Fatigue is the most prevalent symptom in "long COVID", affecting 6-7% of patients after COVID-19 infection. Its pathophysiology remains unclear, with viral persistence, immune dysregulation, and mitochondrial dysfunction among proposed mechanisms. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulatory approach, has been suggested as a potential treatment. We conducted a randomized, sham-controlled, single-blinded pilot study to evaluate adherence and clinical effects of taVNS in long COVID-related fatigue. Forty-five patients were randomized 1:1:1 to sham stimulation, sub-threshold taVNS, or above-threshold taVNS for 4weeks using the Conformité Européenne (CE)-certified tVNS-L device (25 Hz, 250 µs, 4 h/day). The primary co-endpoints were fatigue severity (MFI-20) and adherence, defined as mean daily stimulation duration. Secondary endpoints included depressive symptoms (BDI-II), health-related quality of life (SF-36), and post-COVID symptom burden (PCS). Of 45 enrolled patients (mean age 42.4 years; 73% female), 4 (8.9%) dropped out early. Mean stimulation time was 236 min/day, fulfilling the adherence criterion in > 80% of participants. Adverse events were mild, including skin irritation (6.7%) and vertigo (6.7%). Across all groups, questionnaire scores improved over time; however, no statistically significant differences were observed between the sham and active stimulation groups. Baseline fatigue and quality-of-life scores were markedly impaired compared with normative data. taVNS was safe, feasible, and associated with high adherence in long COVID-related fatigue, but showed no superiority over sham stimulation. Larger multicenter trials with more homogeneous populations and objective biomarkers are required to determine whether taVNS confers therapeutic benefit in this condition. The trial was approved by the ethics committee (23/7798) and registered at the German Clinical Trials Register, identifier DRKS00031974.

• Epilepsy is one of the most common chronic neurological disorders, affecting approximately 1–3 % of the global population and representing a major cause of long-term neurological morbidity worldwide. • Vagus nerve stimulation (VNS) is an established adjunctive therapy for drug-resistant epilepsy (DRE). • While generally safe, stimulation of the cervical vagus nerve may be associated with adverse events involving multiple organ systems, necessitating accurate risk contextualisation and patient-centred management. • Stimulation-related airway symptoms including hoarseness, cough, dyspnoea, stridor, and sleep-disordered breathing were the most frequently reported adverse effects and were typically transient or reversible through adjustment of output current, pulse width, duty cycle, or temporary magnet-controlled suspension. • VNS provides meaningful seizure reduction for a substantial proportion of patients with DRE. Optimal long-term outcomes depend on realistic communication of complication risks, careful differentiation between common stimulation-related effects and rare surgical or device failures, and timely, patient-centred adjustment of therapy throughout the device lifespan. Vagus nerve stimulation (VNS) is an established adjunct for drug-resistant epilepsy (DRE), yet its “wandering” effects across organ systems generate a wide range of adverse events. To collate published VNS-related complications and present pragmatic, system-based management guidance. PubMed, Scopus, and Web of Science were searched from inception to 30 June 2025 for human studies reporting surgical, device-related, or stimulation-linked problems after cervical VNS in DRE or treatment-resistant depression. Two reviewers independently screened, extracted, and synthesised data in this narrative review. Airway sequelae—hoarseness, cough, dyspnoea, stridor and sleep apnoea—were the most typical reactions; most resolved after reducing output current, pulse width or duty-cycle, or by magnet-controlled pauses. Device failures comprised lead fracture (up to 11.9 % in paediatric cohorts), generator battery depletion prompting replacement in 15–27 % of long-term users, and infections in 2–6 % of implants. Rare but serious cardiac events—bradycardia or intra-operative asystole (manufacturer estimate 0.1–1 %)—were reversible when stimulation ceased. Isolated neurological, psychiatric, and gastrointestinal events (pain, tremor, mania, intractable hiccups, diarrhoea) were typically mitigated by parameter adjustment or explantation. Roughly half of DRE patients attain ≥50 % seizure reduction with VNS, but durable benefit hinges on vigilant, system-specific surveillance and early tailored interventions. A structured, organ-oriented approach helps multidisciplinary teams balance seizure control, safety, and quality of life throughout the device’s lifespan

