Transcutaneous Auricular Vagus Nerve Stimulation on Neurological and Mental
Disorders: From Germination to Future
Yu-tian Yu, Jing-jun Zhao, Xiao Guo, Pei-jing Rong*
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- *Corresponding Author:
- Pei-jing Rong
Institute of Acupuncture and Moxibustion
China Academy of Chinese Medical Sciences
E-mail: [email protected]
Received date: July 19, 2016; Accepted date: August 26, 2016; Published date: September 02, 2016
Citation: Yu Y, Zhao J, Guo X, Rong P (2016) Transcutaneous Auricular Vagus Nerve Stimulation on Neurological and Mental Disorders: From Germination to Future. J Clin Trials 6:277. doi:10.4172/2167-0870.1000277
Copyright: © 2016 Yu Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,distribution, and reproduction in any medium, provided the original author and source are credited.
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Auricular therapies have been applied to diseases since ancient times. Inspired by auricular acupuncture of TCM, and to overcome the disadvantages classic vagus nerve stimulation (VNS), we developed transcutaneous auricular vagus nerve stimulation (taVNS). It was applied to neurological and mental disorders, and also shows a bright prospect to these diseases.
Transcutaneous auricular vagus nerve stimulation; taVNS; Pain; Epilepsy; Major depressive disorder; MDD; Disorder of consciousness; DOC
Ancient Applications of Auricular Treatments
Earrings have been favored by the ladies since ancient times (Figure 1). Meanwhile, ears have been used to treat diseases from time immemorial (Figure 2A). The Egyptologist Alexandre Varille (1909-1951) has demonstrated that women in ancient Egypt, who did not want any more children, had their external ear pricked with a needle or cauterized with heat . Mediterranean sailors’ wearing gold earrings were not just used as decorations, but were said to improve vision . Hippocrates, who was the father of Greek medicine, reported doctors made small openings in the veins situated behind the ear to facilitate ejaculation and reduce impotency problems . Cutting of veins situated behind the ear was used to treat leg pain as well . The Greek physician Galen introduced Hippocratic medicine to the Roman Empire in the second century CE, commentating on the healing value of scarification at the outer ear .
Figure 1: Dancing lady with charming earrings on a remnant of ceramics date to 3200 years ago, which is the Nineteenth Dynasty in the ancient Egypt.
Figure 2a: Brick of Chinese Han dynasty which engraved ancient miracle-working doctor Bian Que using auricular acupuncture for diseases.
After the fall of Roman Empire, the medical records of Egyptian, Greek and Roman medicine were best preserved in ancient Persia and Arabian world. Persian records were specific references to medical treatments for sciatic pains and sexual related disease produced by cauterization of the external ear (Figure 2B) .
Figure 2b: Persian Surgery Textbook (Imperial Surgery) in the 12th century illustrated that the doctor cauterizing the external ear for patient’s migraine.
From Auricular Acupuncture to Transcutaneous Auricular Vagus Nerve Stimulation (taVNS)
Vagus nerve stimulation (VNS) has been approved by FDA (Figure 3) for epilepsy in 1997  and treatment-resistant depression in 2005 [6,7]. However, they have their limitations as well, including high cost, the involvement of surgery, perioperative risks, and potentially significant side effects .
Figure 3: Vagus Nerve Stimulation (VNS).
Transcutaneous auricular vagus nervestimulation (taVNS) is developed from auricular acupuncture several years ago by our team. Auricular acupuncture (Figure 4) is a very important part of Traditional Chinese Medicine (TCM) . In the classic TCM text of Huang Di Nei Jing was compiled in around 500 B.C whose correlation between the auricle and the body had been described that all six Yang meridians were directly connected to the auricle, whereas the six Yin meridians were indirectly connected to the ear by their corresponding yang meridian, respectively [4,10]. Since the ancient time, Chinese doctors have been using auricular acupuncture to treat a wild range of diseases, including insomnia, depression and anxiety etc . Nogier presented his discovery in several congresses and published it in an international circulation journal which eventually led to the widespread acceptance of his approach. With some exceptions, the Chinese charts were very similar to Nogier’s originals .
