New Frontiers in Noninvasive Brain Stimulation: Cognitive, Affective and Neurobiological Effects of Transcutaneous Vagus Nerve Stimulation

162.5K
views
121
authors
11
articles
Editors
2
Impact
Loading...

Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic–ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials.

9,556 views
41 citations
Review
12 December 2019

Auricular vagal nerve stimulation (AVNS) is an evolving neuromodulation technology that has a wide range of therapeutic applications across multiple disciplines of medical science. To date, AVNS results had been interpreted in the context of a monolog concept of the auricular branch of the vagus nerve (ABVN): that this is the sole network of the mechanism of action and/or structure in the auricular area of the stimulation in the context of activations in the brainstem nuclei, including the nucleus tractus solitarius (NTS), locus coeruleus (LC), trigeminal brainstem nuclei, and the nucleus cuneatus. This review considers the overlooked aspects of neural networks, connections, hijacking axons from cranial nerves and cervical sympathetic ganglions, the inhomogeneous distribution of perivascular sympathetic nerves, and intrinsic/extrinsic auricular muscles in the auricular zone that can explain the vagal and non-vagal nucleus activations in AVNS. In addition, the unique cortical representation of the human ear and interspecies differences in the auricula are discussed. The detailed auricular anatomy of the AVNS zone explored in the present study references structural and functional neural network information to overcome default designs and misinterpretations of existing research on AVNS to provide a better foundation for future investigations that use this modality.

17,696 views
31 citations
Recommended Research Topics
Frontiers Logo

Frontiers in Psychology

Adaptive hot cognition: How emotion drives information processing and cognition steers affective processing
Edited by Mariska Esther Kret, Bruno Rafael Bocanegra
256.4K
views
56
authors
21
articles
Frontiers Logo

Frontiers in Psychology

Embodied Bounded Rationality
Edited by Riccardo Viale, Vittorio Gallese, Shaun Gallagher
104.2K
views
22
authors
13
articles
Frontiers Logo

Frontiers in Psychology

Affect and Cognition in Upper Echelons’ Strategic Decision Making: Empirical and Theoretical Studies for Advancing Corporate Governance.
Edited by Matteo Cristofaro, Yongjian Bao, Sana Chiu, Ana Beatriz Hernández-Lara, Leticia Perez-Calero
71.7K
views
47
authors
14
articles
Frontiers Logo

Frontiers in Human Neuroscience

Neuromodulation in Basic, Translational and Clinical Research in Psychiatry
Edited by Ryouhei Ishii, Keiichiro Nishida, Nagy A. Youssef, MD, PhD, Kay Jann, Shun Takahashi
139.3K
views
121
authors
17
articles
Frontiers Logo

Frontiers in Human Neuroscience

Neuromodulation in Basic, Translational and Clinical Research in Psychiatry - Volume II
Edited by Kay Jann, Ryouhei Ishii, Shun Takahashi, Shunichiro Ikeda
16.5K
views
38
authors
5
articles