TAVNS for Disorders of Conciousness (Vegetative State)
Kristen Sparrow • May 28, 2022
Having just attended a Neuromodulation Conference where my interest was in TAVNS, (Transcutaneous Vagal Nerve Stimulation), this study in patients in a vegetative state receiving daily TAVNS is pertinent. In this study the patients HRV improved over time. Any noninvasive therapy that can help these patients would be welcome. It was not life-changing in this patient’s case, but it still is an interesting case study. Related to this one.
Neuromodulatory electroceuticals such as vagus nerve stimulation have been recently gaining traction as potential rehabilitation tools for disorders of consciousness (DoC). We present a longitudinal case study of non-invasive auricular vagus nerve stimulation (taVNS) in a patient diagnosed with chronic unresponsive wakefulness syndrome (previously known as vegetative state). Over a period of 6 months we applied taVNS daily and regularly evaluated the patient’s behavioral outcomes using Coma Recovery Scale – Revised. We also took electrophysiological measures: resting state electroencephalography (EEG), heart rate (HR) and heart rate variability (HRV). All these methods revealed signs of improvement in the patient’s condition. The total CRS-R scores fluctuated but rose from 4 and 6 at initial stages to the heights of 12 and 13 in the 3rd and 5th month, which would warrant a change in diagnosis to a Minimally Conscious State. Scores obtained in a 2 months follow-up period, though, suggest this may not have been a lasting improvement. Behavioral signs of recovery are triangulated by EEG frequency spectrum profiles with re-emergence of a second oscillatory peak in the alpha range, which has been shown to characterize aware people. However, sustained spontaneous theta oscillations did not predictably diminish, which most likely reflects structural brain damage. ECG measures revealed a steady decrease in pre-stimulation HR combined with an increase in HRV-HR. This suggests a gradual withdrawal of sympathetic and an increase in parasympathetic control of the heart, which the previous literature has also linked with DoC improvements. Together, this study suggests that taVNS stimulation holds promise as a DoC treatment.