Vagal Stimulation Research Articles

Effect of Vagal Nerve Stimulation and Jacobson Relaxation Technique on Agoraphobia among Post Neurological Ill-Patients: A Pilot Study

Background: This study was developed to determine the effectiveness of transcutaneous auricular vagus nervestimulation and Jacobson relaxation technique on agoraphobia among subjects with post neurological ill-patients.Purpose: The purpose of the study is to compare and evaluate the effectiveness of two non-pharmacologicalmethods of treatment for Agoraphobia patients with Post neurological ill-patients.Methods: The research project was conducted as a pilot study in a private hospital in Chennai. The experimentalgroup (group A) received transcutaneous auricular vagus nerve stimulation for approximately 20 minutes (30seconds ON and 5 minutes OFF) and a conventional Jacobson relaxation technique for 10 minutes. Group B gotconventional cognitive behavioral therapy (20 minutes) and the Jacobson relaxation technique (10 minutes).Following the four-week treatment period, a post-test analysis was performed using the Severity measure ofagoraphobia.Results: The study found that there is a positive impact of transcutaneous auricular vagus nerve stimulation andJacobson relaxation technique on agoraphobia in post neurological ill patients. The analysis obtained a mean valueof about 18 and an SD of 26 for group A, whereas group B revealed 24.8 ± 4.40, mean ± SD, and a significant Pvalue of <0.001.Conclusion: When compared to group B, those in group A who received transcutaneous auricular vagus nervestimulation improved more significantly when dealing with agoraphobia of post neurological ill patients. As aresult, non-invasive transcutaneous auricular vagus nerve stimulation and Jacobson relaxation technique havebeen proven to be effective approaches for preventing agoraphobia.

Effect of Vagal Nerve Stimulation on Swallowing in Subjects with Post Stroke Dysphagia

Background: The study was developed to find the effect of auricular transcutaneous vagal nerve stimulation ondifficulty in swallowing in post stroke dysphagia.Purpose: The purpose of this research is to extensively investigate and analyse how VNS impacts swallowing inpeople with post-stroke dysphagia.Materials and Methods: A total, 30 individuals have been selected mainly according to the criteria of both theinclusion and exclusion, from the above-mentioned study setting. The study was explained to subjects and writtenconsent was collected from all subjects prior to the initiation of procedure. The subjects included the study wasrandomly allocated into 2 groups The participants in group A will receive Transcutaneous auricular vagal nervestimulation, which is given for 20 min with the frequency of about 25 Hz, amplitude: 1 mA, pulse width: 360μs using clip electrode being placed in Cymba Concha, along with the conventional exercises and Group B willreceive Neuromuscular electrical stimulation will be given as Interrupted direct current at 30 Hz for 100ms, andthe intensity was increased until perceptible visible contraction.Results: Auricular transcutaneous vagal nerve stimulation showed a significant effect in improving swallowingfunctions at 4 weeks, with a p value which is < 0.001.Conclusion: This study showed that the transcutaneous auricular vagal nerve stimulation showed a positive effectin improving swallowing functions in patients with dysphagia.

Effectiveness of Vagal Nerve Stimulation on Obsessive Compulsive Disorder Among Post Covid-19 Infected Individuals

Background: COVID-19 has impacted everyday life and many people are affected by it. Regular Hand washing,maintaining hygiene, avoiding handshaking & face-to-face interaction, social distancing, quarantine areprecautionary measures which result in rapidly increasing depression and anxiety among common populationand it results in OCD.Purpose: This study aims to investigate the effectiveness of vagal nerve stimulation on obsessive compulsivedisorder among post-covid 19 infected individuals.Methodology: A total of 20 participants was selected using the Purposive sampling technique based on theinclusion and exclusion criteria. Then, the participants were allocated into 2 groups by closed envelope methodand the participants in the control group receive cognitive behavioural therapy for 30 minutes, 4 sessions/weekfor 4 weeks. The experimental group receive Transcutaneous auricular vagal nerve stimulation. The stimulationwas given for 30 minutes,4sessions/week along with CBT.Result: With a p value of 0.001, transcutaneous auricular vagal nerve activation significantly reduced obsessivecompulsive disorder symptoms after 4weeks in experimental group.Conclusion: The Study showed that transcutaneous auricular vagal nerve stimulation was effective in reducingsymptoms of OCD among post covid-19 infected individuals.

