ABSTRACT
ObjectiveTo investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with bilateral arm training (BAT) on upper limb motor function of hemiplegic stroke patients. MethodsFrom January, 2021 to January, 2022，105 stroke patients from Zhejiang Provincial People's Hospital were randomly divided into taVNS group (n = 35), BAT group (n = 35) and combined group (n = 35). All the patients received routine rehabilitation, while taVNS group received taVNS, BAT group received BAT, and the combined group received both taVNS and BAT, for eight weeks. The root mean square (RMS) of surface electromyography in deltoid, triceps brachii and extensor carpi was measured, and the scores of Box and Block Test (BBT), and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) were obtained before and after treatment. ResultsThe RMS of all these muscles, and the scores of BBT and FMA-UE improved in all the three groups after treatment (|t| > 6.124, P < 0.001), and they were improved the most in the combined group (F > 18.162, P < 0.001). ConclusionBoth taVNS and BAT can enhance the muscle strength on the affected upper limb, increase the hand flexibility, and improve upper limb motor function of stroke patients, while the combination of both methods is more effective.
ABSTRACT
OBJECTIVE@#To explore the brain effect mechanism and the correlation between brain functional imaging and cognitive function in treatment of depressive disorder (DD) with transcutaneous auricular vagus nerve stimulation (taVNS) based on the resting-state functional magenetic reasonance imaging (rs-fMRI).@*METHODS@#Thirty-two DD patients were included in a depression group and 32 subjects of healthy condition were enrolled in a normal group. In the depression group, the taVNS was applied to bilateral Xin (CO15) and Shen (CO10), at disperse-dense wave, 4 Hz/20 Hz in frequency and current intensity ≤20 mA depending on patient's tolerance, 30 min each time, twice daily. The duration of treatment consisted of 8 weeks. The patients of two groups were undertaken rs-fMRI scanning. The scores of Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and Wisconsin card sorting test (WCST) were observed in the normal group at baseline and the depression group before and after treatment separately. The differential brain regions were observed before and after treatment in the two groups and the value of degree centrality (DC) of fMRI was obtained. Their correlation was analyzed in terms of HAMD, HAMA and WCST scores.@*RESULTS@#The scores of HAMD and HAMA in the depression group were all higher than those in the normal group (P<0.05). After treatment, the scores of HAMD and HAMA were lower than those before treatment in the depression group; the scores of total responses, response errors and perseverative errors of WCST were all lower than those before treatment (P<0.05). The brain regions with significant differences included the left inferior temporal gyrus, the left cerebellar peduncles region 1, the left insula, the right putamen, the bilateral supplementary motor area and the right middle frontal gyrus. After treatment, the value of DC in left supplementary motor area was negatively correlated to HAMD and HAMA scores respectively (r=-0.324, P=0.012; r=-0.310, P=0.015); the value of DC in left cerebellar peduncles region 1 was negatively correlated to the total responses of WCST (r=-0.322, P=0.013), and the left insula was positively correlated to the total responses of WCST (r=0.271, P=0.036).@*CONCLUSION@#The taVNS can modulate the intensity of the functional activities of some brain regions so as to relieve depressive symptoms and improve cognitive function.