Figure 4: Auricular Acupuncture.
Also, according to anatomical studies which suggest that the ear is the only place on the surface of human bodies where there is afferent vagus nerve distribution [13,14], especially in the auricular concha (Figure 5) , a direct stimulation of these afferent nerve fibres on ear supposes to has similar effect to classic VNS without surgical intervention, which is fertile for more disorders (Figure 6) .
Figure 5:The innervations of the auricular branch of the vagus nerve are marked by green color which is mainly distributed in auricular concha.
Figure 6: taVNS has similar effect to classic VNS.
Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) on Neurological and Mental Disorders
At the very beginning, transcutaneous auricular vagus nerve stimulation (taVNS) was for pain relief [1,17,18]. As the classic VNS was approved by US FDA for both epilepsy and treatment-resistant depression, clinical trials of taVNS for these two diseases were increased gradually [16,19-22]. And then, because auricular acupuncture was very effective for insomnia disorder (ID), taVNS was therefore applied to these patients . In addition to the above mentioned, more and more results of taVNS on neurological and mental disorders was achieved including tinnitus [24,25], chronic migraine , schizophrenia [27,28], postoperative cognitive dysfunction .
In 2013, Compelling evidence exists to suggest that vagus nerve stimulation (VNS) may improve outcomes after severe brain injury. The clinical trial for which researchers have obtained FDA IDE clearance will be the first step in determining the efficacy of VNS for improvement of consciousness after severe brain injury . Inspired by this, our team is focusing on transcutaneous auricular vagus nerve stimulation (taVNS) on patients with disorder of consciousness (DOC). Stirring results are coming out.
Auricular treatments to diseases can be traced back to ancient Egyptian and Chinese times. Inspired by auricular acupuncture of TCM, and to overcome the disadvantages classic vagus nerve stimulation (VNS), we developed transcutaneous auricular vagus nerve stimulation (taVNS). It was applied to neurological and mental disorders, including pain, epilepsy, depression, insomnia, tinnitus, chronic migraine, schizophrenia, postoperative cognitive dysfunction etc. It also shows a bright prospect in other neurological and mental disorders. Further studies should be carried out.
1. Natural Science Foundation of China (No. 30973798, 81473780); 2. The Fundamental Research Funds for the Central Public Welfare Research Institutes (ZZ16012); 3. Chinese Postdoctoral Science Foundation (2016M590185).
- Horrigan BJ (2008) New auricular therapy providing pain relief to some patients. Explore: J SciHeal 4: 228-231.
- Gori L, Firenzuoli F (2007) Ear acupuncture in European traditional medicine. Evidence-Based Complementary and Alternative Medicine 4:13-16.
- Nogier P (1981) From acuriculotherapy to auriculomedicine Maisonneuve. France, Sainte-Ruffine
- He W, Xiaoyu Wang, Hong Shi, Hongyan Shang, Liang Li, et al. (2012) Auricular acupuncture and vagal regulation. Evidence-Based Complementary and Alternative Medicine.
- Ben-Menachem E (2002) Vagus-nerve stimulation for the treatment of epilepsy. The Lancet Neurology 1: 477-482.
- Nemeroff CB, Mayberg HS, Krahl SE, McNamara J, Frazer A, et al. (2006) VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms. Neuropsychopharmacology 31:1345-1355.
- Daban C, Martinez-Aran A, Cruz N, Vieta E (2008) Safety and efficacy of Vagus Nerve Stimulation in treatment-resistant depression: A systematic review. J Affect Disord 110: 1-15.
- Ventureyra EC (2000) Transcutaneous vagus nerve stimulation for partial onset seizure therapy. Child's Nerv Syst 16: 101-102.
- Oleson T (2013) Auriculotherapy manual: Chinese and Western systems of ear acupuncture. Elsevier Health Sciences.
- Yang H (2009) A brief analysis on the treatise of ears in Huangdi Neijing. Zhejiang Journal of Traditional Chinese Medicine 44: 14-15.
- Chen HY, Shi Y, Ng CS, Chan SM, Yung KK, et al. (2007) Auricular acupuncture treatment for insomnia: a systematic review. J Altern Complement Med 13: 669-676.
