Transcutaneous auricular vagus nerve stimulation would be an alternative to implantable cervical vagus nerve stimulation in some situation

Implantable cervical vagus nerve stimulation(i VNS) is a representative and promising neuromodulation.However,the invasive nature restricts its application.Traditional auricular acupuncture treatment has a long history.The auricular branch of the vagus nerve(ABVN) is a branch on the surface of the ear.Some studies demonstrates that transcutaneous auricular vagus nerve stimulation(ta VNS) would achieve similar effects as i VNS.Ta VNS and i VNS share a common anatomical basis and acting mechanism.In this article,we made a comparison between i VNS and ta VNS in indications and efficacy.The recent studies have revealed similar clinical efficacy of ta VNS,ta VNS would expand the indication of i VNS.Highquality clinical evidences are needed before ta VNS become be an alternative of i VNS.

Transcutaneous Auricular Vagus Nerve Stimulation: From Concept to Application

Whether in the West or the East,the connection between the ear and the rest of the body has been explored for a long time.Especially in the past century or more,the relevant theoretical and applied research on the ear has greatly promoted the development of ear therapy,and finally the concept of transcutaneous auricular vagus nerve stimulation(taVNS)has been proposed.The purpose of taVNS is to treat a disease non-invasively by applying electrical current to the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear.In the past two decades,taVNS has been a topic of basic,clinical,and transformation research.It has been applied as an alternative to drug treatment for a variety of diseases.Based on the rapid understanding of the application of taVNS to human health and disease,some limitations in the development of this field have also been gradually exposed.Here,we comprehensively review the origin and research status of the field.

Effect and mechanism study on transcutaneous auricular vagus nerve stimulation for functional dyspepsia model rats

Objective:To explore the effect and its possible mechanism of the intervention of transcutaneous auricular vagus nerve stimulation(taVNS)for the functional dyspepsia(FD)model rats.Methods:Of the 25 male SD rats,6 rats were set as blank group,the other 19 rats were established to be the functional dyspepsia(FD)model by iodoacetamide intragastric administration,and 18 FD models were successfully established.The 18 model rats were randomly divided into a model group,a shamtaVNS group,and taVNS group,with 6 rats in each group.There was no intervention applied to the rats in the blank and model groups.Whereas,the rats in sham-taVNS group received stimulation to the rim of auricular concha of both sides,and those in taVNS group received stimulation to the cavity of auricular concha of both sides,for 30 min each time,once a day,7 days in succession.After the intervention,the gastric sensitivity of the rats in each group under different pressure conditions in the stomach,the expressions of serum brain-gut peptide motilin(MTL),cholecystokinin(CCK),glucagon-likepeptidel(GLP-1),and inflammatory factors IL-4,IL-10,and IL-1βwere detected.Results:(1)Gastric sensitivity:compared with the blank group,the gastric sensitivity of the model group was higher(P<0.05).Compared with the model group,the gastric sensitivity of the taVNS group was lower(P<0.05).Compared with the sham-taVNS group,the gastric sensitivity of the taVNS group was lower(P<0.05).(2)Expression of brain-gut peptide:compared with the blank group,MTL was lower,CCK and GLP-1 were higher in the model group(all P<0.05).Compared with the model group,MTL was higher,CCK and GLP-1 were lower in the taVNS group(all P<0.05).Compared with the shamtaVNS group,CCK and GLP-1 were lower in the taVNS group(both P<0.05).(3)Expression of inflammatory factors:compared with the blank group,IL-4 and IL-10 were lower and was higher in the model group(all P<0.05).Compared with the model group,IL-10 was higher and IL-1βwas lower in the shamtaVNS group(all P<0.05),while IL-4 and IL-10 were higher and IL-1βwas lower in the taVNS group(all P<0.05).Compared with the sham-taVNS group,IL-4 and IL-10 were higher and IL-1βwas lower in the taVNS group(all P<0.05).Conclusion:TaVNS can reduce the gastric sensitivity of FD model rats by peripheral anti-inflammatory action and regulating the abnormal secretion of brain-gut peptide.

