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Vagus nerve stimulation
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[[File:TranscutaneousVagusNerveStimulation.png|alt=Ear with crocodile crips attaching electrodes to the auricular concha part of the ear for vagus nerve stimulation |thumb|Transcutaneous Vagus Nerve Stimulation at Auricular Brandh of the Vagus Nerve (in red). Source: Jiao et al (2020). ]] '''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."<ref name="EpF">{{Cite web|url=https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/vagus-nerve-stimulation-vns | title = Vagus Nerve Stimulation (VNS)|website=Epilepsy Foundation|language=en|access-date=2020-02-25}}</ref> The effects of VNS were first observed in the 1880s that massage and compression of the carotid artery in the neck could suppress [[seizure]]s, an effect attributable to crude, early form of VNS.<ref name="Lanska2002">{{Cite journal | last =Lanska | first = DJ | date = February 2002 | title = J.L. Corning and vagal nerve stimulation for seizures in the 1880s|url=https://www.ncbi.nlm.nih.gov/pubmed/11839848?dopt=Abstract|journal=Neurology|volume=58|pages=452-9|via=|issue=3|access-date=}}</ref> Currently, VNS is most frequently used as an adjunctive treatment for certain types of intractable [[epilepsy]]<ref name="pisapia2015" /> and treatment-resistant [[depression]].<ref name="pisapia2015" /><ref name="mayo">{{Cite web|url=https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565 | title = Vagus nerve stimulation|website=Mayo Clinic|access-date=2020-02-25}}</ref> === 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.<ref name="EpF" /> ===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.<ref name="Rodriguez2020">{{Cite journal | last =Rodriguez | first = Lucie S. T.|author-link = | last2 = Pou | first2 = Christian|author-link2 = | last3 = Lakshmikanth | first3 = Tadepally | author-link3 = | last4 = Zhang | first4 = Jingdian | authorlink4 = | last5 = Mugabo | first5 = Constantin Habimana | authorlink5 = | last6 = Wang | first6 = Jun | authorlink6 = | last7 = Mikes | first7 = Jaromir | last8 = Olin | first8 = Axel | last9 = Chen | first9 = Yang | date = 2020-02-28 | title = Achieving symptom relief in patients with Myalgic encephalomyelitis by targeting the neuro-immune interface and inducing disease tolerance|url=https://www.biorxiv.org/content/10.1101/2020.02.20.958249v2|journal=bioRxiv|language=en|volume=|issue=|pages=2020.02.20.958249|doi=10.1101/2020.02.20.958249|pmc=|pmid=|access-date=|quote=|via=}}</ref> {{See also|Intranasal mechanical stimulation}} === Surgical VNS === VNS can also be delivered via an implantable device, requiring surgery.<ref name="EpF" /> 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<ref>{{Cite web|url=https://www.drweil.com/health-wellness/body-mind-spirit/stress-anxiety/breathing-three-exercises/ | title = Breathing Exercises: Three To Try {{!}} 4-7-8 Breath {{!}} Andrew Weil, M.D. | date = 2016-10-28 | website = DrWeil.com|language=en-US|access-date=2021-04-07}}</ref>, these techniques include gargling<ref name="Kharrazian2013">{{Cite book | title=Why isn't my brain working? : a revolutionary understanding of brain decline and effective strategies to recover your brain's health|isbn=978-0-9856904-3-4|url=https://www.worldcat.org/oclc/853272721 | date =2013 | last = Kharrazian | first=Datis|oclc=853272721|location=Carlsbad, CA}}</ref>, "The Basic Exercise" (as described by Stanley Rosenberg<ref name="Rosenberg2017">{{Cite book | title=Accessing the healing power of the vagus nerve : self-help exercises for anxiety, depression, trauma, and autism|isbn=978-1-62317-024-0|url=https://www.worldcat.org/oclc/918969766 | date = 2017 | last=Rosenberg | first = Stanley|oclc=918969766|location=Berkeley, California}}</ref>), and stimulating the diving reflex by immersing the face in cool water.