Myasthenia gravis (MG) is a neuromuscular disorder that can precipitate serious and fatal complications, especially when respiratory muscles are affected. Current electrodiagnostic methods, such as Single Fiber Electromyography (SFEMG) and Repetitive Nerve Stimulation (RNS), have notable limitations. While SFEMG is sensitive to neuromuscular abnormalities rather than being specific for MG, it is also a semi-invasive procedure that requires supervision by specialist clinicians and an expensive clinical setup. Conversely, RNS is highly specific for MG, but its sensitivity decreases in cases of low severity. Prior studies, including our previous work, have demonstrated that the manifestation of MG in affecting eye movements can be indirectly quantified using electrooculography (EOG) signals. This non-invasive method could develop into a widely used and easily deployed screening method, especially for early detection of MG using readily obtainable biomarkers. With this goal in mind, our research team developed data collection protocols using a standardized eye movement protocol that could be implemented in a standard clinical setting to acquire EOG data. In this article, we present the experimental setup, test protocols, sample outcomes, and preliminary analysis approaches. Common artifacts encountered, as well as technical and logistical challenges associated with such a setup, are also discussed.1.An approach to non-invasively detect and quantify MG using eye movement signals.2.Data collection protocols for acquiring eye movement signals designed for MG quantification3.Novel eye movement-based biomarkers in quantifying MG.

Vagus nerve stimulation as an adjunctive therapy for super-refractory status epilepticus including NORSE: a retrospective cohort study.

Prevalence, associated disorders and treatment of joint hypermobility syndrome; A systematic review.

Early experience with hypoglossal nerve stimulation in Japanese patients: Trends in operative time and treatment outcomes.

Effects of TDCS and TENS on chronic low back pain: A randomized controlled clinical trial.

The clinical benefits of neurostimulation therapies for treating dysphagia in acute and critical care patients remain controversial. This study aims to comprehensively review the literature to assess the effectiveness of neurostimulation therapies. Databases including PubMed, Cochrane Library, Embase, Ovid, CINAHL, Web of Science, Wanfang, CNKI, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched up to April 16, 2025. Eligible randomised clinical trials (RCTs) involving acutely and critically ill patients with dysphagia were identified. Details of study population, treatments and outcomes were extracted. Forty-four studies involving 2198 patients were selected. These studies encompassed five types of neurostimulation therapies: transcutaneous auricular vagus nerve stimulation (ta-VNS), neuromuscular electrical stimulation (NMES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and pharyngeal electrical stimulation (PES). The pairwise meta-analysis indicated that compared to traditional dysphagia therapy (TDT), usual care or sham stimulation, neurostimulation therapies significantly improved swallowing function post-treatment (SMD = -0.74, 95% CI: -0.90 to -0.58), increased the rate of patients regaining the ability to take food orally (RR = 1.39, 95% CI: 1.12-1.74) and enhanced swallowing function at 1 month (SMD = -1.28, 95% CI: -1.76 to -0.81) and 2 months (SMD = -2.24, 95% CI: -3.25 to -1.23). Additionally, neurostimulation was associated with a reduction in pneumonia incidence (RR = 0.62, 95% CI: 0.39-0.98). However, neurostimulation did not show significant improvements in swallowing function at 3 months post-treatment (SMD = -0.43, 95% CI: -1.08 to 0.22) or decannulation (RR = 3.47, 95% CI: 0.60-20.23), nor did it reduce aspiration post-intervention (RR = 0.67, 95% CI: 0.36-1.26) or shorten hospital stays (MD = -1.74, 95% CI: -4.78 to 1.30). The network meta-analysis revealed that NMES + TDT (SMD = -1.69, 95% CI: -2.83 to -0.58), NMES (SMD = -1.31, 95% CI: -2.61 to -0.02), rTMS + TDT (SMD = -1.58, 95% CI: -2.71 to -0.49), rTMS (SMD = -1.15, 95% CI: -1.79 to -0.53), tDCS + TDT (SMD = -1.19, 95% CI: -2.31 to -0.09), PES + TDT (SMD = -1.53, 95% CI: -2.97 to -0.15) and PES (SMD = -0.71, 95% CI: -1.45 to -0.06) were effective in improving swallowing function. NMES + TDT may be the most potentially effective neurostimulation therapy. The efficacy of ta-VNS + TDT (SMD = -1.89, 95% CI: -3.47 to -0.33) remains to be further validated. Among these, ta-VNS + TDT (SMD = -1.89, 95% CI: -3.47 to -0.33) was supported by only one study, necessitating further validation of its therapeutic efficacy. Our findings suggest that NMES + TDT, rTMS + TDT, NMES, tDCS + TDT, rTMS, PES + TDT and PES are effective therapies for improving swallowing function in acute and critical care patients, while the effectiveness of ta-VNS + TDT requires further investigation. Among the five neurostimulation therapies, NMES + TDT may be the most effective, according to probability rankings.

