A review on transcutaneous vagal nerve stimulation.

Colzato and Beste review the literature on cognitive effects of transcutaneous vagus nerve stimulation (tVNS), with a focus on studies on normal subjects suggesting that it might enhance memory and sharpen task relevant representations. I pass on a few clips from their text and also their abstract. Motivated readers can obtain the whole article by emailing me.

The focus of the present review article is not on clinical populations but on healthy humans and how especially auricular tVNS may be a useful neuromodulatory tool in cognitive neuroscience.

Only after commercially available auricular tVNS (NEMOS®) and cervical tVNS (gammaCore®) devices hit the market in the last few years, the idea of using tVNS as a tool for neuromodulation in cognitive neuroscience has been put forward.

Auricular tVNS is applied through a special earplug electrode to the outer ear, sending electrical impulses to the auricular branch of the vagus nerve, also called Alderman's nerve or Arnold's nerve. By doing so, the afferent (i.e., the thick-myelinated Aβ) fibers of Arnold's nerve are excited and the afferent signal propagates from peripheral nerves to nuclei in the brainstem, such as the locus coeruleus (LC) and the NST, and, ultimately, to intracranial subcortical (hippocampus) and cortical structures such as the insula, the prefrontal cortex (PFC) and the motor cortex. To date, auricular tVNS is applied to the left ear because of cardiac safety concerns, even 310 though, recently, these concerns have been challenged.

To date, most tVNS studies use commercially available stimulation devices. Usually, these are equipped with the following fixed parameters: frequency of 25 Hz, 200 μs pulse width, 30s on / 30s off-cycle, and current intensities up to 3 mA. Findings from animal studies, can thus not directly be transferred to study protocols in humans, since stimulation parameters can vary.

The reviewed literature indicates that the modulation of activation in the locus coeruleus and in th hippocampus and related NA release could be regarded as a possible working mechanism for the memory-enhancing effects of tVNS. Second, that increased cortical inhibition in the motor cortex and PFC due to high GABA levels in response to tVNS can facilitate response selection and inhibition processes via sharpening task-relevant representations and inhibiting competing responses.

Here is their abstract:

Brain stimulation approaches are important to gain causal mechanistic insights into the relevance of functional brain regions and/or neurophysiological systems for human cognitive functions. In recent years, transcutaneous vagus nerve stimulation (tVNS) has attracted considerable popularity. It is a noninvasive brain stimulation technique based on the stimulation of the vagus nerve. The stimulation of this nerve activates subcortical nuclei, such as the locus coeruleus and the nucleus of the solitary tract, and from there, the activation propagates to the cortex. Since tVNS is a novel stimulation technique, this literature review outlines a brief historical background of tVNS, before detailing underlying neurophysiological mechanisms of action, stimulation parameters, cognitive effects of tVNS on healthy humans, and, lastly, current challenges and future directions of tVNS research in cognitive functions. Although more research is needed, we conclude that tVNS, by increasing noradrenaline (NA) and gamma-aminobutyric acid (GABA) levels, affects NA and GABA-related cognitive performance. The review provides detailed background information how to use tVNS as a neuromodulatory tool in cognitive neuroscience and outlines important future leads of research on tVNS.