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Powell K, Lin K, Tambo W, Saavedra AP, Sciubba D, Al Abed Y, Li C. Trigeminal nerve stimulation: a current state-of-the-art review. Bioelectron Med 2023; 9:30. [PMID: 38087375 PMCID: PMC10717521 DOI: 10.1186/s42234-023-00128-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/04/2023] [Indexed: 09/26/2024] Open
Abstract
Nearly 5 decades ago, the effect of trigeminal nerve stimulation (TNS) on cerebral blood flow was observed for the first time. This implication directly led to further investigations and TNS' success as a therapeutic intervention. Possessing unique connections with key brain and brainstem regions, TNS has been observed to modulate cerebral vasodilation, brain metabolism, cerebral autoregulation, cerebral and systemic inflammation, and the autonomic nervous system. The unique range of effects make it a prime therapeutic modality and have led to its clinical usage in chronic conditions such as migraine, prolonged disorders of consciousness, and depression. This review aims to present a comprehensive overview of TNS research and its broader therapeutic potentialities. For the purpose of this review, PubMed and Google Scholar were searched from inception to August 28, 2023 to identify a total of 89 relevant studies, both clinical and pre-clinical. TNS harnesses the release of vasoactive neuropeptides, modulation of neurotransmission, and direct action upon the autonomic nervous system to generate a suite of powerful multitarget therapeutic effects. While TNS has been applied clinically to chronic pathological conditions, these powerful effects have recently shown great potential in a number of acute/traumatic pathologies. However, there are still key mechanistic and methodologic knowledge gaps to be solved to make TNS a viable therapeutic option in wider clinical settings. These include bimodal or paradoxical effects and mechanisms, questions regarding its safety in acute/traumatic conditions, the development of more selective stimulation methods to avoid potential maladaptive effects, and its connection to the diving reflex, a trigeminally-mediated protective endogenous reflex. The address of these questions could overcome the current limitations and allow TNS to be applied therapeutically to an innumerable number of pathologies, such that it now stands at the precipice of becoming a ground-breaking therapeutic modality.
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Affiliation(s)
- Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Kanheng Lin
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Emory University, Atlanta, GA, USA
| | - Willians Tambo
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Daniel Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Yousef Al Abed
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Elmezzi Graduate School of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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White TG, Powell K, Shah KA, Woo HH, Narayan RK, Li C. Trigeminal Nerve Control of Cerebral Blood Flow: A Brief Review. Front Neurosci 2021; 15:649910. [PMID: 33927590 PMCID: PMC8076561 DOI: 10.3389/fnins.2021.649910] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 01/13/2023] Open
Abstract
The trigeminal nerve, the fifth cranial nerve, is known to innervate much of the cerebral arterial vasculature and significantly contributes to the control of cerebrovascular tone in both healthy and diseased states. Previous studies have demonstrated that stimulation of the trigeminal nerve (TNS) increases cerebral blood flow (CBF) via antidromic, trigemino-parasympathetic, and other central pathways. Despite some previous reports on the role of the trigeminal nerve and its control of CBF, there are only a few studies that investigate the effects of TNS on disorders of cerebral perfusion (i.e., ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury). In this mini review, we present the current knowledge regarding the mechanisms of trigeminal nerve control of CBF, the anatomic underpinnings for targeted treatment, and potential clinical applications of TNS, with a focus on the treatment of impaired cerebral perfusion.
