Evaluation of different vagus nerve stimulation anatomical targets in the ear by vagus evoked potential responses.

BACKGROUND: Electrical auricular vagus nerve stimulation (taVNS) is an emerging therapy. Stimuli are transported to brainstem nuclei, whereby its multiple projections reach to many subcortical and cortical areas, thus allowing the neuromodulation of several systemic physiological processes. We aim to define the best auricular target for taVNS through vagus somatosensory evoked potential (VSEP) elicited stimulating different auricular areas with different electrode sizes. METHODS: Twenty-six subjects were enrolled. Three stimulation areas were studied: simultaneous cymba and cavum (CC), cymba (C) and earlobe (L); and two electrode sizes: extra-large (X) and small (S). We studied the effect of five combinations (CCX, CCS, CS, LX and LS) on VSEP´s latency and amplitude, and sensory and pain threshold (Pt) using a lineal mixed model regression analysis. We used CS combination, used in a commercial device, as reference model. RESULTS: Valid VSEP were obtained for CCX, CCS and CS but not in LX and LS. Both CCS and CCX tests showed significant amplitude increases. The same effect was observed in CCX using CCS as reference. Significant increases in Pt were found for CCX and LX. The same effect was observed in CCX using LX as reference. CONCLUSION: The results suggest that CC and C areas are active targets for taVNS but not for earlobe, as anatomical data support. Considering that amplitude reflects the synchronized electrical activity generated, we conclude the most effective topography is the simultaneous stimulation of cymba and concha. The use of X-sized electrodes increases the amplitudes and makes the stimulation more comfortable.

Alpha and beta oscillatory activity during a sequence of two movements.

OBJECTIVE: We studied movement-related electroencephalographic oscillatory changes in the alpha and beta range during a sequence of two movements in 7 healthy volunteers, in order to investigate the relationship between these changes and each component in the sequence. METHODS: The sequence consisted of a wrist active extension-passive flexion followed by a first and second finger pincer. A total of 10.5 s sweeps were recorded using the level of surface electromyographic (EMG) activity in wrist extensors as trigger, including a 7.5 s pre-stimulus. The sweeps were also realigned manually offline using as trigger the end of the first EMG burst, or the beginning of the second movement. An index of the changes in non-phase-locked energy in the 7-37 Hz range was obtained by averaging single-sweep time-frequency transforms. RESULTS: The duration of each of the movements in the sequence and the relationship between them were compatible with the use of two different motor programmes in the sequence. In the beta band, a decrease in energy (event-related desynchronisation, ERD) began 1.5 s before the onset of the first movement, and was sustained until the end of the second movement. No energy increases were observed until the end of the second movement. In the alpha band, the ERD began 0.5 seconds before the first movement and was sustained throughout the recording. CONCLUSION: These findings suggest that the beta-event-related synchronisation is related to the end of the whole motor process, and not to the end of each motor programme.