- Chalmers J (2007) Modern auricular therapy: a brief history and the discovery of the vascular autonomic signal. Journal of Chinese Medicine84: 5.
- Henry TR (2002) Therapeutic mechanisms of vagus nerve stimulation. Neurology 59: S3-14.
- Peuker ET, Filler TJ (2002) The nerve supply of the human auricle. Clin Anat, 15: 35-37.
- He W, Wang X, Shi H, Shang H, Li L, et al. (2012) Auricular acupuncture and vagal regulation. Evid Based Complement Alternat Med 2012: 786839.
- Rong PJ, Ji-Liang Fang, Li-Ping Wang, Hong Meng, Jun Liu, et al. (2012) Transcutaneous vagus nerve stimulation for the treatment of depression: a study protocol for a double blinded randomized clinical trial. BMC Complement Altern Med 12: 255.
- Johnson M, Hajela VK, Ashton CH, Thompson JW (1991) The effects of auricular transcutaneous electrical nerve stimulation (TENS) on experimental pain threshold and autonomic function in healthy subjects. Pain 46: 337-342.
- Noling LB, Clelland JA, Jackson JR, Knowles CJ (1988) Effect of transcutaneous electrical nerve stimulation at auricular points on experimental cutaneous pain threshold. Physical Therapy 68: 328-332.
- He W, Jing X, Wang X, Rong P, Li L, et al. (2013) Transcutaneous auricular vagus nerve stimulation as a complementary therapy for pediatric epilepsy: a pilot trial. Epilepsy & Behavior 28: 343-346.
- Rong P, Liu A, Zhang J, Wang Y, Yang A, et al. (2013) An alternative therapy for drug-resistant epilepsy: transcutaneous auricular vagus nerve stimulation. ChinMed J 127: 300-304.
- Rong P, Liu A, Zhang J, Wang Y, He W, et al. (2014) Transcutaneous vagus nerve stimulation for refractory epilepsy: a randomized controlled trial. Clin Sci : CS20130518.
- Fang J, Rong P, Hong Y, Fan Y, Liu J, et al. (2016) Transcutaneous vagus nerve stimulation modulates default mode network in major depressive disorder.Biological psychiatry79: 266-273.
- Shao-Yuan L, Jiao Yue, Rong Pei-Jing, Li Su-Xia, Yu Yu-Tian, et al. (2016) Transcutaneous Vagus Nerve Stimulation for the Treatment of Insomnia Disorder: A Study Protocol for a Double Blinded Randomized Clinical Trial. J Clin Trials 6: 2167-0870.
- Lehtimäki J, Hyvärinen P, Ylikoski M, Bergholm M, Mäkelä JP, et al. (2013) Transcutaneous vagus nerve stimulation in tinnitus: a pilot study. Acta oto-laryngologica 133: 378-382.
- Kreuzer PM, Landgrebe M, Resch M, Husser O, Schecklmann M, et al. (2014) Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study. Brain stimulation 7: 740-747.
- Straube A, Ellrich J, Eren O, Blum B, Ruscheweyh R, et al. (2015) Treatment of chronic migraine with transcutaneous stimulation of the auricular branch of the vagal nerve (auricular t-VNS): a randomized, monocentric clinical trial. JHeadache Pain 16: 543.
- Schmitt A, Falkai P (2015) Negative symptoms and therapy strategies in schizophrenia. EurArchpsychiatry Clin Neurosci 265: 541-542.
- Hasan A, Wolff-Menzler C, Pfeiffer S, Falkai P, Weidinger E, et al. (2015) Transcutaneous noninvasive vagus nerve stimulation (tVNS) in the treatment of schizophrenia: a bicentric randomized controlled pilot study. European archives of psychiatry and clinical neuroscience 265: 589-600.
- Xiong J, Xue FS, Liu JH, Xu YC, Liao X, et al. (2009) Transcutaneous vagus nerve stimulation may attenuate postoperative cognitive dysfunction in elderly patients. Medical hypotheses 73: 938-941.
- Shi C, Flanagan SR, Samadani U (2013) Vagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial.Neurol Res 35: 263-276.