.f. = 10, I2 = 89.61%, p < 0.000 for general cognition, and ϰ2 = 7.253, T2 = 0.085, d.f. = 5, I2 = 31.06%, p = 0.203 for memory). Improved memory and general cognitive function in patients with AD was shown in this meta-analysis. However, due to the small number of studies and the high heterogeneity of the data, more high-quality studies using standardized parameters and measures are needed before tDCS can be considered as a treatment for AD.
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Affiliation(s)
- Alireza Majdi
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Luuk van Boekholdt
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Myles Mc Laughlin
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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Abstract
The human brain exhibits the remarkable ability to categorize speech sounds into distinct, meaningful percepts, even in challenging tasks like learning non-native speech categories in adulthood and hearing speech in noisy listening conditions. In these scenarios, there is substantial variability in perception and behavior, both across individual listeners and individual trials. While there has been extensive work characterizing stimulus-related and contextual factors that contribute to variability, recent advances in neuroscience are beginning to shed light on another potential source of variability that has not been explored in speech processing. Specifically, there are task-independent, moment-to-moment variations in neural activity in broadly-distributed cortical and subcortical networks that affect how a stimulus is perceived on a trial-by-trial basis. In this review, we discuss factors that affect speech sound learning and moment-to-moment variability in perception, particularly arousal states—neurotransmitter-dependent modulations of cortical activity. We propose that a more complete model of speech perception and learning should incorporate subcortically-mediated arousal states that alter behavior in ways that are distinct from, yet complementary to, top-down cognitive modulations. Finally, we discuss a novel neuromodulation technique, transcutaneous auricular vagus nerve stimulation (taVNS), which is particularly well-suited to investigating causal relationships between arousal mechanisms and performance in a variety of perceptual tasks. Together, these approaches provide novel testable hypotheses for explaining variability in classically challenging tasks, including non-native speech sound learning.
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43
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Liu X, Qiu F, Hou L, Wang X. Review of Noninvasive or Minimally Invasive Deep Brain Stimulation. Front Behav Neurosci 2022; 15:820017. [PMID: 35145384 PMCID: PMC8823253 DOI: 10.3389/fnbeh.2021.820017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022] Open
Abstract
Brain stimulation is a critical technique in neuroscience research and clinical application. Traditional transcranial brain stimulation techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS) have been widely investigated in neuroscience for decades. However, TMS and tDCS have poor spatial resolution and penetration depth, and DBS requires electrode implantation in deep brain structures. These disadvantages have limited the clinical applications of these techniques. Owing to developments in science and technology, substantial advances in noninvasive and precise deep stimulation have been achieved by neuromodulation studies. Second-generation brain stimulation techniques that mainly rely on acoustic, electronic, optical, and magnetic signals, such as focused ultrasound, temporal interference, near-infrared optogenetic, and nanomaterial-enabled magnetic stimulation, offer great prospects for neuromodulation. This review summarized the mechanisms, development, applications, and strengths of these techniques and the prospects and challenges in their development. We believe that these second-generation brain stimulation techniques pave the way for brain disorder therapy.
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Affiliation(s)
- Xiaodong Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Fang Qiu
- Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Lijuan Hou
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
- *Correspondence: Lijuan Hou Xiaohui Wang
| | - Xiaohui Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- *Correspondence: Lijuan Hou Xiaohui Wang
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44
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Hernandez CM, Hernandez AR, Hoffman JM, King PH, McMahon LL, Buford TW, Carter C, Bizon JL, Burke SN. A Neuroscience Primer for Integrating Geroscience With the Neurobiology of Aging. J Gerontol A Biol Sci Med Sci 2022; 77:e19-e33. [PMID: 34623396 PMCID: PMC8751809 DOI: 10.1093/gerona/glab301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/13/2022] Open
Abstract
Neuroscience has a rich history of studies focusing on neurobiology of aging. However, much of the aging studies in neuroscience occur outside of the gerosciences. The goal of this primer is 2-fold: first, to briefly highlight some of the history of aging neurobiology and second, to introduce to geroscientists the broad spectrum of methodological approaches neuroscientists use to study the neurobiology of aging. This primer is accompanied by a corresponding geroscience primer, as well as a perspective on the current challenges and triumphs of the current divide across these 2 fields. This series of manuscripts is intended to foster enhanced collaborations between neuroscientists and geroscientists with the intent of strengthening the field of cognitive aging through inclusion of parameters from both areas of expertise.