Effect of transcutaneous auricular vagus nerve stimulation on fasting blood glucose and serum insulin concentration in Zucker diabetes fatty rats

Objective:To observe the influence of transcutaneous auricular vagus nerve stimulation(taVNS) on fasting plasma glucose(FPG) and serum insulin(INS) in Zucker diabetes fatty(ZDF) rats and explore the regulatory effect of taVNS on blood glucose in ZDF rats.Methods:A total of 20 male ZDF rats were randomized into a model group and a taVNS group,10 rats in each one.Besides,the other 10 Zucker Lean(ZL) rats were selected to be a control group.The rats in the control group were fed with common forage and those in the model group and the taVNS group were fed with high-sugar and high-fat forage.The intervention of electric stimulation was applied in the rats of taVNS group,with 2/15 Hz in frequency,disperse-dense wave and 2 mA in intensity.Each intervention lasted 30 min,once a day,consecutively for 12 weeks.No any intervention was given in the control group and the model group.The body mass and FPG level were recorded once every 2 weeks in the rats.After the experiment,the rats were sacrificed and blood sample was collected.Enzyme linked immunosorbent assay(ELISA) was adopted to determine the level of serum INS in the rats.Results:After the modeling,compared with the control group,the body mass and FPG level were all higher(P <0.05,P <0.01) and the concentration of serum INS was lower(P <0.01) in the rats of the model group.After intervention,compared with the model group,the body mass was lower in week 6 to 10(P <0.01,P <0.05),FPG level was lower in week 8 to 12(P <0.01,P <0.05) and serum INS concentration was higher(P <0.01) in the rats of the taVNS group.Conclusion:TaVNS apparently improves in hyperglycemia in ZDF rats and increases serum insulin concentration in the rats.

Transcutaneous auricular vagus nerve stimulation for functional dyspepsia:A randomized controlled trial

Objectives:To observe the clinical long-term therapeutic effect on functional dyspepsia(FD) in the comparative study of transcutaneous auricular vagus nerve stimulation(taVNS) with transcutaneous auricular none-vagus nerve stimulation(tnVNS).Methods:A total of 90 FD patients were randomized into a taVNS group and a tnVNS group,45 cases in each one.The patients in both the taNVS group and the tnVNS group were treated 5 times a week,30 min each time,for 4 weeks totally.Before treatment,after treatment and in follow-up visit,overall symptom points,functional dyspepsia-related quality of life questionnaire(FDQOL),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD) and self-rating depression scale(SDS) were adopted to evaluate the severity of the symptoms and observe the clinical therapeutic effect of patients.Results:Compared with the scores before treatment,the overall symptom points,FDDQL,HAMA,HAMD and SDS at each time point after treatment were all lower in the patients of the taVNS group.The scores of FDDQL after treatment were almost all higher than that before treatment in the self-comparison of each group.All of the above differences were significant statistically(all P <0.05).Compared with the tnVNS group,the overall symptom points,FDDQL, HAMA,HAMD and SDS at each time point after treatment were all lower in the taVNS group and the score of FDDQL was higher,indicating the statistical differences(all P<0.05).Conclusion:Transcutaneous auricular vagus nerve stimulation is applicable for the treatment of functional dyspepsia.Compared with the control group,taVNS obtains a better long-term effect.

