Abstract
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.
Highlights
Emergency healthcare and reanimation techniques have decreased the mortality of patients with severe traumatic brain injury (TBI) and hypoxic-ischemic encephalopathy (HIE) significantly in recent decades
According to the first auditory score (Table 1), five patients fell into the responded to auditory stimuli (RtAS) group [subscale Auditory Function (A) ≥ 1: Auditory startle], and the other five fell into the non-responded to auditory stimuli group [subscale Auditory Function (A) = 0: None]
Through the Glasgow Outcome Scale (GOS) assessment (Table 1) [7, 29], after the transcutaneous auricular vagal nerve stimulation (taVNS) treatment, five patients can be classified as favorable prognoses (GOS > 2), while the other five patients can be classified as unfavorable prognoses (GOS ≤ 2)
Summary
Emergency healthcare and reanimation techniques have decreased the mortality of patients with severe traumatic brain injury (TBI) and hypoxic-ischemic encephalopathy (HIE) significantly in recent decades. Some patients with TBI or HIE manifest with very poor prognoses and suffer from disorders of consciousness (DOC), a medical condition changed from complete self-awareness taVNS for DOC Monitored by ASL-fMRI to inhibited or absent self-awareness and arousal [1], either temporary or permanent. New neuromodulation techniques, such as transcranial direct current stimulation (tDCS) [2], transcranial magnetic stimulation (TMS) [3], and low intensity focused ultrasound pulse (LIFUP) [4], have been introduced [5], deep brain stimulation (DBS), and spinal cord stimulation (SCS) remain two mostly employed neurostimulation techniques for DOC patients and show some promises in restoring consciousness [6, 7]. High costs, complicated processes, and potential surgical side effects limited their applications
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