<ref name="Godek2020">{{Cite book | last=Godek | first = Devon | last2 = Freeman | first2=Andrew M. | date = 2020 | title=Physiology, Diving Reflex|url=http://www.ncbi.nlm.nih.gov/books/NBK538245/|location=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30855833}}</ref> 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 [[United States|US]], and a non-invasive vagus nerve stimulation device has been approved for cluster headaches in the US.<ref name="mayo" /> In parts of Europe noninvasive vagus nerve stimulation devices have been approved for [[pain]], [[depression]] and [[epilepsy]].<ref name="mayo" /> 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]],<ref name="fanselow2013" /> atrial fibrillation,<ref name="stavrakis2015" /> [[chronic pain]],<ref name="chakravarthy2015" /> [[Crohn's disease]],<ref name="bonaz2016" /> [[fibromyalgia]],<ref name="lange2011" /> heart failure,<ref name="hauptman2012" /> [[insomnia]] [[Sleep dysfunction|sleep problems]],<ref name="Jiao2020" /> [[migraine]]s,<ref name="silberstein2016" /> [[long COVID]],<ref name="Verbanck2021" /> 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.<ref>{{Cite web|url=https://feinstein.northwell.edu/institutes-researchers/our-researchers/kevin-j-tracey-md | title = Kevin J. Tracey, MD | last = | first = | authorlink = | date = |website=feinstein.northwell.edu|language=en|archive-url=|archive-date=|url-status=|access-date=2020-02-25}}</ref> == Mechanisms == The vagus nerve can inhibit [[cytokine]] release, via release of the [[neurotransmitter]] [[acetylcholine]]<ref name="lund1986" /> 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,<ref name="lyudmila2000" /> ischemia/reperfusion injury, hemorrhagic shock, [[arthritis]], and other inflammatory syndromes.<ref name="tracey2007" /> == ME/CFS == ==News and articles== *2016, [http://www.telegraph.co.uk/science/2016/07/07/electronic-implant-in-spock-nerve-could-reverse-rheumatoid-arthr/ Electronic implant in 'Spock' nerve could reverse rheumatoid arthritis] - The Telegraph<ref>{{Cite news | last = Knapton | first= Sarah | date = July 7, 2016 | title = Electronic implant in 'Spock' nerve could reverse rheumatoid arthritis|url= http://www.telegraph.co.uk/science/2016/07/07/electronic-implant-in-spock-nerve-could-reverse-rheumatoid-arthr/|newspaper= The Telegraph|location= London|access-date= 2016-12-12}}</ref> *2016, [http://www.cortjohnson.org/blog/2016/01/11/vagus-nerve-stimulation-fibromyalgia-chronic-fatigue-syndrome-mecfs/ Vagus Nerve Stimulation, Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)] - [[Health Rising]]<ref>{{Cite web |last = Johnson | first = Cort | date = January 11, 2016 | title = Vagus Nerve Stimulation, Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)|url= http://www.cortjohnson.org/blog/2016/01/11/vagus-nerve-stimulation-fibromyalgia-chronic-fatigue-syndrome-mecfs/ | website = HealthRising|location= Henderson, NV|access-date= 2016-12-12}}</ref> *2014, [http://www.nytimes.com/2014/05/25/magazine/can-the-nervous-system-be-hacked.html Can the Nervous System Be Hacked?] - The New York Times<ref>{{Cite news | last = Behar | first= Michael | date = May 23, 2014 | title = Can the Nervous System Be Hacked?|url= https://www.nytimes.com/2014/05/25/magazine/can-the-nervous-system-be-hacked.html|newspaper= The New York Times|location= |access-date= 2016-12-12}}</ref> ==Notable studies == *2022, Non-Invasive Transcutaneous Vagus Nerve Stimulation for the Treatment of Fibromyalgia Symptoms: A Study Protocol<ref name="Chamizo2022">{{Cite journal | title = Non-Invasive Transcutaneous Vagus Nerve Stimulation for the Treatment of Fibromyalgia Symptoms: A Study Protocol | date = Jan 2022|url=https://www.mdpi.com/2076-3425/12/1/95|journal=Brain Sciences|volume=12|issue=1 | pages = 95 | last =Molero-Chamizo | first = Andrés | last2 = Nitsche | first2 = Michael A. | last3 = Bolz | first3 = Armin | last4 = Andújar Barroso | first4 = Rafael Tomás | last5 = Alameda Bailén | first5 = José R. | last6 = García Palomeque | first6 = Jesús Carlos | last7 = Rivera-Urbina | first7 = Guadalupe Nathzidy|language=en|doi=10.3390/brainsci12010095|issn=2076-3425}}</ref> - [https://www.mdpi.com/2076-3425/12/1/95/htm (Full text)] * 2022, Neuromodulation for Chronic Daily Headache<ref name="Coppola2022">{{Cite