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Du L, He X, Xiong X, Zhang X, Jian Z, Yang Z. Vagus nerve stimulation in cerebral stroke: biological mechanisms, therapeutic modalities, clinical applications, and future directions. Neural Regen Res 2024; 19:1707-1717. [PMID: 38103236 PMCID: PMC10960277 DOI: 10.4103/1673-5374.389365] [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: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023] Open
Abstract
Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life. Many stroke victims are left with long-term neurological dysfunction, which adversely affects the well-being of the individual and the broader socioeconomic impact. Currently, post-stroke brain dysfunction is a major and difficult area of treatment. Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autism, refractory depression, epilepsy, and Alzheimer's disease. It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as altering neurotransmitters and the plasticity of central neurons. In animal models of acute ischemic stroke, vagus nerve stimulation has been shown to reduce infarct size, reduce post-stroke neurological damage, and improve learning and memory capacity in rats with stroke by reducing the inflammatory response, regulating blood-brain barrier permeability, and promoting angiogenesis and neurogenesis. At present, vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation. Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in improving upper limb motor and cognitive abilities in stroke patients. Further clinical studies have shown that non-invasive vagus nerve stimulation, including ear/cervical vagus nerve stimulation, can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect. In this paper, we first describe the multiple effects of vagus nerve stimulation in stroke, and then discuss in depth its neuroprotective mechanisms in ischemic stroke. We go on to outline the results of the current major clinical applications of invasive and non-invasive vagus nerve stimulation. Finally, we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends. We believe that vagus nerve stimulation, as an effective treatment for stroke, will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.
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Affiliation(s)
- Li Du
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xuan He
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xu Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhenxing Yang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Kang D, Choi Y, Lee J, Park E, Kim IY. Analysis of taVNS effects on autonomic and central nervous systems in healthy young adults based on HRV, EEG parameters. J Neural Eng 2024; 21:046012. [PMID: 38941990 DOI: 10.1088/1741-2552/ad5d16] [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: 05/11/2023] [Accepted: 06/28/2024] [Indexed: 06/30/2024]
Abstract
Objective.Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive method of stimulating the vagus nerve, simultaneously affects the autonomic nervous system (ANS) and central nervous system (CNS) through efferent and afferent pathways. The purpose of this study is to analyze the effect of taVNS on the ANS and CNS through heart rate variability (HRV) and electroencephalography (EEG) parameters of identified responders.Approach.Two sets of data were collected from each of 10 healthy adult male subjects in their 20 s, and five HRV parameters from the time domain (RMSSD, pNN50, pNN30, pNN20, ppNNx) and two EEG parameters (power of alpha band, power of delta band) were extracted.Main results.Based on pNN50, responders to taVNS were identified; among them, pNN50 (p= 0.0041) and ppNNx (p= 0.0037) showed significant differences before and after taVNS. At the same time, for alpha power and delta power of EEG, significant difference (p< 0.05) was observed in most channels after taVNS compared to before stimulation.Significance.This study demonstrated the validity of identifying responders using pNN50 and the influence of taVNS on both the ANS and CNS. We conclude that taVNS can be used to treat a variety of diseases and as a tool to help control the ANS and CNS.
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Affiliation(s)
- Donghun Kang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Youngseok Choi
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jongshill Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Eunkyoung Park
- Department of Biomedical Engineering, Soonchunhyang University, Asan, Republic of Korea
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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Guerriero G, Liljedahl SI, Carlsen HK, López Muñoz M, Daros AR, Ruocco AC, Steingrimsson S. Transcutaneous auricular vagus nerve stimulation to acutely reduce emotional vulnerability and improve emotional regulation in borderline personality disorder (tVNS-BPD): study protocol for a randomized, single-blind, sham-controlled trial. Trials 2024; 25:397. [PMID: 38898522 PMCID: PMC11186228 DOI: 10.1186/s13063-024-08230-6] [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: 06/07/2023] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is considered a disorder of emotion regulation resulting from the expression of a biologically determined emotional vulnerability (that is, heightened sensitivity to emotion, increased emotional intensity/reactivity, and a slow return to emotional baseline) combined with exposure to invalidating environments. Vagal tone has been associated with activity in cortical regions involved in emotion regulation and a lower resting state of vagal tone has been observed in BPD patients relative to healthy controls. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been shown to reduce temper outbursts in adults with Prader-Willi Syndrome, to enhance recognition of emotions in healthy students, and to improve depressive and anxiety symptoms. Furthermore, a single session of taVNS has been shown to acutely alter the recognition of facial expressions of negative valence in adolescents with MDD and increase emotion recognition in controls. However, the effect of taVNS on emotional vulnerability and regulation in individuals diagnosed with BPD has not been investigated. Our aims are to determine if taVNS is effective in acutely reducing emotional vulnerability and improve emotional regulation in BPD patients. METHODS Forty-two patients will be randomized to a single session of taVNS or sham-taVNS while going through an affect induction procedure. It will consist of the presentation of one neutral and three negative affect-evoking 4-min-long videos in sequence, each of which is followed by a 4-min post-induction period during which participants will rate the quality and intensity of their current self-reported emotions (post-induction ratings) and the perceived effectiveness in managing their emotions during the video presentation. The rating of the current self-reported emotions will be repeated after every post-induction period (recovery ratings). Mixed models with individuals as random effect will be used to investigate the ratings at each stage of the study, taking into account the repeated measures of the same individuals at baseline, pre-induction, post-induction, and recovery. DISCUSSION The study has potential to yield new insights into the role of vagal tone in emotion dysregulation in BPD and offer preliminary data on the effectiveness of taVNS as a possible non-invasive brain stimulation to treat a core symptom of BPD. TRIAL REGISTRATION ClinicalTrials.gov NCT05892900. Retrospectively registered on Jun 07, 2023.
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Affiliation(s)
- Giuseppe Guerriero
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Sophie I Liljedahl
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- National Specialized Medical Care Unit for Severe Self-Harm Behavior, Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Hanne K Carlsen
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
| | - Marta López Muñoz
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - Anthony C Ruocco
- Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Steinn Steingrimsson
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Zhu S, Liu Q, Zhang X, Zhou M, Zhou X, Ding F, Zhang R, Becker B, Kendrick KM, Zhao W. Transcutaneous auricular vagus nerve stimulation enhanced emotional inhibitory control via increasing intrinsic prefrontal couplings. Int J Clin Health Psychol 2024; 24:100462. [PMID: 38665809 PMCID: PMC11044052 DOI: 10.1016/j.ijchp.2024.100462] [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: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background Inhibitory control represents a core executive function that critically facilitates adaptive behavior and survival in an ever-changing environment. Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has been hypothesized to improve behavioral inhibition performance, however the neurocomputational mechanism of taVNS-induced neuroenhancement remains elusive. Method In the current study, we investigated the efficacy of taVNS in a sham-controlled between-subject functional near infrared spectroscopy (fNIRS) experiment with an emotional face Go/No-Go paradigm in ninety healthy young adults. Results After a data quality check, eighty-two subjects were included in the final data analysis. Behaviorally, the taVNS improved No-Go response accuracy, together with computational modeling using Hierarchical Bayesian estimation of the Drift Diffusion Model (HDDM) indicating that it specifically reduced the information accumulation rate for Go responses, and this was negatively associated with increased accuracy of No-Go responses. On the neural level, taVNS enhanced engagement of the bilateral inferior frontal gyrus (IFG) during inhibition of angry expression faces and modulated functional couplings (FCs) within the prefrontal inhibitory control network. Mediation models revealed that taVNS-induced facilitation of inhibitory control was critically mediated by a decreased information accumulation for Go responses and concomitantly enhanced neurofunctional coupling between the inferior and orbital frontal cortex. Discussion Our findings demonstrate a potential for taVNS to improve emotional inhibitory control via reducing pre-potent responses and enhancing FCs within prefrontal inhibitory control networks, suggesting a promising therapeutic role in treating specific disorders characterized by inhibitory control deficits.
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Affiliation(s)
- Siyu Zhu
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
- The Laboratory of Sport Psychology, School of Sport Training, Chengdu Sport University, Chengdu, 610041, PR China
- Sichuan Key Laboratory of Psychology and Behavior of Discipline Inspection and Supervision, Sichuan Normal University, Chengdu 610066, PR China
| | - Qi Liu
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Xiaolu Zhang
- Anhui Children's Hospital, Pediatric Hospital Affiliated to Fudan University, Hefei 230051, PR China
| | - Menghan Zhou
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Xinqi Zhou
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, 610066, PR China
| | - Fangyuan Ding
- College of National Culture and Cognitive Science, Guizhou Minzu University, Guiyang, 550025, PR China
| | - Rong Zhang
- Neuroscience Research Institute, Key Laboratory for Neuroscience, Ministry of Education of China, National Committee of Health and Family Planning of China and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, PR China
| | - Benjamin Becker
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Department of Psychology, Hong Kong, 999077, PR China
| | - Keith M Kendrick
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
| | - Weihua Zhao
- The Center of Psychosomatic Medicine, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, PR China
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Lucchi F, Lloyd B, Nieuwenhuis S. Non-invasive vagus nerve stimulation and the motivation to work for rewards: A replication of Neuser et al. (2020, Nature Communications). Psychophysiology 2024; 61:e14484. [PMID: 37942809 DOI: 10.1111/psyp.14484] [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: 05/24/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
The vagus nerve is thought to be involved in the allostatic regulation of motivation and energy metabolism via gut-brain interactions. A recent study by Neuser and colleagues (2020) provided novel evidence for this process in humans, by reporting a positive effect of transcutaneous auricular vagus nerve stimulation (taVNS) on the invigoration of reward-seeking behaviors, especially for food rewards. We conducted an independent direct replication of Neuser et al. (2020), to assess the robustness of their findings. Following the original study, we used a single-blind, sham-controlled, randomized cross-over design. We applied left-sided taVNS in healthy human volunteers (n = 40), while they performed an effort allocation task in which they had to work for monetary and food rewards. The replication study was purely confirmatory in that it strictly followed the analysis plans and scripts used by Neuser et al. Although, in line with Neuser et al., we found strong effects of task variables on effort invigoration and effort maintenance, we failed to replicate their key finding: taVNS did not increase the strength of invigoration (p = .62); the data were five times more likely (BF10 = 0.19) under the null hypothesis. We also found substantial evidence against an effect of taVNS on effort maintenance (p = .50; BF10 = 0.20). Our results provide evidence against the idea that left-sided taVNS boosts the motivational drive to work for rewards. Our study also highlights the need for direct replications of influential taVNS studies.
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Affiliation(s)
- Federica Lucchi
- Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Beth Lloyd
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Sander Nieuwenhuis
- Institute of Psychology, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
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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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Aranberri Ruiz A. Transcutaneous Auricular Vagus Nerve Stimulation to Improve Emotional State. Biomedicines 2024; 12:407. [PMID: 38398009 PMCID: PMC10886536 DOI: 10.3390/biomedicines12020407] [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: 01/11/2024] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Emotional experiences are a part of our lives. The maladaptive functioning of an individual's emotional field can lead to emotional disturbances of various kinds, such as anxiety and depression. Currently, there is an increasing prevalence of emotional disorders that cause great human suffering and high socioeconomic costs. Emotional processing has a biological basis. The major neuroscientific theories of emotion are based on biological functioning, and all of them take into account the anatomy and function of the tenth cranial nerve: the vagus nerve. The vagus nerve connects the subdiaphragmatic and supradiaphragmatic areas and modulates emotional processing as the basis of interoceptive functioning. Auricular vagus nerve stimulation is a new and innovative neuromodulation technique based on the function of the vagus nerve. Several interventions have shown that this new neurostimulation technique is a very promising resource for treating emotional disorders. In this paper, we summarise three neuroscientific theories of emotion, explain what transcutaneous auricular nerve stimulation is, and present arguments for its use and continued research.