The performances of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) and Self-Report (QIDS-SR) ratings have never been evaluated in markedly treatment-resistant depression (TRD). RECOVER, a 12-month randomized, controlled trial, compared adjunctive active to adjunctive sham vagus nerve stimulation, provided data to address this knowledge gap, and to examine the basis for the differential sensitivities of these scales in detecting overall and between-treatment-group symptom changes. We employed classical test and item response theory methods to characterize each scale. Effect sizes identified items that were most sensitive to change over time across treatments, best discriminated between the two treatments, and best detected at least a partial symptom response in clinician global ratings. All three inventories were unidimensional, with high retest reliability and strong internal consistency. MADRS total scores were less sensitive in detecting overall and between-treatment-group symptom differences. On each scale, five symptom domains-mood, energy/lassitude, interest/inability to feel, negative self-view/pessimism, and concentration-covaried most strongly with overall depression severity and had the largest effect sizes in detecting overall therapeutic change and between-group difference in efficacy. These findings may not generalize to less treatment-resistant populations or to different treatments. The relative insensitivity of suicidal ideation, sleep, and appetite items may be due to study design or concomitant medications. The MADRS, QIDS-C, and QIDS-SR are suitable for use in markedly TRD. Whether sadness, energy, interest, guilt, and concentration are "core" symptoms that are especially sensitive to change deserves further study.

Utility of Embedding a Physical Therapist in a United States National Park: A Pilot Program.

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder frequently complicated by cardiovascular pathologies, notably left ventricular diastolic dysfunction (LVDD), which can progress to heart failure with preserved ejection fraction (HFpEF). There is emerging evidence of a crucial interplay between autonomic dysfunction and chronic low-grade inflammation in the pathogenesis of LVDD in T2DM patients. The bidirectional cross talk between the autonomic nervous system and the immune system has been a novel area explored in preclinical studies. Autonomic dysfunction, as evidenced by reduced heart rate variability and impaired baroreflex sensitivity, is common among patients with T2DM. The interaction between the autonomic nervous system and inflammation is altered in T2DM, shifting toward vagal withdrawal and the release of proinflammatory cytokines [e.g., TNF-α, IL-1β, IL-6, and transforming growth factor-beta (TGF-β)], which can promote myocardial stiffening and fibrosis. These pathophysiological mechanisms, together with metabolic and hemodynamic dysfunction in T2DM, can lead to HFpEF. Neuromodulation techniques, such as vagal nerve stimulation, have shown promise in reducing myocardial fibrosis and HFpEF in preclinical studies. Vagal nerve stimulation is thought to dampen the proinflammatory responses, thereby promoting tissue repair and protecting against cardiac dysfunction. In this review, we explore how inflammation-autonomic cross talk represents a pivotal mechanism in the development of LVDD in T2DM, providing a scientific rationale for neuro-modulatory interventions.

The role of change in peripartum heart rate variability in the prediction of depressive symptoms 18 months after childbirth: a follow-up study.

A wearable system enabling acute stress monitoring and closed-loop mitigation through transcutaneous median nerve stimulation.

Randomized Pilot Study of Transcutaneous Electrical Nerve Stimulation for Neuropathic/Nociplastic Ocular Pain.

Acute postoperative pain remains prevalent among patients undergoing gastrointestinal tumor surgery. The study was conducted to evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) in alleviating postoperative pain in this population. This patient- and assessor-blinded randomized controlled trial was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine. Eligible participants who underwent elective laparoscopic gastrointestinal tumor surgery were randomly assigned to the taVNS or control stimulation group. Both groups received the stimulation on the day before surgery and the day after surgery. The primary outcome was the change in visual analogue scale (VAS) scores at 24h postoperatively. The median reduction in VAS scores was 12.0 in the taVNS group, compared with 5.0 in the control stimulation group (median [interquartile range, IQR] 12.0 [10.0-13.3] mm vs 5.0 [2.0-8.0] mm; P < 0.001). Additionally, the taVNS group showed lower cumulative morphine milligram equivalents (MME) at 48h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P=0.004) and 72h (median [IQR] 0 [0-5] mg vs 5 [0-10] mg; P=0.002), and shorter time to first flatus (median [IQR] 45 [40-60]h vs 75 [60-85]h; P < 0.001). The incidence of complications, length of hospital stay, and quality of recovery-15 (QoR-15) scores are similar between groups. TaVNS statistically alleviated postoperative pain in patients undergoing gastrointestinal tumor surgery, decreased analgesic requirements, and promoted gastrointestinal function recovery. NCT06763913.