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Affiliation(s)
- Timothy G White
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Kevin A Shah
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Henry H Woo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Raj K Narayan
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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San-Juan D, Zenteno MA, Trinidad D, Meza F, Borsody MK, Godinez Garcia MDM, Martinez MC, Prado FC, Sacristan E. A Pilot Study of Facial Nerve Stimulation on Cerebral Artery Vasospasm in Subarachnoid Hemorrhage Patients. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 7:1800707. [PMID: 32309053 PMCID: PMC6822634 DOI: 10.1109/jtehm.2019.2937121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/22/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
Background: The objective of this pilot study was to assess the safety and efficacy of VitalFlow stimulation in aneurysmal subarachnoid hemorrhage (aSAH) patients with vasospasm for the purpose of guiding the design of larger, controlled studies in vasospasm patients, a largely untreated condition [1]. Methods: Six patients with angiographic vasospasm developing post-aSAH were treated with VitalFlow stimulation. Digital subtraction angiograms were obtained at the time of diagnosis (baseline) and then 30 minutes post-stimulation. A single 2-minute period of stimulation was delivered to the patients using parameters previously shown to be safe, tolerable, and effective at increasing cerebral blood flow (CBF) in healthy volunteers. Results: VitalFlow stimulation improved tissue perfusion as assessed by parenchymography and reversed the constriction of vasospastic arteries. Two patients had only partial improvement and so were treated with intraarterial nimodipine after VitalFlow stimulation, whereas four patients had complete resolution of the vasospasm after VitalFlow stimulation per the treating neuroendovascular surgeon’s evaluation. Clinical examination showed improvement in Hunt and Hess Scale scores assessed post-stimulation. Conclusions: Non-invasive magnetic stimulation of the facial nerve with the VitalFlow stimulator appears to be a safe and effective means to reverse angiographic vasospasm in aSAH patients. Clinical Impact: This study provides Class IV evidence that non-invasive magnetic stimulation of the facial nerves reduce angiographic vasospasm in aSAH patients.
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Affiliation(s)
- Daniel San-Juan
- 1Department of Clinical NeurophysiologyNational Institute of Neurology and NeurosurgeryMexico City04257Mexico
| | - Marco A Zenteno
- 2Department of Neuroendovascular TherapyNational Institute of Neurology and NeurosurgeryMexico City04257Mexico
| | - Dania Trinidad
- 2Department of Neuroendovascular TherapyNational Institute of Neurology and NeurosurgeryMexico City04257Mexico
| | - Franklin Meza
- 2Department of Neuroendovascular TherapyNational Institute of Neurology and NeurosurgeryMexico City04257Mexico
| | | | - Maria De Monserrat Godinez Garcia
- 4National Center for Medical Imaging and Instrumentation ResearchUniversidad Autónoma Metropolitana-IztapalapaMexico City04257Mexico
| | - Maria Cecilia Martinez
- 4National Center for Medical Imaging and Instrumentation ResearchUniversidad Autónoma Metropolitana-IztapalapaMexico City04257Mexico
| | - Fernando Castro Prado
- 5Specialties Hospital, XXI Century National Medical CenterIMSS, Angeles Pedregal HospitalMexico City04257Mexico
| | - Emilio Sacristan
- 4National Center for Medical Imaging and Instrumentation ResearchUniversidad Autónoma Metropolitana-IztapalapaMexico City04257Mexico
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Borsody MK, Garcia A, Bielawski DM, Yamada C, Sacristan E. Magnetic facial nerve stimulation in animal models of active seizure. Epilepsy Res 2017; 131:28-36. [PMID: 28236736 DOI: 10.1016/j.eplepsyres.2017.02.002] [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: 01/10/2016] [Revised: 01/04/2017] [Accepted: 02/07/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE As part of our efforts to develop a non-invasive facial nerve stimulator as an emergency treatment for ischemic stroke, we considered possible safety consequences if the technology was misapplied to stroke mimics, e.g., seizure. We hypothesized that magnetic facial nerve stimulation would worsen epileptiform activity in two animal models of active seizures. The rat intraperitoneal kainate model and pig intracortical penicillin model were employed. Magnetic facial nerve stimulation was delivered unilaterally at a variety of stimulation parameters, and the effect on ictal epileptiform activity measured by electroencephalography was determined according to an established categorical scale. PRINCIPAL RESULTS In 6 rats and 3 pigs evaluated with 83 stimulation trials, only a single stimulation trial was associated with worsening epileptiform activity according to a standard categorization scheme. Surprisingly, a reduction in the severity of the epileptiform activity was observed in 20 of 50 stimulation trials using patterned stimulation (3 pulses at 30Hz repeated at 0.5-10Hz) versus 2 of 33 stimulation trials using simple monotonic patterns (P<0.005, chi-squared test). The reduction of epileptiform activity after stimulation lasted a few minutes and was reproducible. Major Conclusions Epileptiform activity measured by electroencephalography was not reliably worsened by repetitive facial nerve stimulation with pulsed magnetic energy, even when significant brain exposure to the magnetic field occurred as in the rat model. To the contrary, a temporary reduction in epileptiform activity was often, but not invariably, observed with certain stimulation parameters.