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Affiliation(s)
- Ainara Aranberri Ruiz
- Department of Basic Psychological Process and Development, University of the Basque Country, 20018 San Sebastian, Spain
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McHaney JR, Schuerman WL, Leonard MK, Chandrasekaran B. Transcutaneous Auricular Vagus Nerve Stimulation Modulates Performance but Not Pupil Size During Nonnative Speech Category Learning. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3825-3843. [PMID: 37652065 DOI: 10.1044/2023_jslhr-22-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE Subthreshold transcutaneous auricular vagus nerve stimulation (taVNS) synchronized with behavioral training can selectively enhance nonnative speech category learning in adults. Prior work has demonstrated that behavioral performance increases when taVNS is paired with easier-to-learn Mandarin tone categories in native English listeners, relative to when taVNS is paired with harder-to-learn Mandarin tone categories or without taVNS. Mechanistically, this temporally precise plasticity has been attributed to noradrenergic modulation. However, prior work did not specifically utilize methodologies that indexed noradrenergic modulation and, therefore, was unable to explicitly test this hypothesis. Our goal for this study was to use pupillometry to gain mechanistic insights into taVNS behavioral effects. METHOD Thirty-eight participants learned to categorize Mandarin tones while pupillometry was recorded. In a double-blinded design, participants were divided into two taVNS groups that, as in the prior study, differed according to whether taVNS was paired with easier-to-learn tones or harder-to-learn tones. Learning performance and pupillary responses were measured using linear mixed-effects models. RESULTS We found that taVNS did not have any tone-specific or group behavioral or pupillary effects. However, in an exploratory analysis, we observed that taVNS did lead to faster rates of learning on trials paired with stimulation, particularly for those who were stimulated at lower amplitudes. CONCLUSIONS Our results suggest that pupillary responses may not be a reliable marker of locus coeruleus-norepinephrine system activity in humans. However, future research should systematically examine the effects of stimulation amplitude on both behavior and pupillary responses. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24036666.
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Baig SS, Kamarova M, Bell SM, Ali AN, Su L, Dimairo M, Dawson J, Redgrave JN, Majid A. tVNS in Stroke: A Narrative Review on the Current State and the Future. Stroke 2023; 54:2676-2687. [PMID: 37646161 DOI: 10.1161/strokeaha.123.043414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Ischemic stroke is a leading cause of disability and there is a paucity of therapeutic strategies that promote functional recovery after stroke. Transcutaneous vagus nerve stimulation (tVNS) has shown promising evidence as a tool to reduce infarct size in animal models of hyperacute stroke. In chronic stroke, tVNS paired with limb movements has been shown to enhance neurological recovery. In this review, we summarize the current evidence for tVNS in preclinical models and clinical trials in humans. We highlight the mechanistic pathways involved in the beneficial effects of tVNS. We critically evaluate the current gaps in knowledge and recommend the key areas of research required to translate tVNS into clinical practice in acute and chronic stroke.
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Affiliation(s)
- Sheharyar S Baig
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Marharyta Kamarova
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Simon M Bell
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Ali N Ali
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Li Su
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Munya Dimairo
- School of Health and Related Research, University of Sheffield, United Kingdom (M.D.)
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (J.D.)
| | - Jessica N Redgrave
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
| | - Arshad Majid
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, United Kingdom (S.S.B., M.K., S.M.B., A.N.A., L.S., J.N.R., A.M.)
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Wienke C, Grueschow M, Haghikia A, Zaehle T. Phasic, Event-Related Transcutaneous Auricular Vagus Nerve Stimulation Modifies Behavioral, Pupillary, and Low-Frequency Oscillatory Power Responses. J Neurosci 2023; 43:6306-6319. [PMID: 37591736 PMCID: PMC10490471 DOI: 10.1523/jneurosci.0452-23.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed to activate the locus ceruleus-noradrenaline (LC-NA) system. However, previous studies failed to find consistent modulatory effects of taVNS on LC-NA biomarkers. Previous studies suggest that phasic taVNS may be capable of modulating LC-NA biomarkers such as pupil dilation and alpha oscillations. However, it is unclear whether these effects extend beyond pure sensory vagal nerve responses. Critically, the potential of the pupillary light reflex as an additional taVNS biomarker has not been explored so far. Here, we applied phasic active and sham taVNS in 29 subjects (16 female, 13 male) while they performed an emotional Stroop task (EST) and a passive pupil light reflex task (PLRT). We recorded pupil size and brain activity dynamics using a combined Magnetoencephalography (MEG) and pupillometry design. Our results show that phasic taVNS significantly increased pupil dilation and performance during the EST. During the PLRT, active taVNS reduced and delayed pupil constriction. In the MEG, taVNS increased frontal-midline theta and alpha power during the EST, whereas occipital alpha power was reduced during both the EST and PLRT. Our findings provide evidence that phasic taVNS systematically modulates behavioral, pupillary, and electrophysiological parameters of LC-NA activity during cognitive processing. Moreover, we demonstrate for the first time that the pupillary light reflex can be used as a simple and effective proxy of taVNS efficacy. These findings have important implications for the development of noninvasive neuromodulation interventions for various cognitive and clinical applications.SIGNIFICANCE STATEMENT taVNS has gained increasing attention as a noninvasive neuromodulation technique and is widely used in clinical and nonclinical research. Nevertheless, the exact mechanism of action of taVNS is not yet fully understood. By assessing physiology and behavior in a response conflict task in healthy humans, we demonstrate the first successful application of a phasic, noninvasive vagus nerve stimulation to improve cognitive control and to systematically modulate pupillary and electrophysiological markers of the noradrenergic system. Understanding the mechanisms of action of taVNS could optimize future clinical applications and lead to better treatments for mental disorders associated with noradrenergic dysfunction. In addition, we present a new taVNS-sensitive pupillary measure representing an easy-to-use biomarker for future taVNS studies.
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Affiliation(s)
| | - Marcus Grueschow
- Zurich Center for Neuroeconomics, Departement of Economics, University of Zurich, 8006 Zurich, Switzerland
| | - Aiden Haghikia
- Otto-von-Guericke University, 39120 Magdeburg, Germany
- Deusches Zentrum für Neurodegenrative Erkrankungen, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, 39120, Germany
| | - Tino Zaehle
- Otto-von-Guericke University, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, 39120, Germany
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Szulczewski MT, D'Agostini M, Van Diest I. Expiratory-gated Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) does not Further Augment Heart Rate Variability During Slow Breathing at 0.1 Hz. Appl Psychophysiol Biofeedback 2023; 48:323-333. [PMID: 36920567 PMCID: PMC10412484 DOI: 10.1007/s10484-023-09584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
As cardiac vagal control is a hallmark of good health and self-regulatory capacity, researchers are seeking ways to increase vagally mediated heart rate variability (vmHRV) in an accessible and non-invasive way. Findings with transcutaneous auricular vagus nerve stimulation (taVNS) have been disappointing in this respect, as its effects on vmHRV are inconsistent at best. It has been speculated that combining taVNS with other established ways to increase vmHRV may produce synergistic effects. To test this idea, the present study combined taVNS with slow breathing in a cross-over design. A total of 22 participants took part in two sessions of breathing at 6 breaths/min: once combined with taVNS, and once combined with sham stimulation. Electrical stimulation (100 Hz, 400 µs) was applied during expiration, either to the tragus and cavum conchae (taVNS) or to the earlobe (sham). ECG was recorded during baseline, 20-minutes of stimulation, and the recovery period. Frequentist and Bayesian analyses showed no effect of taVNS (in comparison to sham stimulation) on the root mean square of successive differences between normal heartbeats, mean inter-beat interval, or spectral power of heart rate variability at a breathing frequency of 0.1 Hz. These findings suggest that expiratory-gated taVNS combined with the stimulation parameters examined here does not produce acute effects on vmHRV during slow breathing.
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Affiliation(s)
| | - Martina D'Agostini
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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D'Agostini M, Burger AM, Jelinčić V, von Leupoldt A, Van Diest I. Effects of transcutaneous auricular vagus nerve stimulation on P300 magnitudes and salivary alpha-amylase during an auditory oddball task. Biol Psychol 2023; 182:108646. [PMID: 37481230 DOI: 10.1016/j.biopsycho.2023.108646] [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: 02/24/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neurostimulation technique that is thought to modulate noradrenergic activity. Previous studies have demonstrated inconsistent effects of taVNS on noradrenergic activity, which is possibly due to insufficient statistical power, suboptimal stimulation parameter settings, and data collection procedures. In this preregistered within-subject experiment, 44 healthy participants received taVNS and sham (earlobe) stimulation during two separate experimental sessions. Stimulation intensity was individually calibrated to the maximum level below pain. During each session, participants received the stimulation continuously ten minutes before an auditory novelty oddball task till the end of the experimental session. The P3b component of the event-related potential served as a marker of phasic noradrenergic activity, whereas P3a magnitude was explored as an index of dopaminergic activity. Salivary alpha-amylase (sAA) was measured as an index of tonic noradrenergic activity before and at the end of the stimulation. The taVNS and sham conditions did not differ in P3a or P3b magnitudes, nor sAA secretion. These findings call into question whether taVNS, administered continuously at high, nonpainful stimulation intensities, reliably augments noradrenergic activity via the vagus nerve.
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Affiliation(s)
- Martina D'Agostini
- Health Psychology Research Group, KU Leuven, Tiensestraat 102/3726, Leuven 3000, Belgium.
| | - Andreas M Burger
- Health Psychology Research Group, KU Leuven, Tiensestraat 102/3726, Leuven 3000, Belgium
| | - Valentina Jelinčić
- Health Psychology Research Group, KU Leuven, Tiensestraat 102/3726, Leuven 3000, Belgium
| | - Andreas von Leupoldt
- Health Psychology Research Group, KU Leuven, Tiensestraat 102/3726, Leuven 3000, Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, KU Leuven, Tiensestraat 102/3726, Leuven 3000, Belgium
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Doerr JM, Juenemann M, Hakel L, Schmidt L, Menzler K, Krause K, Linka L, Skoluda N, Nater UM, Knake S. Effect of transcutaneous vagus nerve stimulation on stress-reactive neuroendocrine measures in a sample of persons with temporal lobe epilepsy. Epilepsia Open 2023; 8:1013-1020. [PMID: 37310988 PMCID: PMC10472404 DOI: 10.1002/epi4.12774] [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: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE Dysregulation of stress-reactive neuroendocrine measures, as well as subjective stress, have been found to worsen epilepsy. Transcutaneous vagus nerve stimulation (tVNS) is a relatively new treatment option for epilepsy. We were interested in its effect on the activity of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) as well as subjective stress and tiredness in patients with temporal lobe epilepsy (TLE). METHODS Twenty patients (age 44 ± 11 years, 13 women) were enrolled in the study. They were free of seizures for more than 1 year. All took part in two sessions with 4 h of stimulation (tVNS vs. sham) in a randomized order. Saliva samples and subjective stress and tiredness levels were measured at five time points each session (before and after stimulation and three time points every hour in between). Data were analyzed using repeated measures analysis of variance as well as paired t-tests. RESULTS There was a dampened salivary cortisol (sCort) decrease during tVNS (time × condition effect: F[2.38, 38.15] = 6.50, P = 0.002, partial η2 = 0.29). Furthermore, we detected a dampened increase in salivary flow rate during tVNS (time × condition effect: F[3.28, 55.67] = 2.82, P = 0.043, partial η2 = 0.14). There was neither a difference in overall sCort or salivary alpha-amylase (sAA) levels nor in subjective stress or tiredness levels between conditions. sAA levels at the last measurement point were slightly higher during tVNS (t(19) = 2.26, P = 0.035, d = 0.51), but this effect failed to reach significance when controlled for multiple comparisons. SIGNIFICANCE Our results partially support that tVNS influences the regulation of stress-reactive neuroendocrine systems (namely the HPA axis and ANS) in epilepsy. More research with larger samples is needed on the difference between short-term and repeated long-term stimulation.