Subject(s)
Humans , Depression/therapy , Magnetic Resonance Imaging/methods , Vagus Nerve Stimulation/methods , Brain/diagnostic imaging , Transcutaneous Electric Nerve Stimulation/methods , Vagus NerveABSTRACT
ObjectiveTo investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with robot-assisted therapy on upper limb function of subacute stroke patients. MethodsFrom March, 2022 to March, 2023, 60 subacute stroke patients from Dushu Lake Hospital and the First People's Hospital of Kunshan were randomly divided into control group (n = 20), robot group (n = 20) and combined group (n = 20). All the groups received conventional treatments including medication, physical therapy and occupational therapy; the robot group received sham taVNS combined with hand robot-assisted therapy; while the combined group received taVNS combined with hand robot-assisted therapy, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and hand part, the root mean square (RMS) electromyography of the extensor carpi radialis and extensor digitorum muscles during contraction, and the latency and amplitude of transcranial magnetic stimulation motor-evoked potential (TMS-MEP) before and after treatment. ResultsAfter treatment, the scores of FMA-UE and hand part, RMS of the extensor carpi radialis and extensor digitorum muscles, and latency and amplitude of TMS-MEP improved in all the groups (t > 2.099, P < 0.05); and they were the best in all indicators in the combined group (F > 9.106, P < 0.001). ConclusiontaVNS combined with robot-assisted therapy can promote central nervous system remodeling and further improve upper limb function in stroke patients.
ABSTRACT
OBJECTIVE@#To observe the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on the sleep quality and nocturnal heart rate variability (HRV) in patients with primary insomnia.@*METHODS@#Twenty-one patients with primary insomnia were included. Using SDZ-ⅡB electric acupuncture apparatus, Xin (CO15) and Shen (CO10) were stimulated with disperse-dense wave, 4 Hz/ 20 Hz in frequency, (0.2±30%) ms of pulse width and tolerable intensity. Electric stimulation was given once every morning and evening of a day, 30 min each time, for 4 weeks totally. Before and after treatment, the score of Pittsburgh sleep quality index (PSQI), objective sleep structure (total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], sleep efficiency [SE], the percentages of non-rapid eye movement period 1, 2, 3, and the percentage of rapid eye movement period to TST [N1%, N2%, N3%, REM%] ) and nocturnal HRV (high frequency [HF], low frequency [LF], the ratio of LF to HF [LF/HF], standard deviation for the normal RR intervals [SDNN], squared root of the mean sum of squares of differences between adjacent intervals RR [RMSSD], the percentage of adjacent RR intervals with differences larger than 50 ms in the entire recording [PNN50%], the mean of sinus RR intervals [NNMean] ) were compared in the patients separately.@*RESULTS@#After treatment, the score of each item and the total score of PSQI and SL were all reduced as compared with those before treatment (P<0.01, P<0.001); SE, N3%, LF, HF, LF/HF, SDNN, NNMean and RMSSD were all increased compared with those before treatment (P<0.001, P<0.01).@*CONCLUSION@#The taVNS improves the sleep quality and objective sleep structure in patients with primary insomnia, which is probably related to the regulation of autonomic nervous functions.
Subject(s)
Humans , Heart Rate/physiology , Sleep/physiology , Sleep Initiation and Maintenance Disorders/therapy , Vagus Nerve , Vagus Nerve StimulationABSTRACT
OBJECTIVE@#To explore the modulation of transcutaneous auricular vagus nerve stimulation (taVNS) on default mode network (DMN) in patients with primary insomnia (PI).@*METHODS@#A total of 22 PI patients (one patient dropped off and two patients were excluded) were included and treated with taVNS. The bilateral auricular points of Xin (CO15) and Shen (CO10) were selected and treated with disperse-dense wave at frequency of 4 Hz/20 Hz, the intensity was based on the patient's tolerance. taVNS was given once in the morning and once in the evening for 30 minutes each time. The treatment lasted for at least 5 days a week for 4 weeks. At the same time, 16 healthy subjects matched with gender and age were recruited. The Pittsburgh sleep quality index (PSQI) score was evaluated before and after treatment in PI patients. The resting-state functional magnetic resonance imaging (rs-fMRI) data of PI patients before and after treatment and healthy subjects at baseline period were collected to observe the effect of taVNS on the functional connection (FC) between posterior cingulate cortex (PCC) and whole brain.@*RESULTS@#After treatment, the total score of PSQI in PI patients was lower than that before treatment (P<0.01). Compared with healthy subjects, the FC of the left PCC was increased either with the left orbital superior frontal gyrus or with left middle frontal gyrus (P<0.001), and the FC between right PCC and left middle frontal gyrus was increased in PI patients before treatment (P<0.001). Compared before treatment, the FC between left PCC and left middle frontal gyrus was decreased (P<0.05), and the FC of the right PCC was decreased either with the right medial prefrontal cortex or with the left middle frontal gyrus in PI patients after treatment (P<0.001, P<0.01).@*CONCLUSION@#taVNS can modulate the FC between anterior and posterior DMN, and between DMN and cognitive control network of PI patients, which may be one of the brain effect mechanisms of taVNS in the treatment of PI patients.