Effect of Vagal Nerve Stimulation on Anxiety and Sleep Disturbances among Geriatric Population: A Pilot Study

Background: Anxiety during the COVID-19 pandemic has been a significant concern for people of all age groups,including geriatric individuals. The elderly population has faced unique challenges during this time, which cancontribute to increased anxiety levels. The uncertainty and fear surrounding the pandemic can lead to increasedanxiety and stress, which can negatively impact sleep quality and duration.Purpose: The aim of this study is to find out the effect of vagal nerve stimulation on anxiety and sleep disturbancesamong geriatric population.Methodology: Using the Purposive Sampling method, a total of 20 individuals were chosen based on the inclusionand exclusion criteria. The participants were divided into two groups using the closed envelope method, and theytook part in therapy sessions lasting 30 minutes, three times per week for a period of four weeks. The control groupreceived Jacobson’s progressive relaxation technique, whereas the experimental group received non-invasiveTranscutaneous auricular vagal nerve stimulation.Result: With a p value of 0.001, transcutaneous auricular vagal nerve activation significantly improved sleepquality and reduced anxiety after 4 weeks.Conclusion: Study showed that transcutaneous vagal nerve stimulation was effective in reducing Anxiety andimproving sleep quality in geriatric population.

Effect of Vagal Nerve Stimulation on Cognitive Impairment Among Subjects with Anterior Cerebral Artery Syndrome: A Pilot Study

Background: Cognitive dysfunction, including impairments in attention, memory, executive function, andprocessing speed. This study was developed to determine the effectiveness of transcutaneous auricular vagalnerve stimulation on cognitive impairment among subjects with anterior cerebral artery syndrome.Purpose: The purpose of the study is to compare and evaluate the effectiveness of two non-pharmacologicalmethods of treatment for cognitive impairment patients with ACA syndrome.Material and Methods: The project was conducted as a pilot study in a private hospital in Chennai. Theexperimental group (group A) received transcutaneous auricular vagal nerve stimulation for 20 minutes andconventional strengthening exercises for the affected limb for 10 minutes. Group B got conventional cognitivetraining (20 minutes) and strengthening exercises (10 minutes). Following the four-week treatment, a post-testanalysis was performed using the Montreal cognitive assessment scale.Results: The post-test analysis obtained a mean value of about 27.25 and SD 1.5 for group A, whereas group Brevealed 22.75 ± 1.25, mean ± SD, and a significant P value of 0.004.Conclusion: Non-invasive transcutaneous auricular vagal nerve stimulation has been proven to be an effectiveapproach for preventing vascular dementia.

Effect of different non-pharmacologic placebo treatments on migraine prevention: a network meta-analysis of randomized controlled trials.

