Department of Neurophysiology, Complejo Hospitalario de Navarra, Pamplona, Spain.
Department of Neurology, Puerta de Hierro Hospital, Madrid, Spain.
Brain Behav. 2021 Nov;11(11):e2343. doi: 10.1002/brb3.2343. Epub 2021 Sep 22.
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.
背景:电耳迷走神经刺激(taVNS)是一种新兴的治疗方法。刺激物被运送到脑干核,其多个投射到达许多皮质下和皮质区域,从而允许对几个全身生理过程进行神经调节。我们旨在通过刺激不同的耳区使用不同大小的电极来定义 taVNS 的最佳耳区目标,从而引出迷走感觉诱发电位(VSEP)。
方法:共纳入 26 名受试者。研究了三个刺激区域:同时刺激耳甲腔和耳甲艇(CC)、耳甲腔(C)和耳垂(L);以及两种电极大小:特大(X)和小(S)。我们使用线性混合模型回归分析研究了五种组合(CCX、CCS、CS、LX 和 LS)对 VSEP 的潜伏期和振幅以及感觉和疼痛阈值(Pt)的影响。我们使用 CS 组合作为参考模型,CS 组合用于商业设备。
结果:CCX、CCS 和 CS 可以获得有效的 VSEP,但 LX 和 LS 则不行。CCS 和 CCX 测试均显示出显著的振幅增加。在使用 CCS 作为参考模型时,也观察到了相同的效果。在 CCX 和 LX 中均发现 Pt 显著增加。在使用 LX 作为参考模型时,也观察到了相同的效果。
结论:结果表明,CC 和 C 区是 taVNS 的有效刺激靶点,但耳垂不是,因为解剖学数据支持这一点。考虑到振幅反映了产生的同步电活动,我们得出结论,最有效的刺激方式是同时刺激耳甲腔和耳甲艇。使用 X 尺寸的电极可以增加振幅并使刺激更舒适。
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