journal | title = Neuromodulation for Chronic Daily Headache | date = 2022-02-07|url=https://link.springer.com/article/10.1007/s11916-022-01025-x|journal=Current Pain and Headache Reports|volume=26|issue=3|pages=267–278 | last =Coppola | first = Gianluca | last2 = Magis | first2=Delphine | last3 = Casillo | first3 = Francesco | last4 = Sebastianelli | first4 = Gabriele | last5 = Abagnale | first5 = Chiara | last6 = Cioffi | first6 = Ettore | last7 = Di Lenola | first7 = Davide | last8 = Di Lorenzo | first8 = Cherubino | last9 = Serrao | first9 = Mariano|language=en|doi=10.1007/s11916-022-01025-x|pmc=PMC8927000|pmid=35129825|issn=1531-3433}}</ref> - [https://link.springer.com/article/10.1007/s11916-022-01025-x (Full text)] *2021, Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness<ref name="Natelson2021">{{Cite journal | title = Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness | date = 2021-10-01|url=https://www.sciencedirect.com/science/article/pii/S0024320521007918|journal=Life Sciences|volume=282|issue=|pages=119805 | last =Natelson | first=Benjamin H. | author-link = Benjamin Natelson | last2 = Stegner | first2=Aaron J.|author-link2 = | last3 = Lange | first3 = Gudrun | author-link3 = Gudrun Lange | last4 = Khan | first4=Sarah | authorlink4 = | last5 = Blate | first5 = Michelle | authorlink5 = | last6 = Sotolongo | first6 = Anays | authorlink6 = | last7 = DeLuca | first7 = Michelle | last8 = Van Doren | first8 = William W. | last9 = Helmer | first9 = Drew A.|language=en|doi=10.1016/j.lfs.2021.119805|pmc=|pmid=|access-date=|issn=0024-3205|quote=|via=}}</ref> - [https://www.sciencedirect.com/science/article/pii/S0024320521007918 (Full text)] * 2021, Transcutaneous Auricular Vagus Nerve Stimulation (tVNS) can Reverse the Manifestations of the Long-COVID Syndrome: A Pilot<ref name="Verbanck2021">{{Cite web|url=https://emrespublisher.com/advances-in-neurology-and-neuroscience-research/volume_2/100011/ | title = Transcutaneous Auricular Vagus Nerve Stimulation (tVNS) can Reverse the Manifestations of the Long-COVID Syndrome: A Pilot Study | date = 2021 | last = Verbanck | first = P | author-link = | last2 = Clarinval AM | first2 = AM | authorlink2 = | last3 = Burton | first3=F | last4 = Corazza | first4 = F | last5 = Nagant | first5 = C | last6 = Cheron | first6 = G|volume=2|journal=Advances in Neurology and Neuroscience Research | website = | pages = 100011 |language=en|doi=10.51956/ANNR.100011|doi-broken-date=2022-04-07|archive-url=http://web.archive.org/web/20220213162837/https://emrespublisher.com/advances-in-neurology-and-neuroscience-research/volume_2/100011/|archive-date=2022-02-13|url-status=|access-date=2022-01-19}}</ref> - [http://web.archive.org/web/20220213162837/https://emrespublisher.com/advances-in-neurology-and-neuroscience-research/volume_2/100011/ (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<ref name="Traianos2021">{{Cite journal | title = 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 | date = 2021-06-01|url=https://ard.bmj.com/content/80/Suppl_1/1057.3|journal=Annals of the Rheumatic Diseases|volume=80|issue=Suppl 1|pages=1057–1058 | last = Traianos | first = E. | last2 = Dibnah | first2 = B. | last3 = Lendrem | first3 = D. | last4 = Clark | first4 = Y. | last5 = Macrae | first5 = V. | last6 = Slater | first6 = V. | last7 = Wood | first7 = K. | last8 = Storey | first8 = D. | last9 = Simon | first9 = B. | last10 = Blake | first10 = J. | last11 = Tarn | first11 = J.|language=en|doi=10.1136/annrheumdis-2021-eular.1999|issn=0003-4967}}</ref> - [https://ard.bmj.com/content/80/Suppl_1/1057.3 (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<ref name="Rodriguez2020" /> - [https://www.biorxiv.org/content/10.1101/2020.02.20.958249v2 (Full text)]] * 2020, Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial<ref name="Jiao2020">{{Cite journal|url=https://www.hindawi.com/journals/ecam/2020/6049891/ | title = Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial | last= Jiao | first = Yue | last2 = Guo | first2 = Xiao | date = 2020-08-07 | website = Evidence-Based Complementary