Placebo control plays an important role in evaluating the effectiveness of interventions. Specifying differential effects of various placebo controls on migraine prevention would be essential in the explanation of preventive treatment for migraine and the indirect comparison between different prophylactic therapeutics. To access the impact of different non-pharmacologic placebo types on different outcomes in migraine patients. We searched PubMed, Cochrane Controlled Register of Trials, Embase, and Web of Science databases from the date of creation to June 19, 2023. Randomized controlled trials of migraine that included sham intervention of acupuncture or cognitive behavioural therapy (CBT) or non-invasive Vagus Nerve Stimulation (nVNS) or repetitive Transcranial Magnetic Stimulation (rTMS) or transcranial Direct Current Stimulation (tDCS) were conducted. The primary outcome was the migraine days, and the secondary outcomes were the number of migraine attacks, headache days, headache frequency, and responder's rate. Placebo effects were assessed using five individual placebos for network meta-analysis, using mean differences to measure the relative effect of pair-wise comparisons between interventions. A total of 50 trials with 4880 subjects were included. Twenty-seven trials were evaluated for low risk of bias. The results of indirect comparisons show that sham rTMS and sham tDCS had optimal and similar effects in reducing migraine days; sham acupuncture has the greatest effect on reducing the number of migraine attacks and relieving headache frequency; sham rTMS had a highly significant advantage in reducing headache days compared with the other placebo controls. Based on the network meta-analysis results, we found that sham acupuncture had the greatest effect on migraine prophylaxis. The strong placebo effect of sham acupuncture should be considered when assessing the therapeutic effect.

Long-term outcomes of cardioneuroablation with and without extra-cardiac vagal stimulation confirmation in severe cardioinhibitory neurocardiogenic syncope.

Cardioneuroablation (CNA) is a novel therapeutic approach for functional bradyarrhythmias, specifically neurocardiogenic syncope or atrial fibrillation, achieved through endocardial radiofrequency catheter ablation of vagal innervation, obviating the need for pacemaker implantation. Originating in the nineties, the first series of CNA procedures was published in 2005. Extra-cardiac vagal stimulation (ECVS) is employed as a direct method for stepwise denervation control during CNA. This study aimed to compare the long-term follow-up outcomes of patients with severe cardioinhibitory syncope undergoing CNA with and without denervation confirmation via ECVS. A cohort of 48 patients, predominantly female (56.3%), suffering from recurrent syncope (5.1 ± 2.5 episodes annually) that remained unresponsive to clinical and pharmacological interventions, underwent CNA, divided into two groups: ECVS and NoECVS, consisting of 34 and 14 cases, respectively. ECVS procedures were conducted with and without atrial pacing. Demographic characteristics, left atrial size, and ejection fraction displayed no statistically significant differences between the groups. Follow-up duration was comparable, with 29.1 ± 15 months for the ECVS group and 31.9 ± 20 months for the NoECVS group (p = .24). Notably, syncope recurrence was significantly lower in the ECVS group (two cases vs. four cases, Log Rank p = .04). Moreover, the Hazard ratio revealed a fivefold higher risk of syncope recurrence in the NoECVS group. This study demonstrates that concluding CNA with denervation confirmation via ECVS yields a higher success rate and a substantially reduced risk of syncope recurrence compared to procedures without ECVS confirmation.

Vagus nerve stimulation: Potential for treating chronic wounds.

Vagus nerve stimulation (VNS) has been approved as a treatment for various conditions, including drug-resistant epilepsy, migraines, chronic cluster headaches and treatment-resistant depression. It is known to have anti-inflammatory, anti-nociceptive and anti-adrenergic effects, and its therapeutic potential for diverse pathologies is being investigated. VNS can be achieved through invasive (iVNS) or non-invasive (niVNS) means, targeting different branches of the vagus nerve. iVNS devices require surgical implantation and have associated risks, while niVNS devices are generally better tolerated and have a better safety profile. Studies have shown that both iVNS and niVNS can reduce inflammation and pain perception in patients with acute and chronic conditions. VNS devices, such as the VNS Therapy System and MicroTransponder Vivistim, have received Food and Drug Administration approval for specific indications. Other niVNS devices, like NEMOS and gammaCore, have shown effectiveness in managing epilepsy, pain and migraines. VNS has also demonstrated potential in autoimmune disorders, such as rheumatoid arthritis and Crohn's disease, as well as neurological disorders like epilepsy and migraines. In addition, VNS has been explored in cardiovascular disorders, including post-operative atrial fibrillation and myocardial ischemia-reperfusion injury, and has shown positive outcomes. The mechanisms behind VNS's effects include the cholinergic anti-inflammatory pathway, modulation of cytokines and activation of specialised pro-resolving mediators. The modulation of inflammation by VNS presents a promising avenue for investigating its potential to improve the healing of chronic wounds. However, more research is needed to understand the specific mechanisms and optimise the use of VNS in wound healing. Ongoing clinical trials may support the use of this modality as an adjunct to improve healing.

