经皮耳迷走神经刺激与意识障碍:作用机制假说

Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action.

作者信息

Briand Marie-Michele, Gosseries Olivia, Staumont Bernard, Laureys Steven, Thibaut Aurore

机构信息

Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.

Centre du Cerveau2, University Hospital of Liège, Liège, Belgium.

出版信息

Front Neurol. 2020 Aug 25;11:933. doi: 10.3389/fneur.2020.00933. eCollection 2020.

Abstract

Disorders of consciousness (DoC) are the hallmark of severe acquired brain injuries characterized by abnormal activity in important brain areas and disruption within and between brain networks. As DoC's therapeutic arsenal is limited, new potential therapies such as transcutaneous auricular vagal nerve stimulation (taVNS) have recently been explored. The potential of taVNS in the process of consciousness recovery has been highlighted in recent studies with DoC patients. However, it is not clear how taVNS plays a role in the recovery of consciousness. In this article, we first describe the neural correlates of consciousness, the vagus nerve anatomy and functions, along with the results of functional magnetic resonance imaging studies using taVNS. Based on consciousness recovery and taVNS mechanisms, we propose the Vagal Cortical Pathways model. This model highlights four consecutive pathways (A. Lower brainstem activation, B. Upper brainstem activation, C. Norepinephrine pathway, and D. Serotonin pathway) likely to have an impact on patients with a brain injury and DoC. Additionally, we suggest six different mechanisms of action: (1) Activation of the ascending reticular activating system; (2) Activation of the thalamus; (3) Re-establishment of the cortico-striatal-thalamic-cortical loop; (4) Promotion of negative connectivity between external and default mode networks by the activation of the salience network; (5) Increase in activity and connectivity within the external network through the norepinephrine pathway; and (6) Increase in activity within the default mode network through the serotonin pathway. This model aims to explain the potential therapeutic effects that taVNS has on brain activity in the process of consciousness recovery.

摘要

意识障碍(DoC)是严重获得性脑损伤的标志,其特征是重要脑区活动异常以及脑网络内部和之间的中断。由于意识障碍的治疗手段有限,近年来人们探索了经皮耳迷走神经刺激(taVNS)等新的潜在治疗方法。最近针对意识障碍患者的研究突出了taVNS在意识恢复过程中的潜力。然而,尚不清楚taVNS如何在意识恢复中发挥作用。在本文中,我们首先描述意识的神经关联、迷走神经的解剖结构和功能,以及使用taVNS的功能磁共振成像研究结果。基于意识恢复和taVNS机制,我们提出了迷走神经 - 皮质通路模型。该模型突出了四条连续的通路(A. 低位脑干激活、B. 高位脑干激活、C. 去甲肾上腺素通路和D. 5-羟色胺通路),这些通路可能对脑损伤和意识障碍患者产生影响。此外,我们提出了六种不同的作用机制:(1)激活上行网状激活系统;(2)激活丘脑;(3)重建皮质 - 纹状体 - 丘脑 - 皮质环路;(4)通过激活突显网络促进外部网络与默认模式网络之间的负性连接;(5)通过去甲肾上腺素通路增加外部网络内的活动和连接;(6)通过5-羟色胺通路增加默认模式网络内的活动。该模型旨在解释taVNS在意识恢复过程中对脑活动的潜在治疗作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c79c/7477388/4c070df86260/fneur-11-00933-g0001.jpg

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