and Alternative Medicine|language=en|doi=10.1155/2020/6049891|pmc =PMC7429019|pmid=32831871|access-date = | last3 = Luo | first3 = Man | last4 = Li | first4 = Suxia | last5 = Liu | first5 = Aihua | last6 = Zhao | first6 = Yufeng | last7 = Zhao | first7 = Bin | last8 = Wang | first8 = Dequan | last9 = Li | first9 = Zaifang|archive-url=|archive-date=|url-status=|volume=2020|pages=6049891}}</ref> - [https://doi.org/10.1155/2020/6049891 (Full text)] *2020, The Impact of Auricular Vagus Nerve Stimulation on Pain and Life Quality in Patients with Fibromyalgia Syndrome<ref name="Kutlu2020">{{Cite journal | title = The Impact of Auricular Vagus Nerve Stimulation on Pain and Life Quality in Patients with Fibromyalgia Syndrome | date = 2020-03-02|url=https://www.hindawi.com/journals/bmri/2020/8656218/|journal=BioMed Research International|volume=2020| pages = e8656218 | last = Kutlu | first = Nazlı | last2 = Özden | first2=Ali Veysel | last3 = Alptekin | first3=Hasan Kerem | last4 = Alptekin | first4=Jülide Öncü|language=en|doi=10.1155/2020/8656218|issn=2314-6133}}</ref> - [https://www.hindawi.com/journals/bmri/2020/8656218/ (Full text)] *2019, Current Directions in the Auricular Vagus Nerve Stimulation I -A Physiological Perspective<ref name="Kaniusas2019a">{{Cite journal | title = Current Directions in the Auricular Vagus Nerve Stimulation I – A Physiological Perspective | date = 2019 | url=https://www.frontiersin.org/article/10.3389/fnins.2019.00854|journal=Frontiers in Neuroscience|volume=13 | last = Kaniusas | first = Eugenijus | last2 = Kampusch| first2 = Stefan | last3 = Tittgemeyer | first3=Marc | last4 = Panetsos | first4=Fivos | last5 = Gines | first5 = Raquel Fernandez | last6 = Papa | first6 = Michele | last7 = Kiss | first7 = Attila | last8 = Podesser | first8 = Bruno | last9 = Cassara | first9 = Antonino Mario | last10 = Tanghe | first10 = Emmeric | last11 = Samoudi | first11 = Amine Mohammed|doi=10.3389/fnins.2019.00854|pmc=PMC6697069|pmid=31447643|issn=1662-453X|issue= | pages = 854|quote=|access-date=|via=}}</ref> - [https://www.researchgate.net/profile/Marc-Tittgemeyer/publication/335082729_Current_Directions_in_the_Auricular_Vagus_Nerve_Stimulation_I_-A_Physiological_Perspective/links/5d4da9d74585153e5949dc4a/Current-Directions-in-the-Auricular-Vagus-Nerve-Stimulation-I-A-Physiological-Perspective.pdf (Full text)] *2019, Current directions in the auricular vagus nerve stimulation II–an engineering perspective<ref name="Kaniusas2019b">{{Cite journal | title = Current Directions in the Auricular Vagus Nerve Stimulation II – An Engineering Perspective | date = 2019 | url=https://www.frontiersin.org/article/10.3389/fnins.2019.00772|journal=Frontiers in Neuroscience|volume=13 | last = Kaniusas | first = Eugenijus | last2 = Kampusch| first2 = Stefan | last3 = Tittgemeyer | first3=Marc | last4 = Panetsos | first4=Fivos | last5 = Gines | first5 = Raquel Fernandez | last6 = Papa | first6 = Michele | last7 = Kiss | first7 = Attila | last8 = Podesser | first8 = Bruno | last9 = Cassara | first9 = Antonino Mario | last10 = Tanghe | first10 = Emmeric | last11 = Samoudi | first11 = Amine Mohammed|doi=10.3389/fnins.2019.00772/full|issn=1662-453X}}</ref> - [https://www.frontiersin.org/articles/10.3389/fnins.2019.00772/full (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<ref name="Aranow2018">{{Cite journal | title = Transcutaneous auricular vagus nerve stimulation reduces pain and fatigue in patients with systemic lupus erythematosus: a randomised, double-blind, sham-controlled pilot trial | date = 2021-02-01|url=https://ard.bmj.com/content/80/2/203|journal=Annals of the Rheumatic Diseases|volume=80|issue=2|pages=203–208 | last = Aranow | first = Cynthia | last2 = Atisha-Fregoso | first2 = Yemil | last3 = Lesser | first3=Martin | last4 = Mackay | first4 = Meggan | last5 = Anderson | first5 = Erik | last6 = Chavan | first6 = Sangeeta | last7 = Zanos | first7 = Theodoros P. | last8 = Datta-Chaudhuri | first8 = Timir | last9 = Bouton | first9 = Chad | last10 = Tracey | first10 = Kevin J. | last11 = Diamond | first11 = Betty |language=en|doi=10.1136/annrheumdis-2020-217872|pmid=33144299|issn=0003-4967|pmc=|quote=|via=}}</ref> - [https://ard.bmj.com/content/80/2/203 (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<ref name="Barbanti2015">{{Cite journal | title = Safety and Efficacy of Vagus Nerve Stimulation in Fibromyalgia: A Phase I/II Proof of Concept Trial | date = 2011-09-01|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173600/|journal=Pain Medicine|volume=12|issue=9|pages=1406–1413 | last =Lange | first = Gudrun | author-link = Gudrun Lange | last2 = Janal | first2 = Malvin N.