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Affiliation(s)
- Caesar M Hernandez
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail R Hernandez
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica M Hoffman
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter H King
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Lori L McMahon
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Nathan Shock Center for the Basic Biology of Aging, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Integrative Center for Aging Research, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas W Buford
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Nathan Shock Center for the Basic Biology of Aging, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Integrative Center for Aging Research, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Christy Carter
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer L Bizon
- Department of Neuroscience, Center for Cognitive Aging and Memory, and the McKnight Brain Institute, The University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Sara N Burke
- Department of Neuroscience, Center for Cognitive Aging and Memory, and the McKnight Brain Institute, The University of Florida, College of Medicine, Gainesville, Florida, USA
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45
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Suh MW, Tran P, Richardson M, Sun S, Xu Y, Djalilian HR, Lin HW, Zeng FG. Electric hearing and tinnitus suppression by noninvasive ear stimulation. Hear Res 2022; 415:108431. [PMID: 35016022 DOI: 10.1016/j.heares.2022.108431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Abstract
While noninvasive brain stimulation is convenient and cost effective, its utility is limited by the substantial distance between scalp electrodes and their intended neural targets in the head. The tympanic membrane, or eardrum, is a thin flap of skin deep in an orifice of the head that may serve as a port for improved efficiency of noninvasive stimulation. Here we chose the cochlea as a target because it resides in the densest bone of the skull and is adjacent to many deep-brain-stimulation structures. We also tested the hypothesis that noninvasive electric stimulation of the cochlea may restore neural activities that are missing in acoustic stimulation. We placed an electrode in the ear canal or on the tympanic membrane in 25 human adults (10 females) and compared their stimulation efficiency by characterizing the electrically-evoked auditory sensation. Relative to ear canal stimulation, tympanic membrane stimulation was four times more likely to produce an auditory percept, required eight times lower electric current to reach the threshold and produced two-to-four times more linear suprathreshold responses. We further measured tinnitus suppression in 14 of the 25 subjects who had chronic tinnitus. Compared with ear canal stimulation, tympanic membrane stimulation doubled both the probability (22% vs. 55%) and the amount (-15% vs. -34%) of tinnitus suppression. These findings extended previous work comparing evoked perception and tinnitus suppression between electrodes placed in the ear canal and on the scalp. Together, the previous and present results suggest that the efficiency of conventional scalp-based noninvasive electric stimulation can be improved by at least one order of magnitude via tympanic membrane stimulation. This increased efficiency is most likely due to the shortened distance between the electrode placed on the tympanic membrane and the targeted cochlea. The present findings have implications for the management of tinnitus by offering a potential alternative to interventions using invasive electrical stimulation such as cochlear implantation, or other non-invasive transcranial electrical stimulation methods.
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Affiliation(s)
- Myung-Whan Suh
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States; Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Phillip Tran
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States
| | - Matthew Richardson
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States
| | - Shuping Sun
- Department of Otolaryngology - Head and Neck Surgery, The First Affiliated Hospital, Zhengzhou University, Henan 450052, China
| | - Yuchen Xu
- Department of Bioengineering, University of California San Diego, San Diego, California 92092, United States
| | - Hamid R Djalilian
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States
| | - Harrison W Lin
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States
| | - Fan-Gang Zeng
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology - Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, United States.
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46
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Achu GF, Kakmeni FMM. Neuromechanical modulation of transmembrane voltage in a model of a nerve. Phys Rev E 2022; 105:014407. [PMID: 35193213 DOI: 10.1103/physreve.105.014407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Despite substantial evidence that mechanical variables play a crucial role in transmembrane voltage regulation, most research efforts focus mostly on the nerve cell's biochemical or electrophysiological activities. We propose an electromechanical model of a nerve in order to advance our understanding of how mechanical forces and thermodynamics also regulate neural electrical activities. We explore the spatiotemporal dynamics of the transmembrane potential using the proposed nonlinear model with a sinusoid as the initial transmembrane potential and periodic boundary conditions. The localized wave from our numerical simulation and transmembrane potentials in nerves are solitary and show the three stages of action potential (depolarization, repolarization, and hyperpolarization), as well as threshold and saturation effects. We show that the mechanical properties of membranes affect the localization of the transmembrane potential. According to simulation data, mechanical pulses of sufficient magnitude can modulate a transmembrane voltage. The current model could be used to describe the dynamics of a transmembrane potential modulated by sound. Mechanical perturbations that modulate an electrical signal have a lot of clinical potential for treating pain and other neurological diseases.