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Affiliation(s)
- Johanna M. Doerr
- Department of NeurologyUniversity Hospital Gießen and MarburgGießenGermany
| | - Martin Juenemann
- Department of NeurologyUniversity Hospital Gießen and MarburgGießenGermany
| | - Lukas Hakel
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Laura Schmidt
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Katja Menzler
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Kristina Krause
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Louise Linka
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Urs M. Nater
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Susanne Knake
- Epilepsy Center Hessen, Department of NeurologyPhilipps‐University MarburgMarburgGermany
- Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany
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Sommer A, Fischer R, Borges U, Laborde S, Achtzehn S, Liepelt R. The effect of transcutaneous auricular vagus nerve stimulation (taVNS) on cognitive control in multitasking. Neuropsychologia 2023; 187:108614. [PMID: 37295553 DOI: 10.1016/j.neuropsychologia.2023.108614] [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: 11/09/2022] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
Current research in brain stimulation suggests transcutaneous auricular vagus nerve stimulation (taVNS) as a promising tool to modulate cognitive functions in healthy populations, such as attention, memory, and executive functions. Empirical evidence in single-task contexts, suggests that taVNS promotes holistic task processing, which strengthens the integration of multiple stimulus features in task processing. However, it is unclear how taVNS might affect performance in multitasking, where the integration of multiple stimuli leads to an overlap in stimulus response translation processes, increasing the risk of between-task interference (crosstalk). In a single-blinded, sham-controlled, within-subject design, participants underwent taVNS while performing a dual task. To assess the effects of taVNS, behavioral (reaction times), physiological (heart rate variability, salivary alpha-amylase), and subjective psychological variables (e.g., arousal) were recorded over three cognitive test blocks. Our results revealed no overall significant effect of taVNS on physiological and subjective psychological variables. However, the results showed a significant increase in between-task interference under taVNS in the first test block, but not in the subsequent test blocks. Our findings therefore suggest that taVNS increased integrative processing of both tasks early during active stimulation.
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Affiliation(s)
- Aldo Sommer
- Department of General Psychology: Judgment, Decision Making, Action, Faculty of Psychology, University of Hagen (FernUniversität in Hagen), Hagen, Germany; Department of Exercise Physiology, German Sport University Cologne, Cologne, Germany.
| | - Rico Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Uirassu Borges
- Department of Health and Social Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany; Normandie Université, UFR STAPS, EA 4260 CESAMS, Caen, France
| | - Silvia Achtzehn
- Department of Exercise Physiology, German Sport University Cologne, Cologne, Germany
| | - Roman Liepelt
- Department of General Psychology: Judgment, Decision Making, Action, Faculty of Psychology, University of Hagen (FernUniversität in Hagen), Hagen, Germany
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Lloyd B, Wurm F, de Kleijn R, Nieuwenhuis S. Short-term transcutaneous vagus nerve stimulation increases pupil size but does not affect EEG alpha power: A replication of Sharon et al. (2021, Journal of Neuroscience). Brain Stimul 2023; 16:1001-1008. [PMID: 37348704 DOI: 10.1016/j.brs.2023.06.010] [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: 03/15/2023] [Revised: 05/29/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) has been tested as a potential treatment for pharmaco-resistant epilepsy and depression. Its clinical efficacy is thought to depend on taVNS-induced activation of the locus coeruleus and other neuromodulator systems. However, unlike for invasive VNS in rodents, there is little evidence for an effect of taVNS on noradrenergic activity. OBJECTIVE We attempted to replicate recently published findings by Sharon et al. (2021), showing that short bursts of taVNS transiently increased pupil size and decreased EEG alpha power, two correlates of central noradrenergic activity. METHODS Following the original study, we used a single-blind, sham-controlled, randomized cross-over design. Human volunteers (n = 29) received short-term (3.4 s) taVNS at the maximum level below the pain threshold, while we collected resting-state pupil-size and EEG data. To analyze the data, we used scripts provided by Sharon and colleagues. RESULTS Consistent with Sharon et al. (2021), pupil dilation was significantly larger during taVNS than during sham stimulation (p = .009; Bayes factor supporting the difference = 7.45). However, we failed to replicate the effect of taVNS on EEG alpha power (p = .37); the data were four times more likely under the null hypothesis (BF10 = 0.28). CONCLUSION Our findings support the effectiveness of short-term taVNS in inducing transient pupil dilation, a correlate of phasic noradrenergic activity. However, we failed to replicate the recent finding by Sharon et al. (2021) that taVNS attenuates EEG alpha activity. Overall, this study highlights the need for continued research on the neural mechanisms underlying taVNS efficacy and its potential as a treatment option for pharmaco-resistant conditions. It also highlights the need for direct replications of influential taVNS studies.
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Affiliation(s)
- Beth Lloyd
- Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands.
| | - Franz Wurm
- Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Roy de Kleijn
- Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Sander Nieuwenhuis
- Institute of Psychology, Leiden University, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
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Konjusha A, Yu S, Mückschel M, Colzato L, Ziemssen T, Beste C. Auricular Transcutaneous Vagus Nerve Stimulation Specifically Enhances Working Memory Gate Closing Mechanism: A System Neurophysiological Study. J Neurosci 2023; 43:4709-4724. [PMID: 37221097 PMCID: PMC10286950 DOI: 10.1523/jneurosci.2004-22.2023] [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: 10/26/2022] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023] Open
Abstract
Everyday tasks and goal-directed behavior involve the maintenance and continuous updating of information in working memory (WM). WM gating reflects switches between these two core states. Neurobiological considerations suggest that the catecholaminergic and the GABAergic are likely involved in these dynamics. Both of these neurotransmitter systems likely underlie the effects to auricular transcutaneous vagus nerve stimulation (atVNS). We examine the effects of atVNS on WM gating dynamics and their underlying neurophysiological and neurobiological processes in a randomized crossover study design in healthy humans of both sexes. We show that atVNS specifically modulates WM gate closing and thus specifically modulates neural mechanisms enabling the maintenance of information in WM. WM gate opening processes were not affected. atVNS modulates WM gate closing processes through the modulation of EEG alpha band activity. This was the case for clusters of activity in the EEG signal referring to stimulus information, motor response information, and fractions of information carrying stimulus-response mapping rules during WM gate closing. EEG-beamforming shows that modulations of activity in fronto-polar, orbital, and inferior parietal regions are associated with these effects. The data suggest that these effects are not because of modulations of the catecholaminergic (noradrenaline) system as indicated by lack of modulatory effects in pupil diameter dynamics, in the inter-relation of EEG and pupil diameter dynamics and saliva markers of noradrenaline activity. Considering other findings, it appears that a central effect of atVNS during cognitive processing refers to the stabilization of information in neural circuits, putatively mediated via the GABAergic system.SIGNIFICANCE STATEMENT Goal-directed behavior depends on how well information in short-term memory can be flexibly updated but also on how well it can be shielded from distraction. These two functions were guarded by a working memory gate. We show how an increasingly popular brain stimulation techniques specifically enhances the ability to close the working memory gate to shield information from distraction. We show what physiological and anatomic aspects underlie these effects.
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Affiliation(s)
- Anyla Konjusha
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden 01307, Germany
| | - Shijing Yu
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden 01307, Germany
| | - Moritz Mückschel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden 01307, Germany
| | - Lorenza Colzato
- Faculty of Psychology, Shandong Normal University, Jinan 250014, China
| | - Tjalf Ziemssen
- Department of Neurology, Faculty of Medicine, MS Centre, TU Dresden, Dresden 01307, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden 01307, Germany
- Faculty of Psychology, Shandong Normal University, Jinan 250014, China
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Sigrist C, Torki B, Bolz LO, Jeglorz T, Bolz A, Koenig J. Transcutaneous Auricular Vagus Nerve Stimulation in Pediatric Patients: A Systematic Review of Clinical Treatment Protocols and Stimulation Parameters. Neuromodulation 2023; 26:507-517. [PMID: 35995653 DOI: 10.1016/j.neurom.2022.07.007] [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: 04/25/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noninvasive transcutaneous vagus nerve stimulation (tVNS) has promising therapeutic potential in a wide range of applications across somatic and psychiatric conditions. Compared with invasive vagus nerve stimulation, good safety and tolerability profiles also support the use of tVNS in pediatric patients. Potential neurodevelopment-specific needs, however, raise concerns regarding the age-appropriate adjustment of treatment protocols and applied stimulation parameters. OBJECTIVE In this study, we aimed to review registered trials and published studies to synthesize existing tVNS treatment protocols and stimulation parameters applied in pediatric patients. MATERIALS AND METHODS A systematic search of electronic data bases (PubMed, Scopus, MEDLINE, Cochrane Library, and PsycINFO) and ClinicalTrials was conducted. Information on patient and study-level characteristics (eg, clinical condition, sample size), the tVNS device (eg, brand name, manufacturer), stimulation settings (eg, pulse width, stimulation intensity), and stimulation protocol (eg, duration, dosage of stimulation) was extracted. RESULTS We identified a total of 15 publications (four study protocols) and 15 registered trials applying tVNS in pediatric patients (<18 years of age). Most of these studies did not exclusively address pediatric patients. None of the studies elaborated on neurodevelopmental aspects or justified the applied protocol or stimulation parameters for use in pediatric patients. CONCLUSIONS No dedicated pediatric tVNS devices exist. Neither stimulation parameters nor stimulation protocols for tVNS are properly justified in pediatric patients. Evidence on age-dependent stimulation effects of tVNS under a neurodevelopment framework is warranted. We discuss the potential implications of these findings with clinical relevance, address some of the challenges of tVNS research in pediatric populations, and point out key aspects in future device development and research in addition to clinical studies on pediatric populations.