Transcutaneous auricular vagus nerve stimulation for impaired glucose tolerance:a randomized controlled trial Protocol

Background:impaired glucose tolerance(IGT)is the early stage of diabetes and it would be deteriorated to type 2 diabetes mellitus(T2 DM)easily if no intervention provided.In western medicine,drug therapy assisted with the intervention of lifestyle is predominated.However,drug therapy brings serious side effect and high prices,while lifestyle intervention is difficult to be insisted on by patients.Therefore,a green and effective intervention mode is urgently needed.Transcutaneous auricular vagus nerve stimulation(taVNS)is a noninvasive and green therapeutic method based on the theory of traditional Chinese medicine(TCM),which can regulate glucose metabolism and reduce blood glucose,but the clinical effect of it has not been clarified yet at present.Hence,this randomized controlled trial(RCT)aims at exploring the effectiveness and safety of taVNS in the treatment of IGT.Methods:a total of 158 patients with IGT will be randomized into a taVNS group and a transcutaneous non-auricular vagus nerve stimulation(tnVNS)group,79 cases in each one.In the taVNS group and the tnVNS group,electric stimulation would be applied to Yidan(胰胆pancreas and gallbladder,CO11)and Pi(脾spleen,CO13)on auricular concha and Jian(肩shoulder SF4,5)on auricular rim respectively.The electric stimulation parameters would be the same in the patients of two groups,for 30 min in each treatment,twice a day,6 weeks as one course and 2 courses of treatment required totally.In week 0,6 and 12 of intervention,the effectiveness indicators would be determined,i.e.fasting plasma glucose(FPG),2 h plasma glucose(2 hPG)and glycosylated hemoglobin(HbA1c)successively.On week 0 and 12,body mass index(BMI)would be calculated,respiration,pulse and blood pressure would be recorded separately.Discussion:through observing the regulatory effect of taVNS on FPG,2 hPG,HbAlc and BMI as well as the adverse reactions,the effectiveness and safety of taVNS in treatment of IGT would be evaluated.This study will provide a safe,effective,convenient and nontoxic side effect intervention for clinical treatment of IGT and prevention from the occurrence and development of T2DM.

Effects of transcutaneous auricular vagus nerve stimulation on intestinal ligandins in a rat model of functional dyspepsia

Objective:Transcutaneous auricular vagus nerve stimulation(taVNS) can relieve the symptoms of functional dyspepsia(FD) and improve the quality of life of patients,however,the mechanism underlying this effect remains unclear.Therefore,this study aimed to investigate the effects of taVNS on the expression of intestinal mucosal ligandins.Methods:This study was conducted on 24 specific Spathogen-free Sprague-Dawley rats(12 males and12 females).The rat model of FD was established by tail-clip stimulation.After FD was established successfully,all rats were randomized to either the normal group(n=6),model group(n=6),taVNS group(n=6),or sham-taVNS group(n=6).After two weeks of the respective intervention,the score of their general conditions,3 h food intake,gastric emptying rate,and the histology of gastric antrum tissues were observed to evaluate modeling success,and then the effect of taVNS was evaluated.Western blotting was used to assess the expression of the tight junction ligandins-ZO-1 and occludin-and the adhesion ligandin-β-catenin-in the duodenum.The effect of taVNs on the expression of intestinal mucosal barrier ligandins-ZO-1,occludin,and β-catenin-in FD rats was preliminarily investigated.Results:When the model-induced period was finished,the manifestations of FD in the model group rats were mental exhaustion,reduced activities,decreased score of the general conditions,and decreased3 h food intake,compared to the normal group rats.In addition,minimal eosinophil infiltration,without any mucosal erosion or ulcer,was observed in the gastric antrum mucosa.At the end of the study,the mental state of the FD rats improved,and their activities and gastric emptying rate increased in the taVNS group rats.Compared to the normal rats,the duodenal mucosa had less expression of the tight junction ligandins ZO-1 and occludin,but β-catenin expression remained unchangedin the model rats.The expression of the tight junction ligandins ZO-1 and occludin were increased in the duodenal mucosa of model rats after the taVNS intervention.Conclusion:TaVNS can improve the gastric motility and mental state of rats with FD.It may play a therapeutic role by improving the expression of the tight junction ligandin ZO-1 and occludin in the duodenal mucosa,while also repairing the duodenal mucosal barrier.