Vagus nerve stimulation on epilepsy and depression

This review presents an overview of vagus nerve stimulation (VNS) utilization. The vagus nerve (VN) is among the most versatile and important nerves, with the capability to regulate a few bodily functions, and has been playing a vital role as part of therapies for a range of health concerns. VNS is an effective therapeutic method, which has gotten the approval of the Food and Drug Administration (FDA) of the United States. It is a type of neurostimulation method that plays a crucial part in drug-resistant depression and refractory epilepsy. It provides a surgical option for patients suffering from the conditions mentioned above, and is rather effective compared with other surgical approaches, thus improving patients life quality. Despite side effects, it is considered a decent therapeutic method and is currently used widely clinically. Furthermore, the mechanisms of VNS have not been completely understood. Therefore, further research is necessary, to discover the potential of VNS as an additional therapy for various other medical conditions.

Effect of dry dynamic apnea on aerobic power in elite rugby athletes: a warm-up method.

Objective: While long-term dynamic breath-holding training has been extensively studied to enhance cardiopulmonary function in athletes, limited research has explored the impact of a single breath-holding session on subsequent athletic capacity. In addition, Dry Dynamic Apnea (DA) has a more immediate physiological response than wet and static breath-holding. This study aims to assess the immediate effects of a single session of DA on the aerobic power and hematological parameters of elite athletes. Methods: Seventeen elite male rugby athletes (average age 23.5 ± 1.8) participated in this study. Two warm-up protocols were employed prior to incremental exercise: a standard warm-up (10min of no-load pedaling) and a DA warm-up (10min of no-load pedaling accompanied by six maximum capacity breath holds, with 30s between each breath hold). Fingertip blood indicators were measured before and after warm-up. The incremental exercise test assessed aerobic parameters with self-regulation applied throughout the study. Results: Compared to the baseline warm-up, the DA warm-up resulted in a significant increase in VO2peak from 3.14 to 3.38L/min (7.64% change, p < 0.05). HRmax increased from 170 to 183 bpm (7.34% change, p < 0.05), and HRpeak increased from 169 to 182 bpm (7.52% change, p < 0.05). Hematocrit and hemoglobin showed differential changes between the two warm-up methods (PHematocrit = 0.674; Phemoglobin = 0.707). Conclusion: This study investigates how DA influences physiological factors such as spleen contraction, oxygen uptake, and sympathetic nerve activation compared to traditional warm-up methods. Immediate improvements in aerobic power suggest reduced vagus nerve stimulation, heightened sympathetic activity, and alterations in respiratory metabolism induced by the voluntarily hypoxia-triggered warm-up. Further research is warranted to comprehensively understand these physiological responses and optimize warm-up strategies for elite athletic performance.

Effectiveness of transcutaneous vagus nerve stimulation (tVNS) on salicylate-induced tinnitus

