Exploration of transcutaneous vagus nerve stimulation as a treatment option for adjuvant cancer and heart failure therapy

Abstract

Vagus nerve stimulation (VNS) has gained prominence in the treatment of various clinical disorders such as migraine, depression, and tinnitus. Based on increased scientific knowledge of the VNS and insights into the vagus nerve (VN) function and anatomy/conduction, robust treatment approaches have been developed. There are both noninvasive and invasive VNS (iVNS) techniques. Currently, only iVNS techniques are approved by the US Food and Drug Administration (FDA). In contrast, transcutaneous VNS (tVNS) is a new treatment option that is receiving increasing attention. The tVNS application uses the cutaneous distribution of afferent VN fibers in the auricle, the auricular branch of the VN (ABVN), or in the neck, the cervical branch of the VN (CBVN). However, the tVNS technique has not yet been sufficiently researched in its application and mode of action to be used clinically on a large scale. Moreover, the stimulation parameters of the VN vary widely in different studies. Despite the growing number of research papers on this topic, more coherence in neurostimulation research and neuroanatomical basis is needed. The aim of this review is to highlight new clinical treatment options based on existing clinically applied treatment options. In this article, current clinical applications of tVNS are analyzed and important stimulation parameters are highlighted. Based on this data, useful new tVNS therapies are recommended. The focus will be placed on the study of inflammatory processes associated with cancer and on applications to cardiovascular events such as heart failure.

Exploratory Review of the Takotsubo Syndrome and the Possible Role of the Psychosocial Stress Response and Inflammaging

“…At this point, tVNS treatment can be very effective. Frank et al [14] showed that tVNS has a positive effect on parasympathetic activity and plays an important role in reducing chronic pro-inflammatory markers. However, as far as its applicability is concerned, clinical studies and results are still lacking and should be the subject of future research.…”

“…As we have shown in our recent research, there is a strong correlation between chronic inflammation and hyperactivity of the SNS. Anti-inflammatory results have been observed when stimulating the parasympathetic nervous system [14], suggesting that the stimulation of the VN may also have beneficial effects on the prevention of TTS, a stress-induced cardiomyopathy.…”

“…Emphasis will be placed on gender differences, particularly sex hormone differences and aging, and more specifically, on inflammaging as an underappreciated risk factor. In addition, we would like to highlight the possibility of transcutaneous vagus nerve stimulation (tVNS) treatment, as we have shown that stimulation of the parasympathetic nervous system via the vagus nerve (VN) has significant anti-inflammatory effects [14]. The attenuation of low-grade inflammation could be useful in suppressing stress responses and trigger events that could lead to TTS [13,15].…”

The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications

“…For an extensive discussion of the topic and of all clinical studies performed so far, the interested reader is referred elsewhere [106,107]. Finally, noninvasive, transcutaneous VNS, delivered at the tragus of the ear, where the auricular branch of the vagus nerve is located, has also been under active investigation in recent years, with promising results [187,188].…”