Preliminary single-arm study of brain effects during transcutaneous auricular vagus nerve stimulation treatment of recurrent depression by resting-state functional magnetic resonance imaging

OBJECTIVE:To examine the brain effects of transcutaneous auricular vagus nerve stimulation(ta VNS)treatment of recurrent depression based on the functional brain network by using resting-state functional magnetic resonance imaging(f MRI).METHODS:Twenty-five patients with recurrent depression were enrolled in a single-arm trial of ta VNS treatment for eight weeks.Clinical results were assessed by 17-item Hamilton Depression Rating Scale(HAMD-17),Hamilton Anxiety Scale(HAMA),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),and Ruminative Response Scale(RRS)scales.Resting-state f MRI was conducted to explore the brain effects before and after treatment.For the functional connectivity(FC)analysis,the bilateral nucleus accumbens,globus pallidus,caudate,and putamen were selected as seeds.Finally,the correlations between FC and the clinical scale scores were calculated.RESULTS:After treatment,the patients’scores of HAMD-17,HAMA,SDS,SAS,and RRS were significantly decreased(P<0.05).FC was considerably decreased between the following areas:the left globus pallidus and the right postcentral gyrus,inferior parietal gyrus,the right globus pallidus and the left superior marginal gyrus,postcentral gyrus,superior parietal gyrus,inferior parietal gyrus,precuneus,right postcentral gyrus,superior marginal gyrus,and inferior parietal gyrus,between the right caudate and the right lingual gyrus,calcarine gyrus,and cerebellum.Changes in FC between the right globus pallidus and the left inferior parietal gyrus,between the left globus pallidus and the right postcentral gyrus were negatively correlated with HAMD-17 scores change before and after treatment(before,P=0.003,r=-0.6;after,P=0.009,r=-0.54).The change of FC between the right globus pallidus and the right postcentral gyrus was negatively correlated with the change in SDS(P=0.026,r=-0.474).The difference in FC between the right globus pallidus and the right postcentral gyrus was negatively correlated with the change in SAS(P=0.016,r=-0.513).CONCLUSIONS:Recurrent depression could be effectively treated with ta VNS.The changes in brain FC involving the basal ganglia,default mode,and sensorimotor networks provide insight into the effects of ta VNS treatment on recurrent depression.

Efficacy and brain mechanism of transcutaneous auricular vagus nerve stimulation for adolescents with mild to moderate depression:Study protocol for a randomized controlled trial

Background Depression is a common mental illness in childhood and adolescence,with an incidence of 4%–5%;it can lead to impairments in learning and social functioning.Transcutaneous auricular vagus nerve stimulation(taVNS)is a commonly used method of auricular acupuncture point stimulation,which is regarded as an effective treatment for adults with depression.The aim of this study was to investigate the efficacy and mechanism of taVNS for adolescents with mild to moderate depression.Methods This randomized controlled clinical trial will include 120 patients aged 12–16 years,all of whom are diagnosed with mild to moderate depression.Patients will be randomly assigned to a taVNS group and a drug control group(sertraline hydrochloride)at a ratio of 1:1.Patients will be evaluated using the 17‐item Hamilton Depression Scale,Hamilton Anxiety Rating Scale,Self‐Rating Depression Scale,Self‐Rating Anxiety Scale,and Pittsburgh Sleep Quality Index scores at baseline,as well as at the 2nd,4th,6th,8th,and 12th weeks.To investigate the underlying neural mechanisms of taVNS treatment from the perspective of the default mode network,multimodal magnetic resonance imaging(MRI;i.e.,structural MRI[sMRI],resting state MRI[rsMRI],and pseudocontinuous arterial spin‐labeled[pcASL]MRI)will be used to compare cerebral images among groups.MRI data will also be collected from 40 healthy volunteers to assess whether the participants exhibit normal development of structural and functional components.Discussion Depression is the most common mental disorder in adolescence.Drug treatment can improve depression symptoms;however,the side effects of drug treatments are often severe.This study proposes a simple physiotherapy that aims to treat adolescents with mild to moderate depression.The mechanism of taVNS in the treatment of depression will also be investigated.The results of this study will provide evidence to guide the application of taVNS in adolescents with depression.