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Affiliation(s)
- Christine Sigrist
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bushra Torki
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Armin Bolz
- tVNS Technologies GmbH, Erlangen, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Gurtubay IG, Perez-Rodriguez DR, Fernandez E, Librero-Lopez J, Calvo D, Bermejo P, Pinin-Osorio C, Lopez M. Immediate effects and duration of a short and single application of transcutaneous auricular vagus nerve stimulation on P300 event related potential. Front Neurosci 2023; 17:1096865. [PMID: 37051148 PMCID: PMC10083261 DOI: 10.3389/fnins.2023.1096865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/10/2023] [Indexed: 03/28/2023] Open
Abstract
IntroductionTranscutaneous auricular vagus nerve stimulation (taVNS) is a neuromodulatory technique that stimulates the auricular branch of the vagus nerve. The modulation of the locus coeruleus-norepinephrine (LC-NE) network is one of the potential working mechanisms of this method. Our aims were 1-to investigate if short and single applications of taVNS can modulate the P300 cognitive event-related potential (ERP) as an indirect marker that reflects NE brain activation under control of the LC, and 2-to evaluate the duration of these changes.Methods20 healthy volunteers executed an auditory oddball paradigm to obtain P300 and reaction time (RT) values. Then a 7 min active or sham taVNS period was initiated and simultaneously a new P300 paradigm was performed. We successively repeated the paradigm on 4 occasions with different time intervals up to 56 min after the stimulation onset.ResultsDuring active taVNS an immediate and significant effect of increasing the amplitude and reducing the latency of P300, as well as a shortening in the RT was observed. This effect was prolonged in time up to 28 min. The values then returned to pre-stimulation levels. Sham stimulation did not generate changes.DiscussionOur results, demonstrate differential facilitating effects in a concrete time window after taVNS. Literature about the modulatory effect of taVNS over P300 ERP shows a wide spread of results. There is not a standardized system for taVNS and currently the great heterogeneity of stimulation approaches concerning targets and parameters, make it difficult to obtain conclusions about this relationship. Our study was designed optimizing several stimulation settings, such as a customized earbud stimulator, enlarged stimulating surface, simultaneous stimulation over the cymba and cavum conchae, a Delayed Biphasic Pulse Burst and current controlled stimulation that adjusted the output voltage and guaranteed the administration of a preset electrical dose. Under our stimulation conditions, targeting vagal nerve fibers via taVNS modulates the P300 in healthy participants. The optimal settings of modulatory function of taVNS on P300, and their interdependency is insufficiently studied in the literature, but our data provides several easily optimizable parameters, that will produce more robust results in future.
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Affiliation(s)
- Iñaki G. Gurtubay
- Department of Neurophysiology, University Hospital of Navarre, Pamplona, Spain
- Navarrabiomed Biomedical Research Centre, Pamplona, Spain
- *Correspondence: Iñaki G. Gurtubay,
| | | | | | | | - David Calvo
- Arrhythmia Unit, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Asturias, Spain
| | - Pedro Bermejo
- Neurologist, Translational Medicine UCB Pharma, Brussels, Belgium
| | | | - Miguel Lopez
- Xana Smart Neurostimulation, Epalinges, Switzerland
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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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D'Agostini M, Burger AM, Franssen M, Perkovic A, Claes S, von Leupoldt A, Murphy PR, Van Diest I. Short bursts of transcutaneous auricular vagus nerve stimulation enhance evoked pupil dilation as a function of stimulation parameters. Cortex 2023; 159:233-253. [PMID: 36640622 DOI: 10.1016/j.cortex.2022.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) is a neurostimulatory technique hypothesised to enhance central noradrenaline. Currently, there is scarce evidence in support of a noradrenergic mechanism of taVNS and limited knowledge on its stimulation parameters (i.e., intensity and pulse width). Therefore, the present study aimed to test whether taVNS enhances pupil dilation, a noradrenergic biomarker, as a function of stimulation parameters. Forty-nine participants received sham (i.e., left ear earlobe) and taVNS (i.e., left ear cymba concha) stimulation in two separate sessions, in a counterbalanced order. We administered short bursts (5s) of seven stimulation settings varying as a function of pulse width and intensity and measured pupil size in parallel. Each stimulation setting was administered sixteen times in separate blocks. We expected short bursts of stimulation to elicit phasic noradrenergic activity as indexed by event-related pupil dilation and event-related temporal derivative. We hypothesised higher stimulation settings, quantified as the total charge per pulse (pulse width x intensity), to drive greater event-related pupil dilation and temporal derivative in the taVNS compared to sham condition. Specifically, we expected stimulation settings in the taVNS condition to be associated with a linear increase in event-related pupil dilation and temporal derivative. We found stimulation settings to linearly increase both pupil measures. In line with our hypothesis, the observed dose-dependent effect was stronger in the taVNS condition. We also found taVNS to elicit more intense and unpleasant sensations than sham stimulation. These results support the hypothesis of a noradrenergic mechanism of taVNS. However, future studies should disentangle whether stimulation elicited sensations mediate the effect of taVNS on evoked pupil dilation.
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Affiliation(s)
| | | | | | - Ana Perkovic
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- The Mind Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | | | - Peter R Murphy
- Department of Psychology, Maynooth University, Co. Kildare, Ireland; Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland.
| | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.
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21
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De Smet S, Ottaviani C, Verkuil B, Kappen M, Baeken C, Vanderhasselt MA. Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition. Psychophysiology 2023; 60:e14250. [PMID: 36683127 DOI: 10.1111/psyp.14250] [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: 12/27/2021] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/24/2023]
Abstract
Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Bart Verkuil
- Department of Clinical Psychology, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Mitchel Kappen
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Psychiatry, Brussels University Hospital, Brussels, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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22
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Engels-Domínguez N, Koops EA, Prokopiou PC, Van Egroo M, Schneider C, Riphagen JM, Singhal T, Jacobs HIL. State-of-the-art imaging of neuromodulatory subcortical systems in aging and Alzheimer's disease: Challenges and opportunities. Neurosci Biobehav Rev 2023; 144:104998. [PMID: 36526031 PMCID: PMC9805533 DOI: 10.1016/j.neubiorev.2022.104998] [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: 06/30/2022] [Revised: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Primary prevention trials have shifted their focus to the earliest stages of Alzheimer's disease (AD). Autopsy data indicates that the neuromodulatory subcortical systems' (NSS) nuclei are specifically vulnerable to initial tau pathology, indicating that these nuclei hold great promise for early detection of AD in the context of the aging brain. The increasing availability of new imaging methods, ultra-high field scanners, new radioligands, and routine deep brain stimulation implants has led to a growing number of NSS neuroimaging studies on aging and neurodegeneration. Here, we review findings of current state-of-the-art imaging studies assessing the structure, function, and molecular changes of these nuclei during aging and AD. Furthermore, we identify the challenges associated with these imaging methods, important pathophysiologic gaps to fill for the AD NSS neuroimaging field, and provide future directions to improve our assessment, understanding, and clinical use of in vivo imaging of the NSS.
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Affiliation(s)
- Nina Engels-Domínguez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Elouise A Koops
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Prokopis C Prokopiou
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maxime Van Egroo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christoph Schneider
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joost M Riphagen
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tarun Singhal
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heidi I L Jacobs
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands.
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23
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Kamboj SK, Peniket M, Simeonov L. A bioelectronic route to compassion: Rationale and study protocol for combining transcutaneous vagus nerve stimulation (tVNS) with compassionate mental imagery. PLoS One 2023; 18:e0282861. [PMID: 36913378 PMCID: PMC10010509 DOI: 10.1371/journal.pone.0282861] [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: 08/26/2022] [Accepted: 02/19/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The vagus nerve (VN) is a neural nexus between the brain and body, enabling bidirectional regulation of mental functioning and peripheral physiology. Some limited correlational findings suggest an association between VN activation and a particular form of self-regulation: compassionate responding. Interventions that are geared towards strengthening self-compassion in particular, can serve as an antidote to toxic shame and self-criticism and improve psychological health. OBJECTIVE We describe a protocol for examining the role of VN activation on 'state' self-compassion, self-criticism, and related outcomes. By combining transcutaneous vagus nerve stimulation (tVNS) with a brief imagery-based self-compassion intervention, we aim to preliminarily test additivity versus synergy between these distinct bottom-up and top-down methods for putatively regulating vagal activity. We also test whether the effects of VN stimulation accumulate with daily stimulation and daily compassionate imagery practice. METHODS Using a randomized 2 x 2 factorial (stimulation x imagery condition) design, healthy volunteers (n = 120) receive active (tragus) or sham (earlobe) tVNS plus standardized (audio-recorded) self-compassionate or sham mental imagery instructions. These interventions are delivered in a university-based psychological laboratory in two sessions, one week apart, as well as being self-administered between sessions by participants at home. Pre-stimulation, peri-stimulation and post-imagery measures of state self-compassion, self-criticism and related self-report outcomes are assessed in two lab sessions, separated by a week (Days 1 and 8). Heart rate variability is used as a physiological metric of vagal activity and an eye-tracking task assesses attentional bias to compassionate faces during the two lab sessions. On Days 2-7, participants continue their randomly assigned stimulation and imagery tasks at home, and complete state measures at the end of each remote session. DISCUSSION Demonstrating modulation of compassionate responding using tVNS would support a causal link between VN activation and compassion. This would provide a basis for future studies of bioelectronic approaches to augmenting therapeutic contemplative techniques. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov, Identifier: NCT05441774 (Date: July 1st 2022). OSF REGISTRATION https://osf.io/4t9ha.
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Affiliation(s)
- Sunjeev K. Kamboj
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- * E-mail:
| | - Matthew Peniket
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Louise Simeonov
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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24
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Forte G, Favieri F, Leemhuis E, De Martino ML, Giannini AM, De Gennaro L, Casagrande M, Pazzaglia M. Ear your heart: transcutaneous auricular vagus nerve stimulation on heart rate variability in healthy young participants. PeerJ 2022; 10:e14447. [PMID: 36438582 PMCID: PMC9686410 DOI: 10.7717/peerj.14447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Transcutaneous auricular vagus nerve stimulation (taVNS) stimulating the auricular branch of the vagus nerve along a well-defined neuroanatomical pathway, has promising therapeutic efficacy. Potentially, taVNS can modulate autonomic responses. Specifically, taVNS can induce more consistent parasympathetic activation and may lead to increased heart rate variability (HRV). However, the effects of taVNS on HRV remain inconclusive. Here, we investigated changes in HRV due to brief alteration periods of parasympathetic-vagal cardiac activity produced by taVNS on the cymba as opposed to control administration via the helix. Materials and Methods We compared the effect of 10 min of active stimulation (i.e., cymba conchae) to sham stimulation (i.e., helix) on peripheral cardiovascular response, in 28 healthy young adults. HRV was estimated in the time domain and frequency domain during the overall stimulation. Results Although active-taVNS and sham-taVNS stimulation did not differ in subjective intensity ratings, the active stimulation of the cymba led to vagally mediated HRV increases in both the time and frequency domains. Differences were significant between active-taVNS and both sham-taVNS and resting conditions in the absence of stimulation for various HRV parameters, but not for the low-frequency index of HRV, where no differences were found between active-taVNS and sham-taVNS conditions. Conclusion This work supports the hypothesis that taVNS reliably induces a rapid increase in HRV parameters when auricular stimulation is used to recruit fibers in the cymba compared to stimulation at another site. The results suggest that HRV can be used as a physiological indicator of autonomic tone in taVNS for research and potential therapeutic applications, in line with the established effects of invasive VNS. Knowledge of the physiological effect of taVNS short sessions in modulating cardiovagal processing is essential for enhancing its clinical use.
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Affiliation(s)
- Giuseppe Forte
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
| | - Francesca Favieri
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
| | - Erik Leemhuis
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
| | - Maria Luisa De Martino
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
| | | | - Luigi De Gennaro
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
| | - Maria Casagrande
- Dipartimento di Psicologia Clinica, Dinamica e Salute, University of Roma “La Sapienza”, Rome, Italy
| | - Mariella Pazzaglia
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy,Department of Psychology, University of Roma “La Sapienza”, Rome, Italy
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25
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Geng D, Yang K, Fu Z, Zhang Y, Wang C, An H. Circadian stage-dependent and stimulation duration effects of transcutaneous auricular vagus nerve stimulation on heart rate variability. PLoS One 2022; 17:e0277090. [PMID: 36327249 PMCID: PMC9632923 DOI: 10.1371/journal.pone.0277090] [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: 04/13/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) can improve autonomic nerve function and is currently undergoing extensive clinical research; however, its efficacy heterogeneity has caused great controversy. Heart rate variability (HRV), a biomarker reflecting autonomic function, exhibits a time-varying pattern with circadian rhythms, which may be the main reason for the inconsistent stimulation effects. To test this conjecture, we performed isochronous acute stimulation experiments at intervals of 12 h. The results showed that HRV indicators representing vagal nerve activity significantly increased when stimulation was performed in the morning, and the enhancement of high frequency continued into the recovery period. However, the evening stimulation did not yield similar results. In addition, we found that improvements in the measures of autonomic balance were more pronounced in the presence of lower vagal activity. By increasing the stimulation duration, we also found that the effect of taVNS on HRV was not regulated by duration; in other words, HRV changes only had the best effect at the beginning of stimulation. These studies allowed us to determine the optimal stimulation phase and duration and potentially screen the optimal candidates for taVNS.