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Affiliation(s)
- G Fongang Achu
- Complex Systems and Theoretical Biology Group (CoSTBiG), and Laboratory of Research on Advanced Materials and Nonlinear Science (LaRAMaNS), Department of Physics, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - F M Moukam Kakmeni
- Complex Systems and Theoretical Biology Group (CoSTBiG), and Laboratory of Research on Advanced Materials and Nonlinear Science (LaRAMaNS), Department of Physics, Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
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47
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Stress-related dysautonomias and neurocardiology-based treatment approaches. Auton Neurosci 2022; 239:102944. [DOI: 10.1016/j.autneu.2022.102944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/13/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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48
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Badran BW, Gruber EM, O’Leary GH, Austelle CW, Huffman SM, Kahn AT, McTeague LM, Uhde TW, Cortese BM. Electrical stimulation of the trigeminal nerve improves olfaction in healthy individuals: A randomized, double-blind, sham-controlled trial. Brain Stimul 2022; 15:761-768. [PMID: 35561963 PMCID: PMC9976566 DOI: 10.1016/j.brs.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Both activated by environmental odorants, there is a clear role for the intranasal trigeminal and olfactory nerves in smell function. Unfortunately, our ability to perceive odorants decreases with age or with injury, and limited interventions are available to treat smell loss. OBJECTIVE We investigated whether electrical stimulation of the trigeminal nerve via trigeminal nerve stimulation (TNS) or transcranial direct current stimulation (tDCS) modulates odor sensitivity in healthy individuals. METHODS We recruited 20 healthy adults (12 Female, mean age = 27) to participate in this three-visit, randomized, double-blind, sham-controlled trial. Participants were randomized to receive one of three stimulation modalities (TNS, tDCS, or sham) during each of their visits. Odor detection thresholds were obtained at baseline, immediately post-intervention, and 30-min post-intervention. Furthermore, participants were asked to complete a sustained attention task and mood assessments before odor detection testing. RESULTS Findings reveal a timeXcondition interaction for guaiacol (GUA) odorant detection thresholds (F (3.188, 60.57) = 3.833, P = 0.0125), but not phenyl ethyl alcohol (PEA) odorant thresholds. At 30-min post-stimulation, both active TNS and active tDCS showed significantly increased sensitivity to GUA compared to sham TNS (Sham TNS = -8.30% vs. Active TNS = 9.11%, mean difference 17.43%, 95% CI 5.674 to 29.18, p = 0.0044; Sham TNS = -8.30% vs. Active tDCS = 13.58%, mean difference 21.89%, 95% CI 10.47 to 33.32, p = 0.0004). CONCLUSION TNS is a safe, simple, noninvasive method for boosting olfaction. Future studies should investigate the use of TNS on smell function across different stimulation parameters, odorants, and patient populations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bernadette M. Cortese
- Corresponding author. Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, 67 President Street, BA 504F, Charleston, South Carolina, 29425, USA. (B.M. Cortese)
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49
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Kerstens S, Orban de Xivry JJ, Mc Laughlin M. A novel tDCS control condition using optimized anesthetic gel to block peripheral nerve input. Front Neurol 2022; 13:1049409. [PMID: 36452171 PMCID: PMC9702085 DOI: 10.3389/fneur.2022.1049409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Recent studies indicate that some transcranial direct current stimulation (tDCS) effects may be caused by indirect stimulation of peripheral nerves in the scalp rather than the electric field in the brain. To address this, we developed a novel tDCS control condition in which peripheral input is blocked using topical anesthetics. We developed a compounded anesthetic gel containing benzocaine and lidocaine (BL10) that blocks peripheral input during tDCS. Methods In a blinded randomized cross-over study of 18 healthy volunteers (M/F), we compared the gel's efficacy to EMLA and an inert placebo gel. Subjects used a visual analog scale (VAS) to rate the stimulation sensation in the scalp produced by 10 s of 2 mA tDCS every 2 min during 1 h. In an additional in-vitro experiment, the effect of a DC current on gel resistivity and temperature was investigated. Results Both the BL10 and EMLA gel, lowered the stimulation sensations compared to the placebo gel. The BL10 gel showed a tendency to work faster than the EMLA gel with reported sensations for the BL10 gel being lower than for EMLA for the first 30 min. The DC current caused a drastic increase in gel resistivity for the EMLA gel, while it did not affect gel resistivity for the BL10 and placebo gel, nor did it affect gel temperature. Conclusions Topical anesthetics reduce stimulation sensations by blocking peripheral nerve input during tDCS. The BL10 gel tends to work faster and is more electrically stable than EMLA gel. Clinical trial registration The study is registered at ClinicalTrials.gov with name "Understanding the Neural Mechanisms Behind tDCS" and number NCT04577677.