The Anticonvulsant Effect of Transcutaneous Auricular Vagus Nerve Stimulation is Associated with Balancing the Autonomic Dysfunction in Rats

Objective:The present study aims to investigate whether the anticonvulsant effect of transcutaneous auricular vagus nerve stimulation is associated with balancing the autonomic dysfunction in rats.Methods:Healthy adult male Sprague-Dawley rats were anesthetized with an intraperitoneal injection of 10% urethane.Seizures were evoked by intraperitoneal injection of pentylenetetrazol(PTZ,60 mg/kg).Femoral vein catheterization was performed for injection of sympathetic agonist and antagonists.Bipolar globe silver electrodes were utilized for epidural EEG recording.Three needles were inserted separately in subcutaneous muscles of left anterior limb,right anterior limb,and left hind limb to record ECG signals.ta-VNS was performed at auricular concha.Results:In comparison with preictal state,the mean heart rate(HR) increased slightly during epileptic seizures(P<0.05).In comparison with ictal state,the mean HR decreased a little at postictal state(P<0.05).When continuous epileptic seizures in EEG traces occurred(in ictal state),vein injection of propranolol hydrochloride(sympathetic antagonist) suppressed the epileptic seizures.When epileptic seizures occurred rarely(in postictal state),vein injection of adrenaline hydrochloride(sympathetic agonist) exacerbated the epileptic seizures.In comparison with prestimulation,the integral of EEG traces after ta-VNS decreased(P<0.05),the mean HR decreased(P<0.05),and the high power(HF) of HRV increased(P<0.05) after ta-VNS.Conclusion:The results showed that autonomic dysfunction occurred in epileptic rats characterized by enhanced sympathetic nerve activity.Epileptic seizures in EEG traces decreased,HR decreased and HF increased after ta-VNS,which indicated that ta-VNS may suppress epileptic seizures via balancing the autonomic dysfunction.

Transcutaneous auricular vague nerve stimulation improved brain connection activity on patients of disorders of consciousness: a pilot study

OBJECTIVE:To evaluate the clinical effect of transcutaneous auricular vagus nerve nerve stimulation(ta VNS)on disorders of consciousness(DOC)patients with Coma Recovery Scale-Revised(CRS-R)and cerebral cortex activity by electroencephalogram(EEG)detection.METHODS:Randomized controlled methods were used to evaluate the clinical effect of ta VNS on patients with DOC.Twelve patients with initial CRS-R of 6-10 were randomly divided into the treatment group of ta VNS and control group of transcutaneous non-auricular vague nerve stimulation(tn VNS).According to clinical diagnosis,the treatment group was divided into vegetative state(VS)group and minimally conscious state(MCS)group.RESULTS:The energy of delta and beta bands is positively correlated with the brain activity of patients.ta VNS has different regulatory effects on patients with different conscious States.In ta VNS group,the energy of delta band in local brain regions changed significantly.Significant changes in brain connection activity were limited to local brain regions.While in patients with MCS in the ta VNS group,delta and beta band energy significantly changed in multiple brain regions and crossbrain connection activity also changed significantly.CONCLUSION:These findings suggest that ta VNS may be a related extra method for arousing patients’awakening by improving brain connection activity.And the effect is remarkable in MCS patients.