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Affiliation(s)
- Duyan Geng
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin, China
- * E-mail:
| | - Kai Yang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin, China
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, Hebei University of Technology, Tianjin, China
| | - Zhigang Fu
- Physical Examination Center of the 983rd Hospital of the Chinese People’s Liberation Army Joint Logistic Support Force, Tianjin, China
| | - Yi Zhang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin, China
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, Hebei University of Technology, Tianjin, China
| | - Chao Wang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin, China
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, Hebei University of Technology, Tianjin, China
| | - Hongxia An
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin, China
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, Hebei University of Technology, Tianjin, China
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26
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Giraudier M, Ventura-Bort C, Burger AM, Claes N, D'Agostini M, Fischer R, Franssen M, Kaess M, Koenig J, Liepelt R, Nieuwenhuis S, Sommer A, Usichenko T, Van Diest I, von Leupoldt A, Warren CM, Weymar M. Evidence for a modulating effect of transcutaneous auricular vagus nerve stimulation (taVNS) on salivary alpha-amylase as indirect noradrenergic marker: A pooled mega-analysis. Brain Stimul 2022; 15:1378-1388. [PMID: 36183953 DOI: 10.1016/j.brs.2022.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) has received tremendous attention as a potential neuromodulator of cognitive and affective functions, which likely exerts its effects via activation of the locus coeruleus-noradrenaline (LC-NA) system. Reliable effects of taVNS on markers of LC-NA system activity, however, have not been demonstrated yet. METHODS The aim of the present study was to overcome previous limitations by pooling raw data from a large sample of ten taVNS studies (371 healthy participants) that collected salivary alpha-amylase (sAA) as a potential marker of central NA release. RESULTS While a meta-analytic approach using summary statistics did not yield any significant effects, linear mixed model analyses showed that afferent stimulation of the vagus nerve via taVNS increased sAA levels compared to sham stimulation (b = 0.16, SE = 0.05, p = 0.001). When considering potential confounders of sAA, we further replicated previous findings on the diurnal trajectory of sAA activity. CONCLUSION(S) Vagal activation via taVNS increases sAA release compared to sham stimulation, which likely substantiates the assumption that taVNS triggers NA release. Moreover, our results highlight the benefits of data pooling and data sharing in order to allow stronger conclusions in research.
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Affiliation(s)
- Manon Giraudier
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | | | - Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | | | - Rico Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | | | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Roman Liepelt
- Department of General Psychology: Judgment, Decision Making, Action, Faculty of Psychology, University of Hagen (FernUniversität in Hagen), Hagen, Germany
| | - Sander Nieuwenhuis
- Institute of Psychology, Leiden University, Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Netherlands
| | - Aldo Sommer
- Department of General Psychology: Judgment, Decision Making, Action, Faculty of Psychology, University of Hagen (FernUniversität in Hagen), Hagen, Germany; Department of Exercise Physiology, German Sport University Cologne, Cologne, Germany
| | - Taras Usichenko
- Department of Anesthesiology, University Medicine of Greifswald, Greifswald, Germany; Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | | | - Christopher M Warren
- Emma Eccles Jones College of Education and Human Services, Utah State University, United States
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany; Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.
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27
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Jensen MK, Andersen SS, Andersen SS, Liboriussen CH, Kristensen S, Jochumsen M. Modulating Heart Rate Variability through Deep Breathing Exercises and Transcutaneous Auricular Vagus Nerve Stimulation: A Study in Healthy Participants and in Patients with Rheumatoid Arthritis or Systemic Lupus Erythematosus. SENSORS (BASEL, SWITZERLAND) 2022; 22:7884. [PMID: 36298234 PMCID: PMC9607552 DOI: 10.3390/s22207884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with an impaired autonomic nervous system and vagus nerve function. Electrical or physiological (deep breathing-DB) vagus nerve stimulation (VNS) could be a potential treatment approach, but no direct comparison has been made. In this study, the effect of transcutaneous auricular VNS (taVNS) and DB on vagal tone was compared in healthy participants and RA or SLE patients. The vagal tone was estimated using time-domain heart-rate variability (HRV) parameters. Forty-two healthy participants and 52 patients performed 30 min of DB and 30 min of taVNS on separate days. HRV was recorded before and immediately after each intervention. For the healthy participants, all HRV parameters increased after DB (SDNN + RMSSD: 21-46%), while one HRV parameter increased after taVNS (SDNN: 16%). For the patients, all HRV parameters increased after both DB (17-31%) and taVNS (18-25%), with no differences between the two types of VNS. DB was associated with the largest elevation of the HRV parameters in healthy participants, while both types of VNS led to elevated HRV parameters in the patients. The findings support a potential use of VNS as a new treatment approach, but the clinical effects need to be investigated in future studies.
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Affiliation(s)
| | | | | | | | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Mads Jochumsen
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
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28
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Choi S, Jang DC, Chung G, Kim SK. Transcutaneous Auricular Vagus Nerve Stimulation Enhances Cerebrospinal Fluid Circulation and Restores Cognitive Function in the Rodent Model of Vascular Cognitive Impairment. Cells 2022; 11:cells11193019. [PMID: 36230988 PMCID: PMC9564197 DOI: 10.3390/cells11193019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Vascular cognitive impairment (VCI) is a common sequela of cerebrovascular disorders. Although transcutaneous auricular vagus nerve stimulation (taVNS) has been considered a complementary treatment for various cognitive disorders, preclinical data on the effect of taVNS on VCI and its mechanism remain ambiguous. To measure cerebrospinal fluid (CSF) circulation during taVNS, we used in vivo two-photon microscopy with CSF and vasculature tracers. VCI was induced by transient bilateral common carotid artery occlusion (tBCCAO) surgery in mice. The animals underwent anesthesia, off-site stimulation, or taVNS for 20 min. Cognitive tests, including the novel object recognition and the Y-maze tests, were performed 24 h after the last treatment. The long-term treatment group received 6 days of treatment and was tested on day 7; the short-term treatment group received 2 days of treatment and was tested 3 days after tBCCAO surgery. CSF circulation increased remarkably in the taVNS group, but not in the anesthesia-control or off-site-stimulation-control groups. The cognitive impairment induced by tBCCAO was significantly restored after both long- and short-term taVNS. In terms of effects, both long- and short-term stimulations showed similar recovery effects. Our findings provide evidence that taVNS can facilitate CSF circulation and that repetitive taVNS can ameliorate VCI symptoms.
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Affiliation(s)
- Seunghwan Choi
- Department of East-West Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
| | - Dong Cheol Jang
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
| | - Geehoon Chung
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
| | - Sun Kwang Kim
- Department of East-West Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea
- Correspondence:
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29
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Höper S, Kaess M, Koenig J. Prefrontal cortex oxygenation and autonomic nervous system activity under transcutaneous auricular vagus nerve stimulation in adolescents. Auton Neurosci 2022; 241:103008. [PMID: 35724559 DOI: 10.1016/j.autneu.2022.103008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/20/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Neurovisceral Integration Model (NIM) proposes a complex interplay of visceral and neural structures that are crucial for adaptive responses to environmental demands. The aim of the present study was to investigate this circuitry using experimental manipulation via transcutaneous auricular vagus nerve stimulation (tVNS), measures of peripheral autonomic nervous system (ANS) activity and prefrontal cortex (PFC) oxygenation, quantified using functional near-infrared spectroscopy (fNIRS). METHODS In a sample of n = 30 adolescents (age 14-17 years), tVNS versus sham stimulation was applied each during a 15-minute stimulation phase in a within-subject-cross-randomized-design. Mean oxygenation of the PFC and functional connectivity were assessed using fNIRS. Additionally, heart rate variability (HRV), heart rate (HR), electrodermal activity (EDA), and saliva alpha-amylase (sAA) were assessed to quantify peripheral ANS activity. RESULTS Using linear mixed-effects models, HRV increased (p < .0001) and HR (p < .0001) decreased during tVNS compared to sham. No effect on EDA or sAA was observed. PFC oxygenation increased over time under tVNS compared to sham (p = .017). The relative increase in HRV and decrease in HR was associated with increased oxygenation of the PFC (HR: p < .0001; HRV: p = .007). Exploratory analyses illustrated, that under tVNS, PFC connectivity increased compared to sham. CONCLUSION The present study supports the NIM by showing that tVNS influences ANS activity and that relative changes in PFC oxygenation contribute to these effects. Implications of these findings and directions for further research are discussed.
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Affiliation(s)
- Saskia Höper
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany.
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Zhu S, Qing Y, Zhang Y, Zhang X, Ding F, Zhang R, Yao S, Kendrick KM, Zhao W. Transcutaneous auricular vagus nerve stimulation increases eye-gaze on salient facial features and oxytocin release. Psychophysiology 2022; 59:e14107. [PMID: 35638321 DOI: 10.1111/psyp.14107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/21/2022]
Abstract
Non-invasive, transcutaneous electrical stimulation of the auricular branch of the vagus nerve (taVNS) via the ear is used therapeutically in epilepsy, pain, and depression, and may also have beneficial effects on social cognition. However, the underlying mechanisms of taVNS are unclear and evidence regarding its role in social cognition improvement is limited. To investigate the impact of taVNS on social cognition we have studied its effects on gaze toward emotional faces in combination with eye-tracking and on the release of the neuropeptide oxytocin which plays a key role in influencing social cognition and motivation. A total of 54 subjects were enrolled (49 were included in the final analysis) in a sham-controlled, participant-blind, crossover experiment, consisting of two treatment sessions 1 week apart. In one session participants received 30-min taVNS (tragus), and in the other, they received 30-min sham (earlobe) stimulation with the treatment order counterbalanced. The proportion of time spent viewing the faces and facial features (eyes, nose, and mouth) was measured together with resting pupil size. Additionally, saliva samples were taken for the measurement of oxytocin concentrations by enzyme-linked immunoassay. Saliva oxytocin concentrations increased significantly after taVNS compared to sham stimulation, while resting pupil size did not. In addition, taVNS increased time spent viewing the nose region irrespective of face emotion, and this was positively correlated with increased saliva oxytocin concentrations. Our findings suggest that taVNS biases visual attention toward socially salient facial features across different emotions and this is associated with its effects on increasing endogenous oxytocin release.