Subject(s)
Humans , Brain/physiology , Default Mode Network , Magnetic Resonance Imaging/methods , Sleep Initiation and Maintenance Disorders/therapy , Vagus Nerve , Vagus Nerve Stimulation/methodsABSTRACT
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.
ABSTRACT
OBJECTIVE: To explore the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on blood glucose regulation and the expression of insulin receptors (INR) of hypothalamus, liver and skeletal muscle tissues in impaired glucose tolerance (IGT) rats, so as to reveal its mechanisms underlying improvement of IGT. METHODS: Thirty-six male Wistar rats were randomly divided into control, model, transcutaneous auricular none-vagus nerve stimulation (tnVNS), and taVNS groups (n=9 in each group). The IGT model was established by feeding the rats with high-fat and high-sugar diet for 5 weeks, and subsequent intraperitoneal injection of a dose of streptozotocin (20 mg/kg). Transcutaneous electrostimulation (2 mA, 2 Hz/15 Hz) was applied to auricular concha (taVNS) or auricular margin (tnVNS), respectively. The treatment was conducted for 30 min once daily for 4 weeks. The body weight, fasting plasma glucose (FPG), 2 h plasma glucose (2 h PG) were recorded every week. The contents of plasma insulin (INS), glucagon (GC), glycosylated hemoglobin (GHbA1c) were detected by using enzyme linked immunosorbent assay (ELISA). The expression levels of INR in hypothalamus, liver and skeletal muscle tissues were detected by Western blot. RESULTS: After modeling, the rats' body weight, the contents of FPG, 2 h PG, GC and GHbA1c were significantly up-regulated (P<0.001, P<0.05, P<0.01), and the content of INS and expression of INR in hypothalamus, liver and skeletal muscle tissues were significantly down-regulated in the model group compared with the control group (P<0.001, P<0.01, P<0.05). Following the treatment, the increased FPG, 2 h PG, GC, and the decreased INS and INR expression of hypothalamus, liver and skeletal muscle tissues were apparently reversed in the taVNS group relevant to the model group (P<0.001, P<0.01, P<0.05). Compared with the tnVNS group, the FPG and 2 h PG contents were considerable decreased, and the content of INS and INR expression of hypothalamus and liver were obviously increased in the taVNS group (P<0.001, P<0.05, P<0.01). CONCLUSION: taVNS can improve the blood glucose and insulin sensitivity in IGT rats, which may contribute to its effectiveness in up-regulating the expression of INR in hypothalamus, liver and skeletal muscle tissues.
ABSTRACT
The transcutaneous auricular vagus nerve stimulation (taVNS) was researched and developed based on traditional Chinese medicine (TCM) auricular acupuncture (AA),vagus nerve stimulation (VNS) and anatomy.It is a typical representative of TCM modernization.Meanwhile,taVNS does not require surgery,with low cost,and has almost no side effects.Most importantly,it ensures a comparable efficiency as the classic VNS.The taVNS regulates the autonomic neural function as its core,opens up a new principle of peripheral nerve-brain network-body function,and has made breakthroughs in the treatment of epilepsy and depression.Other indications of taVNS contain disorders of consciousness (DOC),autism spectrum disorder (ASD),Alzheimer's disease (AD),and etc.The further improvement of taVNS technique will definitely benefit a wider range of patients.