耳迷走神经刺激对运动员赛前焦虑状态影响的研究

目的观察耳迷走神经刺激对赛前焦虑运动员心理状态与运动成绩的影响。方法2022年3月至2023年1月在成都体育学院达到二级跳远运动员标准的运动员55例,随机数字法分为治疗组29例和对照组26例,分别接受耳迷走神经刺激治疗和非迷走神经刺激治疗,比较两组治疗前后汉密尔顿焦虑量表(HAMA)得分、焦虑自评量表(SAS)得分、赛时最差、平均和最差优跳远成绩。结果耳迷走神经刺激治疗后,治疗组有效率高于对照组(P<0.05)。两组HAMA与SAS均较治疗前降低,且治疗组低于对照组(P<0.05),治疗组运动员比赛中的最低成绩与平均成绩均较治疗前提升,且治疗组优于对照组(P<0.05),两组最高成绩比较,差异无统计学意义(P>0.05)。结论耳迷走神经刺激能显著改善赛前焦虑跳远运动员的心理状态,改善其比赛中的竞技状态。

经皮耳迷走神经电刺激对缺血性卒中患者的康复疗效观察

目的探讨不同频率的经皮耳迷走神经电刺激(transcutaneous auricular vagus nerve stimulation,taVNS)结合康复运动对缺血性卒中患者康复疗效的影响。方法选取2023年6月—10月同济大学附属养志康复医院神经内科收治的80例缺血性脑卒中后伴上肢偏瘫患者,随机分为taVNS 0 Hz(n=20)、taVNS 30 Hz组(n=20)、taVNS 300 Hz组(n=20)、taVNS 3000 Hz(n=20)组,4组均接受常规康复训练,同时增加不同频率的taVNS刺激,根据患者耐受情况调整ta-VNS治疗强度,每次30 min,每日1次,连续治疗14 d。在假刺激组中,只夹电极但不给与刺激。分别记录治疗前、治疗30 d、治疗45 d后简式Fugl-Meyer(FMA)运动功能评分。结果治疗前4组FMA评分无显著差异(F=0.195,P=0.900);重复测量方差分析结果显示,治疗30 d及45 d后,4组FMA评分均较治疗前显著提高(P<0.001),同时taVNS 300 Hz组治疗45 d后的FMA评分最优(48.81±20.30);不同治疗方案在治疗30 d前后、治疗45 d前后FMA指标的差值均具有差异(P<0.001),其中taVNS 300 Hz组治疗45 d前后的FMA评分差值最大(9.81±1.69),具有临床意义。结论taVNS结合康复运动能促进缺血性卒中患者的运动功能康复,taVNS 300 Hz治疗组效果最优。

经皮耳甲迷走神经刺激治疗慢性意识障碍临床观察

目的 观察经皮耳甲迷走神经刺激(taVNS)治疗慢性意识障碍(pDoC)的临床效果。方法选取宝鸡第三医院2020-06—2022-12收治的68例pDoC患者,随机分成对照组与治疗组各34例。对照组接受常规促醒治疗,治疗组在对照组的基础上接受taVNS治疗,2组患者均治疗4周。对比2组患者格拉斯哥昏迷量表(GCS)评分、昏迷恢复量表(CRS-R)评分、全身无反应性量表(FOUR)评分、安全性及临床疗效。结果 治疗后,2组患者的GCS单项评分(睁眼、言语和运动)及总分、CRS-R单项评分(听觉、视觉、运动、言语、交流和唤醒)及总分和FOUR单项评分(眼部、运动、脑干和呼吸)及总分均升高(均P<0.05),且治疗组GCS单项评分(睁眼和言语)及总分、CRS-R单项评分(听觉、视觉、言语、交流和唤醒)及总分和FOUR单项评分(眼部和脑干)及总分优于对照组(均P<0.05),但2组患者的GCS单项评分(运动)、CRS-R单项评分(运动)和FOUR单项评分(运动和呼吸)评分比较不明显(均P>0.05)。2组患者均未发生不良事件。治疗组总有效率(79.41%)显著高于对照组(61.76%)(P<0.05)。结论 taVNS治疗pDoC有一定的疗效,可改善患者意识障碍程度,且安全可靠。