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Affiliation(s)
- Siyu Zhu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanan Qing
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yingying Zhang
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Xiaolu Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fangyuan Ding
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Rong Zhang
- Key Laboratory for Neuroscience, Ministry of Education of China
- Key Laboratory for Neuroscience, National Committee of Health and Family Planning of China
- Department of Neurobiology, School of Basic Medical Sciences
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Wang Y, Li L, Li S, Fang J, Zhang J, Wang J, Zhang Z, Wang Y, He J, Zhang Y, Rong P. Toward Diverse or Standardized: A Systematic Review Identifying Transcutaneous Stimulation of Auricular Branch of the Vagus Nerve in Nomenclature. Neuromodulation 2022; 25:366-379. [PMID: 35396069 DOI: 10.1111/ner.13346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES After 20 years of development, there is confusion in the nomenclature of transcutaneous stimulation of the auricular branch of the vagus nerve (ABVN). We performed a systematic review of transcutaneous stimulation of ABVN in nomenclature. MATERIALS AND METHODS A systematic search of the literature was carried out, using the bibliographic search engine PubMed. The search covered articles published up until June 11, 2020. We recorded the full nomenclature and abbreviated nomenclature same or similar to transcutaneous stimulation of ABVN in the selected eligible studies, as well as the time and author information of this nomenclature. RESULTS From 261 studies, 67 full nomenclatures and 27 abbreviated nomenclatures were finally screened out, transcutaneous vagus nerve stimulation and tVNS are the most common nomenclature, accounting for 38.38% and 42.06%, respectively. In a total of 97 combinations of full nomenclatures and abbreviations, the most commonly used nomenclature for the combination of transcutaneous vagus nerve stimulation and tVNS, accounting for 30.28%. Interestingly, the combination of full nomenclatures and abbreviations is not always a one-to-one relationship, there are ten abbreviated nomenclatures corresponding to transcutaneous vagus nerve stimulation, and five full nomenclatures corresponding to tVNS. In addition, based on the analysis of the usage habits of nomenclature in 21 teams, it is found that only three teams have fixed habits, while other different teams or the same team do not always use the same nomenclature in their paper. CONCLUSIONS The phenomenon of confusion in the nomenclature of transcutaneous stimulation of ABVN is obvious and shows a trend of diversity. The nomenclature of transcutaneous stimulation of ABVN needs to become more standardized in the future.
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Affiliation(s)
- Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shaoyuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixuan Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yifei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
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A two-week course of transcutaneous vagal nerve stimulation improves global sleep: Findings from a randomised trial in community-dwelling adults. Auton Neurosci 2022; 240:102972. [DOI: 10.1016/j.autneu.2022.102972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/11/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
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D'Agostini M, Burger AM, Villca Ponce G, Claes S, von Leupoldt A, Van Diest I. No evidence for a modulating effect of continuous transcutaneous auricular vagus nerve stimulation on markers of noradrenergic activity. Psychophysiology 2022; 59:e13984. [PMID: 34990045 DOI: 10.1111/psyp.13984] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023]
Abstract
Although transcutaneous auricular vagus nerve stimulation (taVNS) is thought to increase central noradrenergic activity, findings supporting such mechanism are scarce and inconsistent. This study aimed to investigate whether taVNS modulates indirect markers of phasic and tonic noradrenergic activity. Sixty-six healthy participants performed a novelty auditory oddball task twice on separate days: once while receiving taVNS (left cymba concha), once during sham (left earlobe) stimulation. To maximize potential effects, the stimulation was delivered continuously (frequency: 25 Hz; width: 250 μs) at an intensity individually calibrated to the maximal level below pain threshold. The stimulation was administered 10 min before the oddball task and maintained throughout the session. Event-related pupil dilation (ERPD) to target stimuli and pre-stimulus baseline pupil size were assessed during the oddball task as markers of phasic and tonic noradrenergic activity, respectively. Prior to and at the end of stimulation, tonic pupil size at rest, cortisol, and salivary alpha-amylase were assessed as markers of tonic noradrenergic activity. Finally, we explored the effect of taVNS on cardiac vagal activity, respiratory rate, and salivary flow rate. Results showed a greater ERPD to both target and novelty compared to standard stimuli in the oddball task. In contrast to our hypotheses, taVNS did not impact any of the tested markers. Our findings strongly suggest that continuous stimulation of the cymba concha with the tested stimulation parameters is ineffective to increase noradrenergic activity via a vagal pathway.
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Affiliation(s)
| | | | | | - Stephan Claes
- The Mind Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | | | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
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Yu Y, Ling J, Yu L, Liu P, Jiang M. Closed-Loop Transcutaneous Auricular Vagal Nerve Stimulation: Current Situation and Future Possibilities. Front Hum Neurosci 2022; 15:785620. [PMID: 35058766 PMCID: PMC8763674 DOI: 10.3389/fnhum.2021.785620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Closed-loop (CL) transcutaneous auricular vagal nerve stimulation (taVNS) was officially proposed in 2020. This work firstly reviewed two existing CL-taVNS forms: motor-activated auricular vagus nerve stimulation (MAAVNS) and respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), and then proposed three future CL-taVNS systems: electroencephalography (EEG)-gated CL-taVNS, electrocardiography (ECG)-gated CL-taVNS, and subcutaneous humoral signals (SHS)-gated CL-taVNS. We also highlighted the mechanisms, targets, technical issues, and patterns of CL-taVNS. By reviewing, proposing, and highlighting, this work might draw a preliminary blueprint for the development of CL-taVNS.
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Affiliation(s)
- Yutian Yu
- Acupuncture Department, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Ninth School of Clinical Medicine, Peking University, Beijing, China
- *Correspondence: Yutian Yu Min Jiang
| | - Jing Ling
- Department of Gynecology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Lingling Yu
- Department of Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengfei Liu
- Ninth School of Clinical Medicine, Peking University, Beijing, China
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Min Jiang
- Acupuncture Department, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Ninth School of Clinical Medicine, Peking University, Beijing, China
- *Correspondence: Yutian Yu Min Jiang
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Veiz E, Kieslich SK, Czesnik D, Herrmann-Lingen C, Meyer T, Staab J. Increased Concentrations of Circulating Interleukins following Non-Invasive Vagus Nerve Stimulation: Results from a Randomized, Sham-Controlled, Crossover Study in Healthy Subjects. Neuroimmunomodulation 2022; 29:450-459. [PMID: 35576915 DOI: 10.1159/000524646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/15/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The vagus nerve constitutes the main component of the parasympathetic nervous system and plays an important role in the regulation of neuro-immune responses. Invasive stimulation of the vagus nerve produces anti-inflammatory effects; however, data on humoral immune responses of transcutaneous vagus nerve stimulation (tVNS) are rare. Therefore, the present study investigated changes in serum cytokine concentrations of interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor α (TNFα) following a short-term, non-invasive stimulation of the vagus nerve. METHODS Whole blood samples were collected before and after a short-lived application of active tVNS at the inner tragus as well as sham stimulation of the earlobe. Cytokine serum concentrations were determined in two healthy cohorts of younger (n = 20) and older participants (n = 19). Differences between active and sham conditions were analyzed using linear mixed models and post hoc F tests after applying Yeo-Johnson power transformations. This trial was part of a larger study registered on ClinicalTrials.gov (NCT05007743). RESULTS In the young cohort, IL-6 and IL-1β concentrations were significantly increased after active stimulation, whereas they were slightly decreased after sham stimulation (IL-6: p = 0.012; IL-1β: p = 0.012). Likewise, in the older cohort, IL-1β and IL-8 concentrations were significantly elevated after active stimulation and reduced after sham application (IL-8: p = 0.007; IL-1β: p = 0.001). In contrast, circulating TNFα concentrations did not change significantly in either group. CONCLUSION Our results show that active tVNS led to an immediate increase in the serum concentrations of certain pro-inflammatory cytokines such as IL-1β, IL-6, and/or IL-8 in two independent cohorts of healthy study participants.
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Affiliation(s)
- Elisabeth Veiz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- Department of Neurology, University Medical Centre, Göttingen, Germany
| | - Susann-Kristin Kieslich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
| | - Dirk Czesnik
- Department of Neurology, University Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany,
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany,
| | - Julia Staab
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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Zhu S, Zhang X, Zhou M, Kendrick KM, Zhao W. Therapeutic applications of transcutaneous auricular vagus nerve stimulation with potential for application in neurodevelopmental or other pediatric disorders. Front Endocrinol (Lausanne) 2022; 13:1000758. [PMID: 36313768 PMCID: PMC9596914 DOI: 10.3389/fendo.2022.1000758] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) as a newly developed technique involves stimulating the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear, with resulting activation of vagal connections to central and peripheral nervous systems. Increasing evidence indicates that maladaptive neural plasticity may underlie the pathology of several pediatric neurodevelopmental and psychiatric disorders, such as autism spectrum disorder, attention deficit hyperactivity disorder, disruptive behavioral disorder and stress-related disorder. Vagal stimulation may therefore provide a useful intervention for treating maladaptive neural plasticity. In the current review we summarize the current literature primarily on therapeutic use in adults and discuss the prospects of applying taVNS as a therapeutic intervention in specific pediatric neurodevelopmental and other psychiatric disorders. Furthermore, we also briefly discuss factors that would help optimize taVNS protocols in future clinical applications. We conclude from these initial findings that taVNS may be a promising alternative treatment for pediatric disorders which do not respond to other interventions.
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Affiliation(s)
- Siyu Zhu
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaolu Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Menghan Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M. Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Institute of Electronic and Information Engineering of University of Electronic Science and Technology of China (UESTC) in Guangdong, Dongguan, China
- *Correspondence: Weihua Zhao,
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Wang L, Wang Y, Wang Y, Wang F, Zhang J, Li S, Wu M, Li L, Rong P. Transcutaneous auricular vagus nerve stimulators: a review of past, present and future devices. Expert Rev Med Devices 2021; 19:43-61. [PMID: 34937487 DOI: 10.1080/17434440.2022.2020095] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION As an emerging neuromodulation therapy, transcutaneous auricular vagus nerve stimulation (taVNS) has been proven to be safe and effective for epilepsy, major depressive disorders, insomnia, glucose metabolic disorders, pain, stroke, post stroke rehabilitation, anxiety, fear, cognitive impairment, cardiovascular disorders, tinnitus, Prader-Willi Syndrome and COVID-19. AREAS COVERED Although the history of taVNS is only two decades, the devices carrying taVNS technique have been constantly updated. Especially in recent years, the development of taVNS devices has presented a new trend. To conclude, the development of taVNS devices has entered a new era, thus the update speed and quality of taVNS devices will be considerably improved in the future. This article reviewed the history and classification of taVNS devices. EXPERT OPINION The correlation between the effectiveness and stimulation parameters from taVNS devices still remains unclear. There is a lack of standard or harmonization among different taVNS devices. Strategies, including further comparative research and establishment of standard, have been recommended in this article to promote the future development of taVNS devices.
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Affiliation(s)
- Lei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yifei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Fang Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shaoyuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mozheng Wu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Poppa T, Benschop L, Horczak P, Vanderhasselt MA, Carrette E, Bechara A, Baeken C, Vonck K. Auricular transcutaneous vagus nerve stimulation modulates the heart-evoked potential. Brain Stimul 2021; 15:260-269. [PMID: 34933143 DOI: 10.1016/j.brs.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/28/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is active interest in biomarker discovery for transcutaneous auricular vagus nerve stimulation (taVNS). However, greater understanding of the neurobiological mechanisms is needed to identify candidate markers. Accumulating evidence suggests that taVNS influences activity in solitary and parabrachial nuclei, the primary brainstem relays for the transmission of visceral sensory afferents to the insula. The insula mediates interoception, which concerns the representation and regulation of homeostatic bodily states. Consequently, interoceptive pathways may be relevant to taVNS mechanisms of action. HYPOTHESES We hypothesized that taVNS would modulate an EEG-derived marker of interoceptive processing known as the heart-evoked potential (HEP). We also hypothesized that taVNS-induced HEP effects would be localizable to the insula. METHODS Using a within-subject, sham-controlled design in 43 healthy adults, we recorded EEG and ECG concurrent to taVNS. Using ECG and EEG data, we extracted HEPs. Estimation of the cortical sources of the taVNS-dependent HEP responses observed at the scalp were computed using the Boundary Element Method and weighted Minimum Norm Estimation. Statistics were calculated using cluster-based permutation methods. RESULTS taVNS altered HEP amplitudes at frontocentral and centroparietal electrode sites at various latencies. The taVNS-dependent HEP effect was localized to the insula, operculum, somatosensory cortex, and orbital and ventromedial prefrontal regions. CONCLUSION The results support the hypothesis that taVNS can access the insula as well as functionally and anatomically connected ventral prefrontal regions. HEPs may serve as an objective, non-invasive outcome parameter for the cortical effects of taVNS.