IntroductionTinnitus is the most common symptom of auditory system disorders. It affects the quality of life of millions of people, but it is still incurable in most cases. Vagus nerve stimulation (VNS) therapy is a potential new treatment for subjective tinnitus. In this study, transcutaneous vagus nerve stimulation (tVNS) combined with tones was utilized to treat salicylate-induced tinnitus since salicylate is a reliable and convenient approach for rapidly inducing tinnitus. MethodsWistar rats were divided into acoustic stimulation alone (AS, n = 6), tVNS alone (n = 6), and tVNS with AS (n = 6) groups for behavioral and electrophysiological tests. They were assessed by auditory brainstem response (ABR), prepulse inhibition (PPI), gap prepulse inhibition of the acoustic startle (GPIAS), social interactions, and aggressive behavior tests at baseline and seven days’ post-salicylate (175 mg/kg, twice a day) injection. ResultsThe inhibition percentage of the GPIAS test was significantly reduced post-salicylate injection in the tVNS and AS alone groups, while it was not significant in the tVNS with AS group. There was no significant difference in the mean percentage of the GPIAS test between the tVNS groups (with or without AS) after salicylate injections. Social interactions were significantly different in the AS alone group pre- and post-salicylate injections, but they were not significant in other groups. Moreover, the results of aggressive behavior tests showed significantly increased post-salicylate injections in the AS alone group, while they were not significant in the tVNS groups (with or without AS). ConclusionsThe current study revealed that the application of tVNS alone produced improved social interaction and mood and alleviated salicylate-induced tinnitus severity. Moreover, combining tVNS with acoustic stimulation can prevent salicylate-induced tinnitus.

Efficacy of vagus nerve stimulation for children with drug-resistant epilepsy: Retrospective study

IntroductionAccording to current investigations, there are controversy in our knowledge regarding the safety and efficacy of Vagus Nerve Stimulation (VNS) in children younger than 12 years old. Therefore, we performed this study and aimed to better evaluate the safety and efficacy of VNS in children younger than 12 years. MethodThe retrospective study comprised two groups. In the first group, patients (N = 19) underwent VNS implantation procedure and second group, (N = 21) received no VNS implantation. The main study parameters are as follows: (1) Primary outcome evaluated the proportion of cases with >50 % reduction of seizures at the last follow-up. (2) Changes in patients’ status in VNS group after procedure compared to before procedure. (3) Patient's complaints in VNS group compared to control group. ResultsOur results demonstrated that there was a significant reduction in the frequency of seizures (per month) in patients 6 months after VNS surgery compared to before VNS surgery (1044.3 ± 1526.7 VS 220.7 ± 421.6; P value = 0.028). 57.9 % of patients underwent VNS showed the response rate of 50 % reduction in seizure frequency. There was significant improvement in memory problem, work/ school limitation, social limitation, and tachycardia 6 months after VNS procedure compared to before VNS procedure in patients. The most common reported side effects were difficulty swallowing (31.5 %) and coughing (31.5 %) followed by stomach discomfort (15.8 %). ConclusionConsidering the significant reduction in the frequency of seizures and improvement of life aspects including in memory problem, work/ school limitation, social limitation, we recommend VNS as an effective treatment modality for drug-resistant epilepsy in children. However, the combination of VNS with other treatment modalities that could improve other aspects of quality such as energy levels, sleep pattern, and feeling management of life is recommended.

Effect of non-invasive transcutaneous auricular vagus nerve stimulation on cerebral motor excitability-Study protocol for a randomized, sham controlled trial.

www.drks.de, number: DRKS00029937.

Personalized inference for neurostimulation with meta-learning: a case study of vagus nerve stimulation.

Objective. Neurostimulation is emerging as treatment for several diseases of the brain and peripheral organs. Due to variability arising from placement of stimulation devices, underlying neuroanatomy and physiological responses to stimulation, it is essential that neurostimulation protocols are personalized to maximize efficacy and safety. Building such personalized protocols would benefit from accumulated information in increasingly large datasets of other individuals' responses.Approach. To address that need, we propose a meta-learning family of algorithms to conduct few-shot optimization of key fitting parameters of physiological and neural responses in new individuals. While our method is agnostic to neurostimulation setting, here we demonstrate its effectiveness on the problem of physiological modeling of fiber recruitment during vagus nerve stimulation (VNS). Using data from acute VNS experiments, the mapping between amplitudes of stimulus-evoked compound action potentials (eCAPs) and physiological responses, such as heart rate and breathing interval modulation, is inferred.Main results. Using additional synthetic data sets to complement experimental results, we demonstrate that our meta-learning framework is capable of directly modeling the physiology-eCAP relationship for individual subjects with much fewer individually queried data points than standard methods.Significance. Our meta-learning framework is general and can be adapted to many input-response neurostimulation mapping problems. Moreover, this method leverages information from growing data sets of past patients, as a treatment is deployed. It can also be combined with several model types, including regression, Gaussian processes with Bayesian optimization, and beyond.