耳甲电针(taVNS)治疗轻度认知障碍研究进展

轻度认知障碍的治疗是老年健康需要解决的难题。基于中医“脑病耳治”理论的新型神经调控技术——耳甲电针(taVNS),可辅助治疗多种神经、精神系统疾病,近年研究发现其对轻度认知障碍有效。对目前国内外耳甲电针治疗轻度认知障碍的研究现状进行综述,探讨其疗效、机制,展示其研究成果,提出进一步研究方向。将为MCI非药物疗法提供可借鉴的新思路,为广大老年患者的认知功能改善和生活品质提高提供新技术。

耳穴压豆经皮耳迷走神经刺激治疗卒中后认知障碍临床研究

目的:观察耳穴压豆经皮耳迷走神经刺激(taVNS)对卒中后认知障碍(PSCI)患者认知功能的影响。方法:选取84例PSCI患者,按随机数字表法分为干预组、对照组各42例。2组均接受基础药物治疗及认知康复训练,干预组心耳穴、肾耳穴予耳穴贴压,肘耳穴、肩耳穴予假磁疗贴治疗;对照组肘耳穴、肩耳穴予耳穴贴压,心耳穴、肾耳穴予假磁疗贴治疗。2组疗程均为12周。比较2组治疗前后简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、改良Barthel指数(MBI)、神经精神问卷(NPI)评分的变化。结果:治疗后,2组MMSE、MoCA评分均较治疗前上升(P<0.05),干预组MMSE、MoCA评分均高于对照组(P<0.05)。治疗后,2组MBI评分均较治疗前上升(P<0.05),NPI-1、NPI-2评分均较治疗前下降(P<0.05);干预组MBI评分高于对照组,差异无统计学意义(P>0.05);干预组NPI-1、NPI-2评分均低于对照组(P<0.05)。结论:耳穴压豆taVNS可改善PSCI患者的全局认知功能及神经精神症状,降低照料者的苦恼程度。

经皮耳穴迷走神经电刺激治疗失眠障碍的研究现状

失眠障碍是一种以入睡困难或易醒、睡眠质量下降与睡眠时间减少为主要临床表现的睡眠障碍性疾病,其发病率高,严重影响患者的生活质量。中医学理论认为失眠多由机体阴阳失调、脏腑功能下降与营卫不和所致。经皮耳穴迷走神经电刺激是一种将低频脉冲电刺激作用于耳廓皮肤感受区的非侵入性神经调节技术,其机制主要与耳-迷走神经反射有关,刺激耳区局部能够调节机体神经递质和炎症反应,可以有效缓解患者的失眠症状。现通过查找和整理相关文献,从中医理论、西医机制、刺激部位、参数运用和临床应用等方面来总结经皮耳穴迷走神经电刺激治疗失眠障碍的研究现状,以期为今后相关研究提供思路,有助于推动非侵入性神经调控技术的发展。