Alzheimer's disease (AD) is associated with behavioral and physical manifestations, such as sleep disturbances, which worsen the course of the disease and require effective management strategies. This review investigates non-pharmacological interventions available for the control of sleep disorders in patients with Alzheimer's disease. This is an integrative review, with searches carried out in the Public Medical Database, Science Direct, Scientific Electronic Library Online and Latin American and Caribbean Literature in Health Sciences, using the descriptors: "Alzheimer Disease", "Sleep Wake Disorders", "Sleep Disorders", and "Therapeutics". Original studies evaluating non-pharmacological treatments for sleep disorders in patients with AD and using specific instruments to assess improvement in sleep disorders were included. The non-pharmacological interventions evaluated included bright light therapy, morning light exposure, personalized lighting intervention, blue-enriched white light exposure, transcranial magnetic stimulation, acupressure, multimodal exercise program, aromatic oil bath salts, light visor phototherapy, transcutaneous electrical nerve stimulation and deep brain stimulation. Additionally, one article investigated the combination of bright light exposure with walking, as well as the isolated effects of each intervention. Non-pharmacological interventions for managing sleep disorders in patients with AD have shown promising strategies, including approaches such as light therapy, physical stimulation techniques, and acupressure, with results indicating potential benefits in improving sleep quality and mitigating behavioral and cognitive symptoms associated with the disease. However, current evidence highlights the need for future studies with more rigorous methodologies, larger population samples, and long-term follow-up to consolidate the efficacy and applicability of these interventions in clinical practice.

Comparative effects of cognitive training with whole-body vibration vs. traditional physiotherapy on balance and plantar sensation in diabetic neuropathy.

Vagus nerve stimulation (VNS) is a therapeutic option for pharmacoresistant epilepsy patients who are not eligible for surgery. While its primary aim is seizure reduction, the effects of VNS on sleep remain unclear, with previous studies reporting conflicting outcomes. This study uses ultra-long-term EEG recordings to assess the impact of VNS on sleep by comparing extensive baseline and post-VNS data. Patients were enrolled from the PREDYct study, which involves ultra-long-term subcutaneous EEG monitoring initiated approximately three months prior to VNS activation and continuing for up to fifteen months. Patients with fewer than five complete nights of EEG during the baseline or post-VNS period were excluded. Sleep stages were classified using the EpiSight sleep classifier. For each patient, fractions of REM, N1, N2, and N3 sleep, total sleep time (TST), and wakefulness after sleep onset (WASO) were computed for each night. Changes at the individual and group-level were assessed using Wilcoxon rank-sum tests and generalized linear mixed-effects models with a Gamma distribution, respectively. Ten patients were included, with a median of 42.5 (IQR: 33-48) complete nights during the baseline period and 61 (IQR: 28-166) nights during the post-VNS period. Significant changes between baseline and post-VNS periods were observed in three patients, with no consistent pattern across individuals. No significant group-level effects were observed. In this small cohort, VNS therapy did not result in consistent changes in sleep parameters at the individual or group level, suggesting that VNS has no significant impact on the assessed sleep parameters in pharmacoresistant epilepsy patients.

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic pelvic pain condition with unclear etiology that significantly affects quality of life. Although physiotherapeutic interventions are considered low-risk conservative options and may be incorporated into multimodal management in selected patients, evidence regarding their effectiveness remains limited. This review aimed to evaluate the effects of physiotherapy on pain and urinary symptoms in PBS/IC. This systematic review followed the PRISMA 2020 guidelines and was registered in the PROSPERO database (CRD42024539744). A comprehensive search was conducted in PubMed and Web of Science up to August 2025 without language restrictions. Titles and abstracts were screened using the Rayyan AI. Risk of bias was assessed with RoB-2 and ROBINS-I tools, and the quality of evidence was rated using GRADE criteria. Given the heterogeneity of the included studies, a narrative synthesis was conducted. Fourteen studies involving 609 participants were included-eight randomized controlled trials and six prospective single-arm studies. Common interventions included electrotherapy techniques such as extracorporeal shock wave therapy (ESWT), posterior tibial nerve stimulation (PTNS), and transcutaneous electrical nerve stimulation (TENS), along with manual therapies like myofascial release and Thiele massage. Most studies reported short-term improvements in pain and urinary symptoms, though long-term results were inconsistent. Many studies had significant methodological limitations and a high risk of bias. Moderate-quality evidence suggests that ESWT may provide short-term pain relief, while low-quality evidence indicates potential benefits from manual therapies, bladder training, and multimodal approaches. Physiotherapeutic interventions may provide short-term symptom relief in PBS/IC. However, given the limited quality of existing research, more rigorous, long-term randomized trials are needed.

Vagal Nerve Stimulation in Patients With Heart Failure and Reduced Ejection Fraction: The ANTHEM-HFrEF Trial.