The Vagus Nerve Regulates Immunometabolic Homeostasis in the Ovine Fetus near Term: The Impact on Terminal Ileum.

Glucosensing elements are widely distributed throughout the body and relay information about circulating glucose levels to the brain via the vagus nerve. However, while anatomical wiring has been established, little is known about the physiological role of the vagus nerve in glucosensing. The contribution of the vagus nerve to inflammation in the fetus is poorly understood. Increased glucose levels and inflammation act synergistically when causing organ injury, but their interplay remains incompletely understood. We hypothesized that vagotomy (Vx) will trigger a rise in systemic glucose levels and this will be enhanced during systemic and organ-specific inflammation. Efferent vagus nerve stimulation (VNS) should reverse this phenotype. Near-term fetal sheep (n = 57) were surgically prepared using vascular catheters and ECG electrodes as the control and treatment groups (lipopolysaccharide (LPS), Vx + LPS, Vx + LPS + selective efferent VNS). The experiment was started 72 h postoperatively to allow for post-surgical recovery. Inflammation was induced with LPS bolus intravenously (LPS group, 400 ng/fetus/day for 2 days; n = 23). For the Vx + LPS group (n = 11), a bilateral cervical vagotomy was performed during surgery; of these n = 5 received double the LPS dose, LPS800. The Vx + LPS + efferent VNS group (n = 8) received cervical VNS probes bilaterally distal from Vx in eight animals. Efferent VNS was administered for 20 min on days 1 and 2 +/10 min around the LPS bolus. Fetal arterial blood samples were drawn on each postoperative day of recovery (-72 h, -48 h, and -24 h) as well as at the baseline and seven selected time points (3-54 h) to profile inflammation (ELISA IL-6, pg/mL), insulin (ELISA), blood gas, and metabolism (glucose). At 54 h post-LPS, a necropsy was performed, and the terminal ileum macrophages' CD11c (M1 phenotype) immunofluorescence was quantified to detect inflammation. The results are reported for p < 0.05 and for Spearman R2 > 0.1. The results are presented as the median (IQR). Across the treatment groups, blood gas and cardiovascular changes indicated mild septicemia. At 3 h in the LPS group, IL-6 peaked. That peak was decreased in the Vx + LPS400 group and doubled in the Vx + LPS800 group. The efferent VNS sped up the reduction in the inflammatory response profile over 54 h. The M1 macrophage activity was increased in the LPS and Vx + LPS800 groups only. The glucose and insulin concentrations in the Vx + LPS group were, respectively, 1.3-fold (throughout the experiment) and 2.3-fold higher vs. control (at 3 h). The efferent VNS normalized the glucose concentrations. The complete withdrawal of vagal innervation resulted in a 72-h delayed onset of a sustained increase in glucose for at least 54 h and intermittent hyperinsulinemia. Under the conditions of moderate fetal inflammation, this was related to higher levels of gut inflammation. The efferent VNS reduced the systemic inflammatory response as well as restored both the concentrations of glucose and the degree of terminal ileum inflammation, but not the insulin concentrations. Supporting our hypothesis, these findings revealed a novel regulatory, hormetic, role of the vagus nerve in the immunometabolic response to endotoxin in near-term fetuses.

