Vagus nerve stimulation

Vagus nerve stimulation or vagal nerve stimulation or VNS is a medical treatment that involves delivering electrical impulses to the vagus nerve via a device that is either implanted or wearable. This VNS device sometimes referred to informally as a "pacemaker for the brain."

The effects of VNS were first observed in the 1880s that massage and compression of the carotid artery in the neck could suppress seizures, an effect attributable to crude, early form of VNS. Currently, VNS is most frequently used as an adjunctive treatment for certain types of intractable epilepsy and treatment-resistant depression.

Transcutaneous Vagus Nerve Stimulation
Transcutaneous Vagus Nerve Stimulation (t-VNS or ta-VNS), sometimes called auricular Vagus Nerve Stimulation or (aVNS) is a noninvasive method of VNS involving using a device with electrodes attached to the ear to transmit the signal through the skin to stimulate the vagus nerve. Transcutaneous vagus nerve stimulation can be done by patients at home, and the device does not need to be worn continually.

Intranasal Mechanical Stimulation
Intranasal mechanical stimulation of the vagus nerve (e.g., using INMEST) is a non-invasive wearable form of vagus nerve stimulation which has been the subject of a small clinical trial in ME/CFS patients who met the Canadian Consensus Criteria. INMEST resulted in an significant improvement in symptoms in moderate and severe ME but no improvement in fatigue.

Surgical VNS
VNS can also be delivered via an implantable device, requiring surgery.

It is possible that paced breathing (e.g., via deep breathing exercise, yoga or aerobic exercise) can also influence brain electrical activity, mediated by VNS arising from the diaphragm.

Manual vagus nerve stimulation
Some ME/CFS patients have found that regular manual vagus nerve stimulation improves ME/CFS symptoms both in the short and long term, although these reports have not been confirmed by clinicians. In addition to deep breathing, these techniques include gargling , "The Basic Exercise" (as described by Stanley Rosenberg ), and stimulating the diving reflex by immersing the face in cool water. These techniques can be done by the patient at home and are free.

Uses
Implantable vagus nerve stimulation has been approved for epilepsy and depression in the US, and a non-invasive vagus nerve stimulation device has been approved for cluster headaches in the US.

In parts of Europe noninvasive vagus nerve stimulation devices have been approved for pain, depression and epilepsy.

While still experimental, researchers are trialing with vagus nerve stimulation as an adjunct therapy on a host of mental health, neurological, and inflammatory illnesses, including anxiety, atrial fibrillation, chronic pain, Crohn's disease, fibromyalgia, heart failure, insomnia sleep problems, migraines, long COVID, and many other conditions.

Kevin J. Tracey, MD and his research group at The Feinstein Institute for Medical Research have shown that vagus nerve stimulation has decreased inflammation in methotrexate-resistant rheumatoid arthritis patients.

Mechanisms
The vagus nerve can inhibit cytokine release, via release of the neurotransmitter acetylcholine and thereby prevent tissue injury and death. In research studies, stimulation of the vagus nerve prevents the damaging effects of cytokine release in experimental sepsis, endotoxemia, ischemia/reperfusion injury, hemorrhagic shock, arthritis, and other inflammatory syndromes.

News and articles

 * 2016, Electronic implant in 'Spock' nerve could reverse rheumatoid arthritis - The Telegraph
 * 2016, Vagus Nerve Stimulation, Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS) - Health Rising
 * 2014, Can the Nervous System Be Hacked? - The New York Times

Notable studies

 * 2022, Non-Invasive Transcutaneous Vagus Nerve Stimulation for the Treatment of Fibromyalgia Symptoms: A Study Protocol - (Full text)
 * 2022, Neuromodulation for Chronic Daily Headache - (Full text)
 * 2021, Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness - (Full text)
 * 2021, Transcutaneous Auricular Vagus Nerve Stimulation (tVNS) can Reverse the Manifestations of the Long-COVID Syndrome: A Pilot - (Full text, archived)
 * AB0051 The Effects Of Non-Invasive Vagus Nerve Stimulation On Immunological Responses And Patient Reported Outcome Measures Of Fatigue In Patients With Chronic Fatigue Syndrome, Fibromyalgia, And Rheumatoid Arthritis - (Abstract)
 * gammaCore (made by ElectroCore) is a device for non-invasive vagus nerve stimulation at the left or right side of the neck. Conflicts of interest: Bruce Simon is an employee and shareholder of electroCore, Justyna Blake is an employee of electroCore, and receives stock ownership.


 * 2020, Achieving symptom relief in patients with Myalgic encephalomyelitis by targeting the neuro-immune interface and inducing disease tolerance - (Full text)]
 * 2020, Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial - (Full text)
 * 2020, The Impact of Auricular Vagus Nerve Stimulation on Pain and Life Quality in Patients with Fibromyalgia Syndrome - (Full text)
 * 2019, Current Directions in the Auricular Vagus Nerve Stimulation I -A Physiological Perspective - (Full text)
 * 2019, Current directions in the auricular vagus nerve stimulation II–an engineering perspective - (Full text)
 * 2018, Transcutaneous auricular vagus nerve stimulation reduces pain and fatigue in patients with systemic lupus erythematosus: a randomised, double-blind, sham-controlled pilot trial - (Abstract)
 * Both pain and fatigue were signiﬁcantly reduced.


 * 2015, Noninvasive vagus nerve stimulation for acute treatment of high-frequency and chronic migraine: an open-label study - (Full text)