Abstract
A recent multicenter trial provided Class I evidence that for patients with an episodic migraine, non-invasive vagus nerve stimulation (nVNS) significantly increases the probability of having mild pain or being pain-free 2 h post-stimulation. Here we aimed to investigate the potential effect of nVNS in the modulation of spontaneous and pain related bioelectrical activity in a subgroup of migraine patients enrolled in the PRESTO trial by using resting-state electroencephalography and trigeminal laser-evoked potentials (LEPs). LEPs were recorded for 27 migraine patients who received active or sham nVNS over the cervical vagus nerve. We measured power values for frequencies between 1–100 Hz in a resting-state condition and the latency and amplitude of N1, N2, and P2 components of LEPs in a basal condition during and after active or sham vagus nerve stimulation (T0, T1, T2). The P2 evoked by the right and the left trigeminal branch was smaller during active nVNS. The sham device also attenuated the P2 amplitude evoked by the left trigeminal branch at T1 and T2, but this attenuation did not reach significance. No changes were observed for N1 amplitude, N1, N2, P2 latency, or pain rating. nVNS induced an increase of EEG power in both slow and fast rhythms, but this effect was not significant as compared to the sham device. These findings suggest that nVNS acts on the cortical areas that are responsible for trigeminal pain control and pave the ground for future studies aimed at confirming the possible correlations with clinical outcomes, including the effect on symptoms that are directly correlated with trigeminal pain processing and modulation.
Highlights
Non-invasive Vagus Nerve Stimulation is a promising new treatment for migraine
Previous work in animal models has shown that vagus nerve stimulation (VNS) activates the nucleus tractus solitarius, locus coeruleus, and dorsal raphe nuclei (Dorr and Debonnel, 2006; Cunningham et al, 2008; Ay et al, 2015). functional magnetic resonance imaging (fMRI) studies demonstrated the action of vagal nerve activation
Deactivations were found in the hippocampus, visual cortex, and spinal trigeminal nucleus. These changes were similar to those reported in fMRI studies of invasive VNS in patients with epilepsy and in a study from the same group on the effects of Non-invasive Vagus Nerve Stimulation (nVNS) applied to the external ear in regions innervated by the auricular branch of the vagus nerve (Frangos et al, 2015)
Summary
Non-invasive Vagus Nerve Stimulation (nVNS) is a promising new treatment for migraine. Frangos and Komisaruk (2017) compared the effects of nVNS vs control sternocleidomastoid muscle stimulation and reported that nVNS activated the nucleus tractus solitarius and parabrachial area, primary sensory cortex, basal ganglia, frontal cortex, and insula. Deactivations were found in the hippocampus, visual cortex, and spinal trigeminal nucleus These changes were similar to those reported in fMRI studies of invasive VNS in patients with epilepsy and in a study from the same group on the effects of nVNS applied to the external ear in regions innervated by the auricular branch of the vagus nerve (Frangos et al, 2015)
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