BackgroundTranscutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique. Several studies have reported the effectiveness of taVNS in patients with disorders of consciousness (DOC); however, differences in the modulation paradigm have led to inconsistent treatment outcomes.Methods/designThis prospective exploratory trial will include 15 patients with a minimally conscious state (MCS) recruited according to the coma recovery scale-revised (CRS-R). Each patient will receive 5 different frequencies of taVNS (1, 10, 25, 50, and 100 Hz); sham stimulation will be used as a blank control. The order of stimulation will be randomized, and the patients’ CRS-R scores and resting electroencephalography (EEG) before and after stimulation will be recorded.DiscussionThe overall study of taVNS used in treating patients with DOC is still in the preliminary stage of exploration. Through this experiment, we aim to explore the optimal stimulation frequency parameters of taVNS for the treatment of DOC patients. Furthermore, we expect to achieve a stable improvement of consciousness in DOC patients by continuously optimizing the neuromodulation paradigm of taVNS for the treatment of DOC patients.Clinical trial registrationhttps://www.chictr.org.cn/index.aspx, identifier ChiCTR 2200063828.
The brain is probably the most complex organ in the human body. It has been the hot spot and direction of brain science research all over the world to deeply study the pathogenesis of various kinds of brain diseases and find effective treatment methods. Acupuncture is a nonpharmacological therapy of traditional Chinese medicine originating from ancient clinical practice. The research on the treatment of brain diseases by acupuncture has been constantly enriched and updated with the promotion of interdisciplinary research. In order to account for the current achievements in the field of acupuncture for brain diseases, this article reviews it in terms of conception, application, and exploration. Based on the literature review, we found that in the past decades, acupuncture has received widespread attention worldwide and many literatures have reported the clinical efficacy and underlying mechanisms of acupuncture in the treatment of brain diseases. Presently, the conception, application, and exploration of acupuncture in the treatment of brain diseases have evolved from empirical medicine to evidence‐based medicine and precision medicine, and are experiencing a deeper understanding of the information about acupuncture regulating the brain function based on interdisciplinary research.
Introduction:
Seed-based analysis has shown that transcutaneous auricular vagus nerve stimulation (taVNS) can modulate the dysfunctional brain network in patients with major depressive disorder (MDD). However, the voxel-based neuropsychological mechanism of taVNS on patients with first-episode MDD is poorly understood. The objective of this study was to assess the effects of an 8-week course of taVNS on patients with first-episode MDD.
Methods:
Twenty-two patients with first-episode MDD accepted an 8-week course of taVNS treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment. Voxel-based analyses were performed to characterize spontaneous brain activity. Healthy controls (n=23) were recruited to minimize test-retest effects. Analysis of covariance (ANCOVA) was performed to ascertain treatment-related changes. Then, correlations between changes in brain activity and the Hamilton Depression Rating Scale (HAM-D)/Hamilton Anxiety Scale (HAM-A) remission rate were estimated.
Results:
Significant group-by-time interactions on voxel-based analyses were observed in the inferior ventral striatum (VSi) and precuneus. Post-hoc analyses showed that taVNS inhibited higher brain activity in the VSi, while upregulating it in the precuneus. Functional connectivity (FC) between the VSi and precuneus decreased. Positive correlations were found between the HAM-D remission rate and changes in brain activity in the VSi.
Conclusion:
taVNS reduced the FC between VSi and precuneus by normalizing the abnormal spontaneous brain activity of VSi in first-episode MDD patients.
The cortical-striatal abnormalities are commomly found in the mental disorders. Instant transcutaneous auricular vagus nerve stimulation (taVNS) has been found to modulate the ventral striatial functional connectivity (FC) in patients with major depressive disorder (MDD). However, the neural mechanism of prolonged longitudinal taVNS treatment on different striatal subregions has not yet been elucidated. We used resting state functional magnetic resonance to estimate the effect of taVNS on the FC of striatal subregions in patients with MDD. Compared with healthy control subjects, lower prefrontal-striatal rsFC and higher occipital-striatal rsFC were found in patients with MDD. While the prefrontal-striatal rsFC increased and the occipital-striatal rsFC decreased after taVNS treatment. Specifically, the decreased Hamilton Depression Scale (HAMD) scores were positive correlated with the change of rsFCs between left ventral caudate (vCa) and right ventral prefrontal cortex (vPFC), and negatively correlated with the change of rsFCs between left vCa and right superior occipital gyrus. The rsFC between right nucleus accumbens (NAc)and right dorsal medial prefrontal cortex (dmPFC)at baseline predicted the longitudinal taVNS effects on HAMD score at 8 weeks. Therefore, taVNS can relief depressive sympotoms by modulating the aberrant striatal rsFC in patients with MDD. The strength of rsFC between the right NAc and right dmPFC may serve as a potential biomarker for the prolonged longitudinal taVNS and predict treatment responses.
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