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Affiliation(s)
- Mark K Borsody
- NeuroSpring, 35756 Foothills, Sterling Heights, MI 48312, United States; Nervive, Inc., 526 S. Main St., Suite 801-A, Akron, OH 44311, United States.
| | - Andrea Garcia
- National Center for the Investigation of Imaging and Medical Instrumentation, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Dawn M Bielawski
- NeuroSpring, 35756 Foothills, Sterling Heights, MI 48312, United States
| | - Chisa Yamada
- NeuroSpring, 35756 Foothills, Sterling Heights, MI 48312, United States
| | - Emilio Sacristan
- Nervive, Inc., 526 S. Main St., Suite 801-A, Akron, OH 44311, United States; National Center for the Investigation of Imaging and Medical Instrumentation, Universidad Autónoma Metropolitana, Mexico City, Mexico
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Borsody MK, Sacristan E. Facial nerve stimulation as a future treatment for ischemic stroke. Brain Circ 2016; 2:164-177. [PMID: 30276294 PMCID: PMC6126226 DOI: 10.4103/2394-8108.195281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 11/23/2022] Open
Abstract
Stimulation of the autonomic parasympathetic fibers of the facial nerve system (hereafter simply “facial nerve”) rapidly dilates the cerebral arteries and increases cerebral blood flow whether that stimulation is delivered at the facial nerve trunk or at distal points such as the sphenopalatine ganglion. Facial nerve stimulation thus could be used as an emergency treatment of conditions of brain ischemia such as ischemic stroke. A rich history of scientific research has examined this property of the facial nerve, and various means of activating the facial nerve can be employed including noninvasive means. Herein, we review the anatomical and physiological research behind facial nerve stimulation and the facial nerve stimulation devices that are in development for the treatment of ischemic stroke.
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Affiliation(s)
- Mark K Borsody
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Iztapalapa, Mexico City, Mexico, NeuroSpring, Dover, Delaware, USA
| | - Emilio Sacristan
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Iztapalapa, Mexico City, Mexico, NeuroSpring, Dover, Delaware, USA
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Effect of pulsed magnetic stimulation of the facial nerve on cerebral blood flow. Brain Res 2013; 1528:58-67. [DOI: 10.1016/j.brainres.2013.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 11/19/2022]
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Ishii H, Niioka T, Izumi H. Parasympathetic reflex vasodilatation in the masseter muscle compensates for carotid hypoperfusion during the vagus-mediated depressor response. Brain Res 2011; 1370:145-53. [DOI: 10.1016/j.brainres.2010.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/09/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
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Ishii H, Niioka T, Izumi H. Difference between male and female rats in cholinergic activity of parasympathetic vasodilatation in the masseter muscle. Arch Oral Biol 2009; 54:533-42. [DOI: 10.1016/j.archoralbio.2009.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/30/2009] [Accepted: 02/18/2009] [Indexed: 11/28/2022]
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Abstract
The blood vessels of orofacial tissues are innervated by cranial parasympathetic, superior cervical sympathetic, and trigeminal nerves, a situation somewhat different from that seen in body skin. This review summarizes our current knowledge of the nervous control of blood flow in the orofacial region, and focuses on what we know of the respective roles of sympathetic, parasympathetic, and trigeminal sensory nerves in the regulation of blood flow in this region, with particular attention being paid to the mutual interaction between them.
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Affiliation(s)
- H Izumi
- Department of Physiology, Tohoku University School of Dentistry, Sendai, Japan
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