|author-link2 = | last3 = Maniker | first3=Allen | author-link3 = | last4 = FitzGibbons | first4=Jennifer | author-link4 = | last5 = Fobler | first5 = Malusha | authorlink5 = | last6 = Cook | first6 = Dane | authorlink6 = Dane Cook | last7 = Natelson | first7 = Benjamin H. | authorlink7 = Benjamin Natelson | doi=10.1111/j.1526-4637.2011.01203.x|pmc=PMC3173600|pmid=21812908|access-date=|issn=1526-2375|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173600/ (Full text)] ==See also== *[[Vagus nerve hypothesis]] *[[Intranasal mechanical stimulation]] *[[Vagus nerve]] ==Learn more == ==References== <references> <ref name="fanselow2013">{{Cite journal | doi = 10.1016/j.biopsych.2013.03.025| issn = 1873-2402| volume = 73 | issue = 11| pages = 1043–1044| last = Fanselow | first = Michael S.| title = Fear and anxiety take a double hit from vagal nerve stimulation| journal = Biological Psychiatry | date = 2013-06-01 | pmid = 23647735}}</ref> <ref name="stavrakis2015">{{Cite journal | doi = 10.1016/j.jacc.2014.12.026| issn = 1558-3597| volume = 65 | issue = 9| pages = 867–875| 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immunology of the cholinergic antiinflammatory pathway| journal = Journal of Clinical Investigation| access-date = 2016-12-12 | date = 2007-02-01| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783813/| pmid = 17273548}}</ref> <ref name="lyudmila2000">{{Cite journal | doi = 10.1038/35013070| issn = 0028-0836| volume = 405 | issue = 6785| pages = 458–462| last1 = Borovikova | first1 = Lyudmila V. | last2 = Ivanova | first2 = Svetlana | last3 = Zhang | first3 = Minghuang | last4 = Yang | first4 = Huan | last5 = Botchkina | first5 = Galina I. | last6 = Watkins | first6 = Linda R. | last7 = Wang | first7 = Haichao | last8 = Abumrad | first8 = Naji | last9 = Eaton | first9 = John W. | last10 = Tracey | first10 = Kevin J.| title = Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin| journal = Nature| access-date = 2016-12-12 | date = 2000-05-25| url = http://www.nature.com/nature/journal/v405/n6785/abs/405458a0.html}}</ref> <ref name="lund1986">{{Cite 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D. | last2 = Oda | first2 = R.P. | last3 = Pardini | first3 = B.J. | last4 = Schmid | first4 = P.G. | title = Vagus nerve stimulation alters regional acetylcholine turnover in rat heart| journal = Circulation Research| date = March 1986 | url = https://www.ahajournals.org/doi/10.1161/01.res.58.3.372?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed| pmid = 3719926}}</ref> <ref name="pisapia2015">{{Cite book | last1 = Pisapia | first1 = Jared | last2 = Baltuch | first2 = Gordon |editor-last1 = Hamani |editor-first1 = Clement |editor-last2 = Holtzheimer |editor-first2=Paul |editor-last3=Lozano |editor-first3=Andres |editor-last4=Mayberg |editor-first4=Helen | title = Neuromodulation in Psychiatry |publisher=Wiley-Blackwell | date = January 22, 2016 |location=Chicester, UK |pages = |chapter=Vagus nerve stimulation: Introduction and technical aspects |url=https://www.amazon.co.uk/Neuromodulation-Psychiatry-Clement-Hamani/dp/1118801040 |isbn=978-1118801048 |doi=10.1002/9781118801086.ch17/}}</ref> </references> [[Category:Potential treatments]] [[Category:Electrical and nerve stimulation]] [[Category:Nerve-based treatments]] [[Category:Depression treatments]] [[Category:Drug-free pain management]] [[Category:Depression alternative treatments]] [[Category:Depression alternative treatments]]
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