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Affiliation(s)
- Tasha Poppa
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
| | - Lars Benschop
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Paula Horczak
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Marie-Anne Vanderhasselt
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Evelien Carrette
- 4Brain, Neurology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Antoine Bechara
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Chris Baeken
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium; Department of Psychiatry, Brussels University Hospital, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Kristl Vonck
- 4Brain, Neurology, Department of Head and Skin, Ghent University Hospital, Belgium
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Baig SS, Kamarova M, Ali A, Su L, Dawson J, Redgrave JN, Majid A. Transcutaneous vagus nerve stimulation (tVNS) in stroke: the evidence, challenges and future directions. Auton Neurosci 2021; 237:102909. [PMID: 34861612 DOI: 10.1016/j.autneu.2021.102909] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/19/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
Stroke is one of the leading causes of death and disability globally. A significant proportion of stroke survivors are left with long term neurological deficits that have a detrimental effect on personal wellbeing and wider socioeconomic impacts. As such, there is an unmet need for novel therapies that improve neurological recovery after stroke. Invasive vagus nerve stimulation (VNS) paired with rehabilitation has been shown to improve upper limb motor function in chronic stroke. However, invasive VNS requires a surgical procedure and therefore may not be suitable for all stroke patients. Non-invasive, transcutaneous VNS (tVNS) via auricular vagus nerve stimulation in the ear (taVNS) and cervical vagus nerve stimulation in the neck (tcVNS) have been shown to activate similar vagal nerve projections in the central nervous system to invasive VNS. A number of pre-clinical studies indicate that tVNS delivered in acute middle cerebral artery occlusion reduces infarct size through anti-inflammatory effects, reduced excitotoxicity and increased blood-brain barrier integrity. Longer term effects of tVNS in stroke that may mediate neuroplasticity include microglial polarisation, angiogenesis and neurogenesis. Pilot clinical trials of taVNS indicate that taVNS paired with rehabilitation may improve upper limb motor and sensory function in patients with chronic stroke. In this review, we summarise and critically appraise the current pre-clinical and clinical evidence, outline the major ongoing clinical trials and detail the challenges and future directions regarding tVNS in acute and chronic stroke.
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Affiliation(s)
- Sheharyar S Baig
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
| | - Marharyta Kamarova
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
| | - Ali Ali
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
| | - Li Su
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom.
| | - Jessica N Redgrave
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
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Human intracranial recordings reveal distinct cortical activity patterns during invasive and non-invasive vagus nerve stimulation. Sci Rep 2021; 11:22780. [PMID: 34815529 PMCID: PMC8611055 DOI: 10.1038/s41598-021-02307-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022] Open
Abstract
Vagus nerve stimulation (VNS) is being used increasingly to treat a wide array of diseases and disorders. This growth is driven in part by the putative ability to stimulate the nerve non-invasively. Despite decades of use and a rapidly expanding application space, we lack a complete understanding of the acute effects of VNS on human cortical neurophysiology. Here, we investigated cortical responses to sub-perceptual threshold cervical implanted (iVNS) and transcutaneous auricular (taVNS) vagus nerve stimulation using intracranial neurophysiological recordings in human epilepsy patients. To understand the areas that are modulated by VNS and how they differ depending on invasiveness and stimulation parameters, we compared VNS-evoked neural activity across a range of stimulation modalities, frequencies, and amplitudes. Using comparable stimulation parameters, both iVNS and taVNS caused subtle changes in low-frequency power across broad cortical networks, which were not the same across modalities and were highly variable across participants. However, within at least some individuals, it may be possible to elicit similar responses across modalities using distinct sets of stimulation parameters. These results demonstrate that both invasive and non-invasive VNS cause evoked changes in activity across a set of highly distributed cortical networks that are relevant to a diverse array of clinical, rehabilitative, and enhancement applications.
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Zaehle T, Galazky I, Krauel K. The LC-NE system as a potential target for neuromodulation to ameliorate non-motor symptoms in Parkinson's disease. Auton Neurosci 2021; 236:102901. [PMID: 34757309 DOI: 10.1016/j.autneu.2021.102901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 10/15/2021] [Indexed: 01/24/2023]
Abstract
Parkinson's disease (PD) is associated with severe motor symptoms but also with several non-motor symptoms (NMS). A substantial reduction of norepinephrine (NE) levels in various brain regions reflecting an extensive loss of innervation from the LC has been assumed as causal for the development of NMS and specifically of attentional impairments in PD. Transcutaneous auricular vagus nerve stimulation (taVNS) is a new, non-invasive neurostimulation method supposed to modulate the LC-NE system in humans. In the current opinion paper, we introduce taVNS as a systemic approach to directly affect NE neurotransmission in healthy as well as clinical populations and discuss its potential as therapeutic option for the treatment of NMS, specifically attentional deficits, in patients with PD. Here, we first describe the LC-NE system and discuss how LC-NE dysfunction might affects cognition in PD before detailing the mode of action of taVNS and proposing its use to modulate cognitive deficits in these patients.
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Affiliation(s)
- Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany
| | - Imke Galazky
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Kerstin Krauel
- Center for Behavioral Brain Sciences (CBBS), Magdeburg 39106, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany.
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Veiz E, Kieslich SK, Staab J, Czesnik D, Herrmann-Lingen C, Meyer T. Men Show Reduced Cardiac Baroreceptor Sensitivity during Modestly Painful Electrical Stimulation of the Forearm: Exploratory Results from a Sham-Controlled Crossover Vagus Nerve Stimulation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111193. [PMID: 34769711 PMCID: PMC8582936 DOI: 10.3390/ijerph182111193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
This paper presents data from a transcutaneous vagus nerve stimulation experiment that point towards a blunted cardiac baroreceptor sensitivity (cBRS) in young males compared to females during electrical stimulation of the forearm and a rhythmic breathing task. Continuous electrocardiography, impedance cardiography and continuous blood-pressure recordings were assessed in a sex-matched cohort of twenty young healthy subjects. Electrical stimulation of the median nerve was conducted by using a threshold-tracking method combined with two rhythmic breathing tasks (0.1 and 0.2 Hz) before, during and after active or sham transcutaneous vagus nerve stimulation. Autonomic and hemodynamic parameters were calculated, and differences were analyzed by using linear mixed models and post hoc F-tests. None of the autonomic and hemodynamic parameters differed between the sham and active conditions. However, compared to females, male participants had an overall lower total cBRS independent of stimulation condition during nerve stimulation (females: 14.96 ± 5.67 ms/mmHg, males: 11.89 ± 3.24 ms/mmHg, p = 0.031) and rhythmic breathing at 0.2 Hz (females: 21.49 ± 8.47 ms/mmHg, males: 15.12 ± 5.70 ms/mmHg, p = 0.004). Whereas vagus nerve stimulation at the left inner tragus did not affect the efferent vagal control of the heart, we found similar patterns of baroreceptor sensitivity activation over the stimulation period in both sexes, which, however, significantly differed in their magnitude, with females showing an overall higher cBRS.
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Affiliation(s)
- Elisabeth Veiz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Göttingen, 37075 Göttingen, Germany; (S.-K.K.); (J.S.); (C.H.-L.)
- Department of Neurology, University Medical Center, University of Göttingen, 37075 Göttingen, Germany;
- Correspondence: (E.V.); (T.M.)
| | - Susann-Kristin Kieslich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Göttingen, 37075 Göttingen, Germany; (S.-K.K.); (J.S.); (C.H.-L.)
| | - Julia Staab
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Göttingen, 37075 Göttingen, Germany; (S.-K.K.); (J.S.); (C.H.-L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
| | - Dirk Czesnik
- Department of Neurology, University Medical Center, University of Göttingen, 37075 Göttingen, Germany;
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Göttingen, 37075 Göttingen, Germany; (S.-K.K.); (J.S.); (C.H.-L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Göttingen, 37075 Göttingen, Germany; (S.-K.K.); (J.S.); (C.H.-L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, 37075 Göttingen, Germany
- Correspondence: (E.V.); (T.M.)
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Wolf V, Kühnel A, Teckentrup V, Koenig J, Kroemer NB. Does transcutaneous auricular vagus nerve stimulation affect vagally mediated heart rate variability? A living and interactive Bayesian meta-analysis. Psychophysiology 2021; 58:e13933. [PMID: 34473846 DOI: 10.1111/psyp.13933] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022]
Abstract
Non-invasive brain stimulation techniques, such as transcutaneous auricular vagus nerve stimulation (taVNS), have considerable potential for clinical use. Beneficial effects of taVNS have been demonstrated on symptoms in patients with mental or neurological disorders as well as transdiagnostic dimensions, including mood and motivation. However, since taVNS research is still an emerging field, the underlying neurophysiological processes are not yet fully understood, and the replicability of findings on biomarkers of taVNS effects has been questioned. The objective of this analysis was to synthesize the current evidence concerning the effects of taVNS on vagally mediated heart rate variability (vmHRV), a candidate biomarker that has, so far, received most attention in the field. We performed a living Bayesian random effects meta-analysis. To keep the synthesis of evidence transparent and up to date as new studies are being published, we developed a Shiny web app that regularly incorporates new results and enables users to modify study selection criteria to evaluate the robustness of the inference across potential confounds. Our analysis focuses on 16 single-blind studies comparing taVNS versus sham in healthy participants. The meta-analysis provides strong evidence for the null hypothesis (g = 0.014, CIshortest = [-0.103, 0.132], BF01 = 24.678), indicating that acute taVNS does not alter vmHRV compared to sham. To conclude, there is no support for the hypothesis that vmHRV is a robust biomarker for acute taVNS. By increasing transparency and timeliness, the concept of living meta-analyses can lead to transformational benefits in emerging fields such as non-invasive brain stimulation.