Stress-induced vagal activity influences anxiety-relevant prefrontal and amygdala neuronal oscillations in male mice

The vagus nerve crucially affects emotions and psychiatric disorders. However, the detailed neurophysiological dynamics of the vagus nerve in response to emotions and its associated pathological changes remain unclear. In this study, we demonstrated that the spike rates of the cervical vagus nerve change depending on anxiety behavior in an elevated plus maze test, and these changes were eradicated in stress-susceptible male mice. Furthermore, instantaneous spike rates of the vagus nerve were negatively and positively correlated with the power of 2–4 Hz and 20–30 Hz oscillations, respectively, in the prefrontal cortex and amygdala. The oscillations also underwent dynamic changes depending on the behavioral state in the elevated plus maze, and these changes were no longer observed in stress-susceptible and vagotomized mice. Chronic vagus nerve stimulation restored behavior-relevant neuronal oscillations with the recovery of altered behavioral states in stress-susceptible mice. These results suggested that physiological vagal-brain communication underlies anxiety and mood disorders.

Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample.

Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy and investigate the outcomes associated with these procedural trends in the United States. Using the National Inpatient Sample database from 2010 to 2020, patients with drug-resistant focal epilepsy who underwent laser interstitial thermal therapy (LITT), open surgical resection, vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) were identified. Trend analysis was performed using piecewise joinpoint regression. Propensity score matching was used to compare outcomes between 10 years prepandemic before 2020 and the first peak of the COVID-19 pandemic. This study analyzed a total of 33 969 patients with a diagnosis of drug-resistant epilepsy, with 3343 patients receiving surgical resection (78%), VNS (8.21%), RNS (8%), and LITT (6%). Between 2010 and 2020, there was an increase in the use of invasive electroencephalography monitoring for seizure zone localization (P = .003). There was an increase in the use of LITT and RNS (P < .001), while the use of surgical resection and VNS decreased over time (P < .001). Most of these patients (89%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (11%) underwent treatment during the COVID pandemic (2020). After propensity score matching, the rate of pulmonary complications, postprocedural hematoma formation, and mortality were slightly higher during the pandemic compared with the prepandemic period (P = .045, P = .033, and P = .026, respectively). This study indicates a relative decrease in the use of surgical resections, as a treatment for drug-resistant focal epilepsy. By contrast, newer, minimally invasive surgical approaches including LITT and RNS showed gradual increases in usage.

Current status and prospect of transcutaneous auricular vagus nerve stimulation for disorders of consciousness.

Disordered Consciousness (DOC) is among neurological disorders for which there is currently no admitted treatment. The pathogenesis of DOC is still unclear, covering a variety of indistinguishable types of diseases, high misdiagnosis rate and poor prognosis. Most treatments remain to be clarified in the future to provide adequate evidence for clinical guidance. Neuromodulation technology aims to regulate neural circuits to promote awakening more directly. At present, it is confirmed that the potential of transcutaneous auricular vagus nerve stimulation (taVNS) as a therapeutic tool is worth exploring in the context of consciousness disorders, as previously proposed for invasive forms of VNS, in which the means of stimulating the vagus nerve to change the brain areas related to cosciousness have also received widespread attention. In this paper, we review the literature on taVNS and DOC to better understand the current status and development prospect of taVNS treament as a non-invasive neuromodulation method with sensitivity and/or specificity at the single subject.