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Affiliation(s)
- Silke Kerstens
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, The Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Research Group Experimental Oto-Rhino-Laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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50
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Bremner JD, Wittbrodt MT, Gurel NZ, Shandhi MH, Gazi AH, Jiao Y, Levantsevych OM, Huang M, Beckwith J, Herring I, Murrah N, Driggers EG, Ko YA, Alkhalaf ML, Soudan M, Shallenberger L, Hankus AN, Nye JA, Park J, Woodbury A, Mehta PK, Rapaport MH, Vaccarino V, Shah AJ, Pearce BD, Inan OT. Transcutaneous Cervical Vagal Nerve Stimulation in Patients with Posttraumatic Stress Disorder (PTSD): A Pilot Study of Effects on PTSD Symptoms and Interleukin-6 Response to Stress. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6:100190. [PMID: 34778863 PMCID: PMC8580056 DOI: 10.1016/j.jadr.2021.100190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a highly disabling condition associated with alterations in multiple neurobiological systems, including increases in inflammatory and sympathetic function, responsible for maintenance of symptoms. Treatment options including medications and psychotherapies have limitations. We previously showed that transcutaneous Vagus Nerve Stimulation (tcVNS) blocks inflammatory (interleukin (IL)-6) responses to stress in PTSD. The purpose of this study was to assess the effects of tcVNS on PTSD symptoms and inflammatory responses to stress. METHODS Twenty patients with PTSD were randomized to double blind active tcVNS (N=9) or sham (N=11) stimulation in conjunction with exposure to personalized traumatic scripts immediately followed by active or sham tcVNS and measurement of IL-6 and other biomarkers of inflammation. Patients then self administered active or sham tcVNS twice daily for three months. PTSD symptoms were measured with the PTSD Checklist (PCL) and the Clinician Administered PTSD Scale (CAPS), clinical improvement with the Clinical Global Index (CGI) and anxiety with the Hamilton Anxiety Scale (Ham-A) at baseline and one-month intervals followed by a repeat of measurement of biomarkers with traumatic scripts. After three months patients self treated with twice daily open label active tcVNS for another three months followed by assessment with the CGI. RESULTS Traumatic scripts increased IL-6 in PTSD patients, an effect that was blocked by tcVNS (p<.05). Active tcVNS treatment for three months resulted in a 31% greater reduction in PTSD symptoms compared to sham treatment as measured by the PCL (p=0.013) as well as hyperarousal symptoms and somatic anxiety measured with the Ham-A p<0.05). IL-6 increased from baseline in sham but not tcVNS. Open label tcVNS resulted in improvements measured with the CGI compared to the sham treatment period p<0.05). CONCLUSIONS These preliminary results suggest that tcVNS reduces inflammatory responses to stress, which may in part underlie beneficial effects on PTSD symptoms.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Matthew T. Wittbrodt
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - MdMobashir H. Shandhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Asim H. Gazi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Yunshen Jiao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Oleksiy M. Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joy Beckwith
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Isaias Herring
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily G. Driggers
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - MhmtJamil L. Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Majd Soudan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Allison N. Hankus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jeanie Park
- Atlanta VA Medical Center, Decatur, Georgia
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Woodbury
- Atlanta VA Medical Center, Decatur, Georgia
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mark H. Rapaport
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Amit J. Shah
- Atlanta VA Medical Center, Decatur, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
- Coulter Department of Bioengineering, Georgia Institute of Technology, Atlanta, Georgia
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