Transcutaneous Vagus Nerve Stimulation in Patients With Severe Traumatic Brain Injury: A Feasibility Trial

Hakon, Jakob; Moghiseh, Melika; Poulsen, Ingrid; Øland, Christoffer M.L.; Hansen, Christian Pilebæk; Sabers, Anne

doi:10.1111/ner.13148

Cited by 49 publications

(59 citation statements)

References 35 publications

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“…Behavioral improvement was also reported in a study of five traumatic brain injury participants (18). After 8 weeks of 4 h of daily stimulation, four out of five participants improved their CRS-R total scores and three of them presented a better diagnosis, with two of them becoming EMCS.…”

Section: Studies In Patients With Docsupporting

confidence: 57%

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Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action

et al. 2020

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Disorders of consciousness (DoC) are the hallmark of severe acquired brain injuries characterized by abnormal activity in important brain areas and disruption within and between brain networks. As DoC's therapeutic arsenal is limited, new potential therapies such as transcutaneous auricular vagal nerve stimulation (taVNS) have recently been explored. The potential of taVNS in the process of consciousness recovery has been highlighted in recent studies with DoC patients. However, it is not clear how taVNS plays a role in the recovery of consciousness. In this article, we first describe the neural correlates of consciousness, the vagus nerve anatomy and functions, along with the results of functional magnetic resonance imaging studies using taVNS. Based on consciousness recovery and taVNS mechanisms, we propose the Vagal Cortical Pathways model. This model highlights four consecutive pathways (A. Lower brainstem activation, B. Upper brainstem activation, C. Norepinephrine pathway, and D. Serotonin pathway) likely to have an impact on patients with a brain injury and DoC. Additionally, we suggest six different mechanisms of action: (1) Activation of the ascending reticular activating system; (2) Activation of the thalamus; (3) Re-establishment of the cortico-striatal-thalamic-cortical loop; (4) Promotion of negative connectivity between external and default mode networks by the activation of the salience network; (5) Increase in activity and connectivity within the external network through the norepinephrine pathway; and (6) Increase in activity within the default mode network through the serotonin pathway. This model aims to explain the potential therapeutic effects that taVNS has on brain activity in the process of consciousness recovery.

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Section: Studies In Patients With Docsupporting

confidence: 57%

“…Consequently, we believe that taVNS has the potential to promote ExN activity (mechanism 5), which is essential to improve interaction with the environment. It could also be a possible explanation to the higher CRS-R scores measured in the DoC's case report and series involving taVNS (16)(17)(18).…”

Section: Vagal Cortical Pathways Model Applied To Docmentioning

confidence: 93%

Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action

et al. 2020

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“…Initially, we designed a clinical trial, planning to use taVNS and transcutaneous non-vagal nerve stimulation (tnVNS, as a sham control group) in DOC patients. However, previous studies (36,37) and this one found that only a portion of DOC patients is responsive to taVNS, which implied that designing a tnVNS group is not yet necessary presently (and that the clinical trial might have failed); however, finding the prior key factor(s) of the taVNS responders in DOC patients is more valuable and instructive to future studies. It has been reported that the auditory network FC has good correspondence with the level of consciousness (25), which is also estimated to be capable of predicting the prognoses of DOC (38).…”

Section: Discussionmentioning

confidence: 90%

“…VNS (8) and taVNS (16) have been identified as therapeutic strategies for DOC (5). Signs of consciousness recovery after taVNS were recorded in some severe TBI patients (36). It was also suggested that taVNS is a feasible, safe, and effective tool for DOC patients (37).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamic Correlates of Transcutaneous Auricular Vagal Nerve Stimulation in Consciousness Restoration: An Open-Label Pilot Study

Yang

Gan

et al. 2021

Front. Neurol.

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This study aimed to preliminarily illustrate the cerebral hemodynamic correlates of transcutaneous auricular vagal nerve stimulation (taVNS) in consciousness restoration. Arterial spin labeling (ASL) was adopted with functional magnetic resonance imaging (fMRI) to measure cerebral blood flow (CBF) changes before and after taVNS in 10 qualified patients with disorders of consciousness (DOC). Before taVNS, five patients responded to auditory stimuli (RtAS), and five did not respond to auditory stimuli (nRtAS). The RtAS DOC patients obtained favorable prognoses after the 4-week taVNS treatment, whereas the nRtAS ones did not. Simultaneously, taVNS increased CBF of multiple brain regions in the RtAS DOC patients, but hardly in the nRtAS ones. In conclusion, the preserved auditory function might be the prior key factor of the taVNS responders in DOC patients, and taVNS might alleviate RtAS DOC by activating the salience network, the limbic system, and the interoceptive system.

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“…Transcutaneous electrical stimulation to the ear branch of the vagus nerve. This procedure stimulates the autonomic nerve of the ear to regulate the function of the vagus nerve, which is based on superficial branches of this nerve and the acupuncture principle of traditional Chinese medicine (20 min/time, 1 mA, and 4-8 weeks) [37][38][39][40].…”

Section: Neurostimulation Therapymentioning

confidence: 99%

Clinical diagnosis guidelines and neurorestorative treatment for chronic disorders of consciousness (2021 China version)

Li¹,

He²,

Yang³

et al. 2021

Journal of Neurorestoratology

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Chronic disorders of consciousness (DOC) include the vegetative state and the minimally consciousness state. The DOC diagnosis mainly relies on the evaluation of clinical behavioral scales, electrophysiological testing, and neuroimaging examinations. No specifically effective neurorestorative methods for chronic DOC currently exist. Any valuable exploration therapies of being able to repair functions and/or structures in the consciousness loop (e.g., drugs, hyperbaric medicines, noninvasive neurostimulation, sensory and environmental stimulation, invasive neuromodulation therapy, and cell transplantation) may become effective neurorestorative strategies for chronic DOC. In the viewpoint of Neurorestoratology, this guideline proposes the diagnostic and neurorestorative therapeutic suggestions and future exploration direction for this disease following the review of the existing treatment exploration achievements for chronic DOC.

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Transcutaneous Vagus Nerve Stimulation in Patients With Severe Traumatic Brain Injury: A Feasibility Trial

Cited by 49 publications

References 35 publications

Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action

Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action

Cerebral Hemodynamic Correlates of Transcutaneous Auricular Vagal Nerve Stimulation in Consciousness Restoration: An Open-Label Pilot Study

Clinical diagnosis guidelines and neurorestorative treatment for chronic disorders of consciousness (2021 China version)

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