Gut-targeted therapies for type 2 diabetes mellitus: A review.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance. The global prevalence of T2DM has reached epidemic proportions, affecting approximately 463 million adults worldwide in 2019. Current treatments for T2DM include lifestyle modifications, oral antidiabetic agents, and insulin therapy. However, these therapies may carry side effects and fail to achieve optimal glycemic control in some patients. Therefore, there is a growing interest in the role of gut microbiota and more gut-targeted therapies in the management of T2DM. The gut microbiota, which refers to the community of microorganisms that inhabit the human gut, has been shown to play a crucial role in the regulation of glucose metabolism and insulin sensitivity. Alterations in gut microbiota composition and diversity have been observed in T2DM patients, with a reduction in beneficial bacteria and an increase in pathogenic bacteria. This dysbiosis may contribute to the pathogenesis of the disease by promoting inflammation and impairing gut barrier function. Several gut-targeted therapies have been developed to modulate the gut microbiota and improve glycemic control in T2DM. One potential approach is the use of probiotics, which are live microorganisms that confer health benefits to the host when administered in adequate amounts. Several randomized controlled trials have demonstrated that certain probiotics, such as Lactobacillus and Bifidobacterium species, can improve glycemic control and insulin sensitivity in T2DM patients. Mechanisms may include the production of short-chain fatty acids, the improvement of gut barrier function, and the reduction of inflammation. Another gut-targeted therapy is fecal microbiota transplantation (FMT), which involves the transfer of fecal material from a healthy donor to a recipient. FMT has been used successfully in the treatment of Clostridioides difficile infection and is now being investigated as a potential therapy for T2DM. A recent randomized controlled trial showed that FMT from lean donors improved glucose metabolism and insulin sensitivity in T2DM patients with obesity. However, FMT carries potential risks, including transmission of infectious agents and alterations in the recipient's gut microbiota that may be undesirable. In addition to probiotics and FMT, other gut-targeted therapies are being investigated for the management of T2DM, such as prebiotics, synbiotics, and postbiotics. Prebiotics are dietary fibers that promote the growth of beneficial gut bacteria, while synbiotics combine probiotics and prebiotics. Postbiotics refer to the metabolic products of probiotics that may have beneficial effects on the host. The NIH SPARC program, or the Stimulating Peripheral Activity to Relieve Conditions, is a research initiative aimed at developing new therapies for a variety of health conditions, including T2DM. The SPARC program focuses on using electrical stimulation to activate peripheral nerves and organs, in order to regulate glucose levels in the body. The goal of this approach is to develop targeted, non-invasive therapies that can help patients better manage their diabetes. One promising area of research within the SPARC program is the use of electrical stimulation to activate the vagus nerve, which plays an important role in regulating glucose metabolism. Studies have shown that vagus nerve stimulation can improve insulin sensitivity and lower blood glucose levels in patients with T2DM. Gut-targeted therapies, such as probiotics and FMT, have shown potential for improving glycemic control and insulin sensitivity in T2DM patients. However, further research is needed to determine the optimal dose, duration, and safety of these therapies.

Youtube as a source of information vagal nerve stimulation: A quality analysis

PurposeTo evaluate the quality of available information on Youtube videos about VNS as a “source of health information” for patients with drug resistant epilepsy. MethodsYoutube videos were searched and screened using the terms “VNS for seizures,” and “VNS surgery,” “VNS epilepsy” in May 2023. The quality of the videos was evaluated the Quality Criteria for Consumer Health Information (DISCERN) and Global Quality Scale (GQS). The videos were analyzed in terms of content, accuracy, reliability, and quality. ResultsA total of 104 videos were searched. After excluding duplicate or inappropriate videos, 51 videos were analyzed. Youtube videos about vagal nerve stimulation are mostly on general information, surgical procedures, patient experiences and magnet use. When video sources are examined according to the quality, according to GQS, 75 % of high quality videos were narrated by physicians, all intermediate quality videos were narrated by physicians, and low quality ones narrated by physicians were 47.4 % and 28.9 % by the patients. All of the videos narrated by the patients were of low quality. There was a significant and strong correlation between GQS and Discern score (r = 0.807, p < 0.001). Only GQS scores of videos with different content were found to be statistically significant (p < 0.05). Two pediatric neurologists independently reviewed the videos and classified the videos as useful or misleading according to the GQS, DISCERN scala. The overall κ value for interobserver consistency according to Global Quality Scale was 0.781 (p < 0.001). (95 % confidence interval), indicating a very good level of agreement. ConclusionYoutube videos may provide a worthful source for patients and parents seeking to find more information about VNS However incorrect information could easily be disseminated by high number of views of videos with low quality. High skilled and experienced professionals should create videos on Youtube to ensure that patients and parents can access more useful, high-quality, and accurate information on VNS.