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Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: underscoring anatomical landmarks and connections
Author(s) -
Barros Mirna Duarte,
Trevizol Alisson,
Sato Isa,
Liquidato Bianca Maria,
Cordeiro Quirino,
Shiozawa Pedro
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.227.3
Subject(s) - medicine , vagus nerve stimulation , anesthesia , supine position , trigeminal nerve , transcranial direct current stimulation , trigeminal neuralgia , stimulation , anxiety , cortical spreading depression , physical medicine and rehabilitation , vagus nerve , migraine , psychiatry
We analyzed trigeminal nerve stimulation (TNS) and transcutaneous vagus nerve stimulation (tVNS). All techniques have shown preliminary promising results regarding different neuropsychiatric scenarios. Our group recently developed a new TNS protocol for different disorders such as depression, generalized anxiety, fibromyalgia, panic attacks and substance addiction. Considering all patients enrolled for our different studies, a total of 100 patients underwent the referred stimulation protocol despite clinical scenario. We used an external neurostimulator to deliver electric current transcutaneously through orbital branch of the trigeminal nerve. The parameters for this technique are frequency, pulse duration, train duration, density (intensity of stimuli/electrode area) and electrode position, revealing the importance of anatomical knowledge about trigeminal nerve branches, their position and connections. The protocol is as follows: frequency of 120 Hz, 200ms of pulse duration for 30 minutes. The intensity is determined individually and corresponds to the intensity that each subject refers as a non‐painful mild paresthesia without muscle contraction. The electrodes are 25cm2 and are positioned over supraorbital foramen with the negative (cathode) on the right side and positive (anode) on the left. A total of 10 sessions (one session a day) are performed. Regarding clinical outcomes, overall data analysis demonstrate a significant participation of TNS in ameliorating neuropsychiatric symptoms of patients enrolled for our trials and case studies. The technique was not related to any severe adverse effect. In fact, patients presented only a mild transient erythema following the active TNS stimulation, which would fade away in a few minutes. Skin injury is systematically assessed in every study protocol following the suggestion of Basketter and colleagues. The authors provide evidence that visual scoring can be sensitive reliable and reproducible within a study protocol. The present TNS protocol used for different clinical trials in neuropsychiatry is a safe strategy regarding skin injury, in contrast to similar non‐invasive neuromodulation strategy such as tDCS, which markedly present safety concerns regarding skin integrity in different reports. The present results, however significant, need to be taken as hypothesis‐driven. We understand that the trends seen so far shall strongly justify larger double‐blind studies in this area