Vagus nerve stimulation

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Ear with crocodile crips attaching electrodes to the auricular concha part of the ear for vagus nerve stimulation
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 is referred to informally as a "pacemaker for the brain."[1]

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.[2] Currently, VNS is most frequently used as an adjunctive treatment for certain types of intractable epilepsy[3] and treatment-resistant depression.[3][4]

Transcutaneous Vagus Nerve Stimulation[edit | edit source]

Transcutaneous Vagus Nerve Stimulation (t-VNS or ta-VNS) is a wearable form of vagus nerve stimulation involving attaching electrodes to a part of the ear daily, and this can be done by patients at home.[1]

Intranasal Mechanical Stimulation[edit | edit source]

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.[5]

Surgical VNS[edit | edit source]

VNS can also be delivered via an implantable device, requiring surgery.[1]

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[edit | edit source]

Some ME/CFS patients have found that regular manual vagus nerve stimulation improves ME/CFS symptoms both in the short and long term. In addition to deep breathing[6], these techniques include gargling[7], "The Basic Exercise" (as described by Stanley Rosenberg[8]), and stimulating the diving reflex by immersing the face in cool water.[9] These techniques can be done by the patient at home and are free.

Uses[edit | edit source]

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.[4]

In parts of Europe noninvasive vagus nerve stimulation devices have been approved for pain, depression and epilepsy.[4]

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,[10] atrial fibrillation,[11]chronic pain,[12]Crohn's disease,[13]fibromyalgia,[14] heart failure,[15]insomnia and sleep problems,[16]migraines,[17] 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.[18]

Mechanisms[edit | edit source]

The vagus nerve can inhibit cytokine release, via release of the neurotransmitter acetylcholine[19] 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,[20] ischemia/reperfusion injury, hemorrhagic shock, arthritis, and other inflammatory syndromes.[21]

ME/CFS[edit | edit source]

News and articles[edit | edit source]

Notable studies[edit | edit source]

  • 2020, Achieving symptom relief in patients with Myalgic encephalomyelitis by targeting the neuro-immune interface and inducing disease tolerance[5] - [1]
  • 2020, Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial[16] - (Full text)