经皮耳穴迷走神经电刺激治疗难治性及非难治性抑郁症的脑效应比较

目的:比较经皮耳穴迷走神经电刺激(taVNS)治疗难治性抑郁症(TRD)与非难治性抑郁症(nTRD)患者的脑功能效应机制。方法:纳入24例TRD(TRD组)与31例nTRD(nTRD组)患者,2组均行8周的taVNS治疗,治疗前后均行静息态fMRI扫描。采用17项汉密尔顿抑郁量表(HAMD-17)作为主要临床疗效指标,冗思量表(RRS)为次要临床疗效指标。采用混合效应分析比较2组治疗前后的低频振幅(ALFF)差异。结果:治疗后2组HAMD-17评分均显著下降,nTRD组RRS评分显著下降(均P<0.001)。fMRI结果显示,治疗前nTRD组在左侧丘脑/下丘脑/苍白球及右侧初级视觉皮质ALFF值均显著低于TRD组(均P<0.001)。治疗后,nTRD组左侧中央后回与右侧中央前回ALFF值显著升高(P<0.005,P<0.001),右侧岛叶ALFF值显著降低(P<0.001);TRD组左侧中央后回ALFF值显著升高(P<0.005),右侧岛叶ALFF值显著降低(P<0.001)。混合效应分析显示,左侧眶部额中回与右侧小脑Crus2是2组治疗前后的差异脑区(均P<0.005);nTRD组治疗后左侧眶部额中回与右侧小脑Crus2的ALFF值均显著降低(P<0.05,P<0.001),TRD组治疗后左侧眶部额中回与右侧小脑Crus2的ALFF值均显著升高(P<0.001,P<0.05)。结论:taVNS治疗抑郁症有效,但对TRD患者反刍思维改善方面疗效欠佳。TRD与nTRD的脑机制存在差异。taVNS可调制抑郁症关键脑区,如岛叶、眶部额中回,小脑可能与taVNS调制抑郁症的脑机制有关,这可能是其治疗TRD与nTRD的多个靶点;taVNS治疗TRD与nTRD可能存在不同的脑效应机制。这些不同的脑区突出了抑郁症治疗的复杂性和个体化性质,需进一步研究以充分了解TRD和nTRD的神经生物学基础。

即刻耳甲电针刺激对轻度认知障碍脑功能影像的影响初探

目的:基于静息态功能磁共振成像(rs-fMRI)探讨即刻(30分钟)耳甲电针(taVNS)刺激对轻度认知障碍(MCI)患者脑功能的影响。方法:纳入22例MCI患者,随机分为taVNS组和sham taVNS组,每组各11例,同时纳入11例健康对照(HCs)。3组受试者均进行30分钟耳部电针刺激,其中taVNS组和HCs组接受耳甲刺激位于迷走神经主要分布区,sham taVNS组接受的刺激位于非迷走神经分布的耳舟部,在刺激前后各进行一次rs-fMRI扫描。采用DPABI 8.0软件对rs-fMRI扫描结果进行预处理,随后计算功能连接(FC),对3组受试者刺激前后的FC图像进行比较,并将结果提值,用Graphpad Prism9.0.0进行事后分析,观察taVNS对脑功能的影响。结果:与刺激前相比,刺激后taVNS组右侧海马与右侧小脑_6的FC值显著降低(P<0.005)、左侧尾状核与右侧额上回以及右侧苍白球与左侧尾状核的FC值显著升高(P<0.05);刺激后HCs组左侧尾状核与小脑_8的FC值显著降低(P<0.05)。结论:即刻taVNS可以调节记忆及认知脑区,以及基底节区及小脑等脑功能网络,可能是taVNS治疗MCI的效应靶点。

经皮耳迷走神经刺激对恐惧情绪的实时干预效果研究

目的探索经皮耳迷走神经刺激(taVNS)不同刺激强度对恐惧情绪的实时干预效果。方法本研究筛选80名被试,随机分为4组,每组20名,分别接受不同强度的taVNS。采用基于VR的恐惧诱发平台诱发恐惧情绪,通过绩效评估、生理变化和主观量表评分考察实时干预效果。结果绩效评估方面,30%刺激组的行走距离显著高于10%刺激组(P<0.01),10%刺激组和30%刺激组的九灯任务正确率显著高于伪刺激组(P<0.05),30%刺激组的平均按键反应时显著低于伪刺激组平均按键反应时(P<0.05);生理变化方面,30%刺激组的呼吸率显著高于10%刺激组的呼吸率(P<0.01);主观量表评分方面,伪刺激组的后测分数显著高于30%刺激组的后测分数(P<0.05)。结论taVNS可能会降低恐惧情绪的强度,在本研究taVNS的不同刺激强度中,30%刺激强度为恐惧情绪实时干预的最优参数。