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Affiliation(s)
- Vinzent Wolf
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany.,Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Anne Kühnel
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany.,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry and International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Vanessa Teckentrup
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils B Kroemer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
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Rangon CM, Barruet R, Mazouni A, Le Cossec C, Thevenin S, Guillaume J, Léguillier T, Huysman F, Luis D. Auricular Neuromodulation for Mass Vagus Nerve Stimulation: Insights From SOS COVID-19 a Multicentric, Randomized, Controlled, Double-Blind French Pilot Study. Front Physiol 2021; 12:704599. [PMID: 34408665 PMCID: PMC8365750 DOI: 10.3389/fphys.2021.704599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022] Open
Abstract
Importance: An exacerbated inflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is believed to be one of the major causes of the morbidity and mortality of the coronavirus disease 2019 (COVID-19). Neuromodulation therapy, based on vagus nerve stimulation, was recently hypothesized to control both the SARS-CoV-2 replication and the ensuing inflammation likely through the inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells pathway and could improve the clinical outcomes as an adjunct treatment. We proposed to test it by the stimulation of the auricular branch of the vagus nerve, i.e., auricular neuromodulation (AN), a non-invasive procedure through the insertion of semipermanent needles on the ears. Objective: The aim of this study was to assess the effect of AN on the clinical outcomes in patients affected by COVID-19. Design, Setting, and Participants: A multicenter, randomized, placebo-controlled, double-blind clinical trial included 31 patients with respiratory failure due to COVID-19 requiring hospitalization. Within 72 h after admission, patients received either AN (n = 14) or sham neuromodulation (SN, n = 15) in addition to the conventional treatments. Main Outcome and Measures: The primary endpoint of the study was the rate of a clinical benefit conferred by AN at Day 14 (D14) as assessed by a 7-point Clinical Progression Scale. The secondary endpoint of the study was the impact of AN on the rate of transfer to the intensive care unit (ICU) and on the survival rate at D14. Results: The AN procedure was well-tolerated without any reported side effects but with no significant improvement for the measures of both primary (p > 0.3) and secondary (p > 0.05) endpoints at the interim analysis. None of the AN-treated patients died but one in the SN group did (81 years). Two AN-treated patients (73 and 79 years, respectively) and one SN-treated patient (59 years) were transferred to ICU. Remarkably, AN-treated patients were older with more representation by males than in the SN arm (i.e., the median age of 75 vs. 65 years, 79% male vs. 47%). Conclusion: The AN procedure, which was used within 72 h after the admission of patients with COVID-19, was safe and could be successfully implemented during the first two waves of COVID-19 in France. Nevertheless, AN did not significantly improve the outcome of the patients in our small preliminary study. It is pertinent to explore further to validate AN as the non-invasive mass vagal stimulation solution for the forthcoming pandemics. Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [NCT04341415].
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Affiliation(s)
- Claire-Marie Rangon
- Pain and Neuromodulation Unit, Neurosurgery Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Régine Barruet
- Infectious Diseases Department, Centre Hospitalier Simone Veil, Beauvais, France
| | | | - Chloé Le Cossec
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Sophie Thevenin
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Jessica Guillaume
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Teddy Léguillier
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Fabienne Huysman
- Clinical Research Department, Centre Hospitalier Simone Veil, Beauvais, France
| | - David Luis
- Clinical Research Department, Centre Hospitalier Simone Veil, Beauvais, France.,Intensive Care Unit, Centre Hospitalier Simone Veil, Beauvais, France
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De Smet S, Baeken C, Seminck N, Tilleman J, Carrette E, Vonck K, Vanderhasselt MA. Non-invasive vagal nerve stimulation enhances cognitive emotion regulation. Behav Res Ther 2021; 145:103933. [PMID: 34332299 DOI: 10.1016/j.brat.2021.103933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022]
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed as a potential new tool in the treatment of major depressive disorder. Prior studies have demonstrated that taVNS enhances cognitive control and is able to modulate brain activity in key regions involved in cognitive emotion regulation, such as the anterior cingulate and medial prefrontal cortex, which is known to be impaired in depressed patients. Preclinical studies are lacking but may provide important insights into the working mechanisms of taVNS on cognitive emotion regulatory processes. In this between-subject study, 83 healthy subjects underwent a single-session of active taVNS or sham stimulation, after which cognitive reappraisal was examined using a computer-based cognitive emotion regulation task. Our results indicate that participants receiving active taVNS, compared to sham, were better at using cognitive reappraisal and rated their response to emotion-eliciting pictures as less intense. Yet, even though we found significant differences in behavioral measures of cognitive emotion regulation, no differences between groups were found in terms of physiological responses to the emotional stimuli. Overall, these findings suggest a positive effect of taVNS on the cognitive reappraisal of emotions, but future studies assessing objective measures of neural activity during cognitive emotion regulation following taVNS are warranted.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Psychiatry, Brussels University Hospital, Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Nina Seminck
- Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | | | - Evelien Carrette
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Head and Skin, Neurology, 4 Brain, Ghent University Hospital, Ghent, Belgium
| | - Kristl Vonck
- Department of Head and Skin, Neurology, 4 Brain, Ghent University Hospital, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Mertens A, Carrette S, Klooster D, Lescrauwaet E, Delbeke J, Wadman WJ, Carrette E, Raedt R, Boon P, Vonck K. Investigating the Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Cortical Excitability in Healthy Males. Neuromodulation 2021; 25:395-406. [PMID: 35396071 DOI: 10.1111/ner.13488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES As a potential treatment for epilepsy, transcutaneous auricular vagus nerve stimulation (taVNS) has yielded inconsistent results. Combining transcranial magnetic stimulation with electromyography (TMS-EMG) and electroencephalography (TMS-EEG) can be used to investigate the effect of interventions on cortical excitability by evaluating changes in motor evoked potentials (MEPs) and TMS-evoked potentials (TEPs). The goal of this study is to objectively evaluate the effect of taVNS on cortical excitability with TMS-EMG and TMS-EEG. These findings are expected to provide insight in the mechanism of action and help identify more optimal stimulation paradigms. MATERIALS AND METHODS In this prospective single-blind cross-over study, 15 healthy male subjects underwent active and sham taVNS for 60 min, using a maximum tolerated stimulation current. Single and paired pulse TMS was delivered over the right-sided motor hotspot to evaluate MEPs and TEPs before and after the intervention. MEP statistical analysis was conducted with a two-way repeated measures ANOVA. TEPs were analyzed with a cluster-based permutation analysis. Linear regression analysis was implemented to investigate an association with stimulation current. RESULTS MEP and TEP measurements were not affected by taVNS in this study. An association was found between taVNS stimulation current and MEP outcome measures indicating a decrease in cortical excitability in participants who tolerated higher taVNS currents. A subanalysis of participants (n = 8) who tolerated a taVNS current ≥2.5 mA showed a significant increase in the resting motor threshold, decrease in MEP amplitude and modulation of the P60 and P180 TEP components. CONCLUSIONS taVNS did not affect cortical excitability measurements in the overall population in this study. However, taVNS has the potential to modulate specific markers of cortical excitability in participants who tolerate higher stimulation levels. These findings indicate the need for adequate stimulation protocols based on the recording of objective outcome parameters.
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Affiliation(s)
- Ann Mertens
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Sofie Carrette
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Debby Klooster
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Emma Lescrauwaet
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Jean Delbeke
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Wytse Jan Wadman
- Swammerdam Institute of Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Carrette
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Robrecht Raedt
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kristl Vonck
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
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Transcutaneous auricular VNS applied to experimental pain: A paired behavioral and EEG study using thermonociceptive CO2 laser. PLoS One 2021; 16:e0254480. [PMID: 34252124 PMCID: PMC8274876 DOI: 10.1371/journal.pone.0254480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Transcutaneous auricular Vagal Nerve Stimulation (taVNS) is a non-invasive neurostimulation technique with potential analgesic effects. Several studies based on subjective behavioral responses suggest that taVNS modulates nociception differently with either pro-nociceptive or anti-nociceptive effects. Objective This study aimed to characterize how taVNS alters pain perception, by investigating its effects on event-related potentials (ERPs) elicited by different types of spinothalamic and lemniscal somatosensory stimuli, combined with quantitative sensory testing (detection threshold and intensity ratings). Methods We performed 3 experiments designed to study the time-dependent effects of taVNS and compare with standard cervical VNS (cVNS). In Experiment 1, we assessed the effects of taVNS after 3 hours of stimulation. In Experiment 2, we focused on the immediate effects of the duty cycle (OFF vs. ON phases). Experiments 1 and 2 included 22 and 15 healthy participants respectively. Both experiments consisted of a 2-day cross-over protocol, in which subjects received taVNS and sham stimulation sequentially. In addition, subjects received a set of nociceptive (thermonociceptive CO2 laser, mechanical pinprick) and non-nociceptive (vibrotactile, cool) stimuli, for which we recorded detection thresholds, intensity of perception and ERPs. Finally, in Experiment 3, we tested 13 epileptic patients with an implanted cVNS by comparing OFF vs. ON cycles, using a similar experimental procedure. Results Neither taVNS nor cVNS appeared to modulate the cerebral and behavioral aspects of somatosensory perception. Conclusion The potential effect of taVNS on nociception requires a cautious interpretation, as we found no objective change in behavioral and cerebral responses to spinothalamic and lemniscal somatosensory stimulations.
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D'Agostini M, Burger AM, Franssen M, Claes N, Weymar M, von Leupoldt A, Van Diest I. Effects of transcutaneous auricular vagus nerve stimulation on reversal learning, tonic pupil size, salivary alpha-amylase, and cortisol. Psychophysiology 2021; 58:e13885. [PMID: 34245461 DOI: 10.1111/psyp.13885] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022]
Abstract
This study investigated whether transcutaneous auricular vagus nerve stimulation (taVNS) enhances reversal learning and augments noradrenergic biomarkers (i.e., pupil size, cortisol, and salivary alpha-amylase [sAA]). We also explored the effect of taVNS on respiratory rate and cardiac vagal activity (CVA). Seventy-one participants received stimulation of either the cymba concha (taVNS) or the earlobe (sham) of the left ear. After learning a series of cue-outcome associations, the stimulation was applied before and throughout a reversal phase in which cue-outcome associations were changed for some (reversal), but not for other (distractor) cues. Tonic pupil size, salivary cortisol, sAA, respiratory rate, and CVA were assessed at different time points. Contrary to our hypothesis, taVNS was not associated with an overall improvement in performance on the reversal task. Compared to sham, the taVNS group performed worse for distractor than reversal cues. taVNS did not increase tonic pupil size and sAA. Only post hoc analyses indicated that the cortisol decline was steeper in the sham compared to the taVNS group. Exploratory analyses showed that taVNS decreased respiratory rate but did not affect CVA. The weak and unexpected effects found in this study might relate to the lack of parameters optimization for taVNS and invite to further investigate the effect of taVNS on cortisol and respiratory rate.
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Affiliation(s)
| | - Andreas M Burger
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Laboratory for Biological Psychology, KU Leuven, Leuven, Belgium
| | | | - Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | | | - Ilse Van Diest
- Research Group Health Psychology, KU Leuven, Leuven, Belgium
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Szulczewski MT. Transcutaneous Auricular Vagus Nerve Stimulation Combined With Slow Breathing: Speculations on Potential Applications and Technical Considerations. Neuromodulation 2021; 25:380-394. [PMID: 35396070 DOI: 10.1111/ner.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing. MATERIALS AND METHODS A nonsystematic review. RESULTS Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises. CONCLUSIONS Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.
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50
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Ruhnau P, Zaehle T. Transcranial Auricular Vagus Nerve Stimulation (taVNS) and Ear-EEG: Potential for Closed-Loop Portable Non-invasive Brain Stimulation. Front Hum Neurosci 2021; 15:699473. [PMID: 34194308 PMCID: PMC8236702 DOI: 10.3389/fnhum.2021.699473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
No matter how hard we concentrate, our attention fluctuates – a fact that greatly affects our success in completing a current task. Here, we review work from two methods that, in a closed-loop manner, have the potential to ameliorate these fluctuations. Ear-EEG can measure electric brain activity from areas in or around the ear, using small and thus portable hardware. It has been shown to capture the state of attention with high temporal resolution. Transcutaneous auricular vagus nerve stimulation (taVNS) comes with the same advantages (small and light) and critically current research suggests that it is possible to influence ongoing brain activity that has been linked to attention. Following the review of current work on ear-EEG and taVNS we suggest that a combination of the two methods in a closed-loop system could serve as a potential application to modulate attention.
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Affiliation(s)
- Philipp Ruhnau
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Otto von Guericke University, Magdeburg, Germany
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