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. "Vagus Nerve Stimulation (VNS)". Epilepsy Foundation. Retrieved February 25, 2020.
  2. Lanska, DJ (February 2002). "J.L. Corning and vagal nerve stimulation for seizures in the 1880s". Neurology.
  3. 3.03.1 Pisapia, Jared; Baltuch, Gordon (January 22, 2016), "Vagus nerve stimulation: Introduction and technical aspects", in Hamani, Clement; Holtzheimer, Paul; Lozano, Andres; Mayberg, Helen (eds.), Neuromodulation in Psychiatry, Chicester, UK: Wiley-Blackwell, doi:10.1002/9781118801086.ch17/, ISBN 978-1118801048
  4. "Vagus nerve stimulation". Mayo Clinic. Retrieved February 25, 2020.
  5. 5.05.1 Rodriguez, Lucie S. T.; Pou, Christian; Lakshmikanth, Tadepally; Zhang, Jingdian; Mugabo, Constantin Habimana; Wang, Jun; Mikes, Jaromir; Olin, Axel; Chen, Yang (February 28, 2020). "Achieving symptom relief in patients with Myalgic encephalomyelitis by targeting the neuro-immune interface and inducing disease tolerance". bioRxiv: 2020.02.20.958249. doi:10.1101/2020.02.20.958249.
  6. "Breathing Exercises: Three To Try | 4-7-8 Breath | Andrew Weil, M.D." October 28, 2016. Retrieved April 7, 2021.
  7. Kharrazian, Datis (2013). Why isn't my brain working? : a revolutionary understanding of brain decline and effective strategies to recover your brain's health. Carlsbad, CA. ISBN 978-0-9856904-3-4. OCLC 853272721.
  8. Rosenberg, Stanley (2017). Accessing the healing power of the vagus nerve : self-help exercises for anxiety, depression, trauma, and autism. Berkeley, California. ISBN 978-1-62317-024-0. OCLC 918969766.
  9. Godek, Devon; Freeman, Andrew M. (2020). Physiology, Diving Reflex. Treasure Island (FL): StatPearls Publishing. PMID 30855833.
  10. Fanselow, Michael S. (June 1, 2013), "Fear and anxiety take a double hit from vagal nerve stimulation", Biological Psychiatry, 73 (11): 1043–1044, doi:10.1016/j.biopsych.2013.03.025, ISSN 1873-2402, PMID 23647735
  11. Stavrakis, Stavros; Humphrey, Mary Beth; Scherlag, Benjamin J.; Hu, Yanqing; Jackman, Warren M.; Nakagawa, Hiroshi; Lockwood, Deborah; Lazzara, Ralph; Po, Sunny S. (March 10, 2015), "Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation", Journal of the American College of Cardiology, 65 (9): 867–875, doi:10.1016/j.jacc.2014.12.026, ISSN 1558-3597, PMID 25744003
  12. Chakravarthy, Krishnan; Chaudhry, Hira; Williams, Kayode; Christo, Paul J. (December 2015), "Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management", Current Pain and Headache Reports, 19 (12): 54, doi:10.1007/s11916-015-0528-6, ISSN 1534-3081, PMID 26493698
  13. Bonaz, B.; Sinniger, V.; Hoffmann, D.; Clarençon, D.; Mathieu, N.; Dantzer, C.; Vercueil, L.; Picq, C.; Trocmé, C.; Faure, P.; Cracowski, J.-L.; Pellissier, S. (June 2016), "Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study", Neurogastroenterology and Motility: The Official Journal of the European Gastrointestinal Motility Society, 28 (6): 948–953, doi:10.1111/nmo.12792, ISSN 1365-2982, PMID 26920654
  14. Lange, Gudrun; Janal, Malvin N.; Maniker, Allen; Fitzgibbons, Jennifer; Fobler, Malusha; Cook, Dane; Natelson, Benjamin H. (September 2011), "Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase I/II proof of concept trial", Pain Medicine (Malden, Mass.), 12 (9): 1406–1413, doi:10.1111/j.1526-4637.2011.01203.x, ISSN 1526-4637, PMID 21812908
  15. Hauptman, Paul J.; Schwartz, Peter J.; Gold, Michael R.; Borggrefe, Martin; Van Veldhuisen, Dirk J.; Starling, Randall C.; Mann, Douglas L. (June 2012), "Rationale and study design of the increase of vagal tone in heart failure study: INOVATE-HF", American Heart Journal, 163 (6): 954–962.e1, doi:10.1016/j.ahj.2012.03.021, ISSN 1097-6744, PMID 22709747
  16. 16.016.1 Jiao, Yue; Guo, Xiao; Luo, Man; Li, Suxia; Liu, Aihua; Zhao, Yufeng; Zhao, Bin; Wang, Dequan; Li, Zaifang (August 7, 2020). "Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomized Clinical Trial". Evidence-Based Complementary and Alternative Medicine. doi:10.1155/2020/6049891. PMC 7429019. PMID 32831871. Retrieved December 15, 2020.
  17. Silberstein, Stephen D.; Calhoun, Anne H.; Lipton, Richard B.; Grosberg, Brian M.; Cady, Roger K.; Dorlas, Stefanie; Simmons, Kristy A.; Mullin, Chris; Liebler, Eric J.; Goadsby, Peter J.; Saper, Joel R.; EVENT Study Group (August 2, 2016), "Chronic migraine headache prevention with noninvasive vagus nerve stimulation: The EVENT study", Neurology, 87 (5): 529–538, doi:10.1212/WNL.0000000000002918, ISSN 1526-632X, PMID 27412146
  18. "Kevin J. Tracey, MD". Retrieved February 25, 2020.
  19. Lund, D. D.; Oda, R. P.; Pardini, B. J.; Schmid, P. G. (March 1986), "Vagus nerve stimulation alters regional acetylcholine turnover in rat heart", Circulation Research, 58 (3): 372–377, ISSN 0009-7330, PMID 3719926
  20. Borovikova, Lyudmila V.; Ivanova, Svetlana; Zhang, Minghuang; Yang, Huan; Botchkina, Galina I.; Watkins, Linda R.; Wang, Haichao; Abumrad, Naji; Eaton, John W.; Tracey, Kevin J. (May 25, 2000), "Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin", Nature, 405 (6785): 458–462, doi:10.1038/35013070, ISSN 0028-0836, retrieved December 12, 2016
  21. Tracey, Kevin J. (February 1, 2007), "Physiology and immunology of the cholinergic antiinflammatory pathway", Journal of Clinical Investigation, 117 (2): 289–296, doi:10.1172/JCI30555, ISSN 0021-9738, PMID 17273548, retrieved December 12, 2016
  22. Knapton, Sarah (July 7, 2016), "Electronic implant in 'Spock' nerve could reverse rheumatoid arthritis", The Telegraph, London, retrieved December 12, 2016
  23. Johnson, Cort (January 11, 2016), "Vagus Nerve Stimulation, Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)", HealthRising, Henderson, NV, retrieved December 12, 2016
  24. Behar, Michael (May 23, 2014), "Can the Nervous System Be Hacked?", The New York Times, retrieved December 12, 2016

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

phase one A drug trial involving only a small group of humans, often healthy volunteers, to assess drug safety and side effects. Typically 20-80 participants, often using a comparison group.

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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history.