Higher Dose Noninvasive Transcutaneous Auricular Vagus Nerve Stimulation Increases Feeding Volumes and White Matter Microstructural Complexity in Open-Label Study of Infants Slated for Gastrostomy Tube.

OBJECTIVE: To determine whether transcutaneous auricular vagus nerve stimulation (taVNS) paired with twice daily bottle feeding increases the volume of oral feeds and white matter neuroplasticity in term-age-equivalent infants failing oral feeds and determined to need a gastrostomy tube. STUDY DESIGN: In this prospective, open-label study, 21 infants received taVNS paired with 2 bottle feeds for 2 - 3 weeks (2x). We compared 1) increase oral feeding volumes with 2x taVNS and previously reported once daily taVNS (1x) to determine a dose response, 2) number of infants who attained full oral feeding volumes, and 3) diffusional kurtosis imaging and magnetic resonance spectroscopy before and after treatment by paired t tests. RESULTS: All 2x taVNS treated infants significantly increased their feeding volumes compared with 10 days before treatment. Over 50% of 2x taVNS infants achieved full oral feeds but in a shorter time than 1x cohort (median 7 days [2x], 12.5 days [1x], P < .05). Infants attaining full oral feeds showed greater increase in radial kurtosis in the right corticospinal tract at the cerebellar peduncle and external capsule. Notably, 75% of infants of diabetic mothers failed full oral feeds, and their glutathione concentrations in the basal ganglia, a measure of central nervous system oxidative stress, were significantly associated with feeding outcome. CONCLUSIONS: In infants with feeding difficulty, increasing the number of daily taVNS-paired feeding sessions to twice-daily significantly accelerates response time but not the overall response rate of treatment. taVNS was associated with white matter motor tract plasticity in infants able to attain full oral feeds. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04643808).

A review of the new minimally invasive brain stimulation techniques in psychiatry

O conhecimento acerca de regiões específicas do cérebro envolvidas em transtornos psiquiátricos está em franca expansäo como resultado dos avanços recentes em técnicas de neuroimagem funcional. A capacidade de estimular o cérebro em adultos despertos em estado de alerta, sem necessidade de neurocirurgia, é um avanço real sonhado havia muito pelos neurocientistas. Recentemente, desenvolveram-se várias novas técnicas minimamente invasivas para estimular o cérebro. Entre essas novas intervenções somáticas, a estimulaçäo transcraniana magnética (ETM), a estimulaçäo do nervo vago (ENV) e a estimulaçäo cerebral profunda (ECP) revelam-se promissoras ferramentas terapêuticas no tratamento de transtornos neuropsiquiátricos. Neste artigo se faz uma revisäo da história, da metodologia e das perspectivas futuras das técnicas minimamente invasivas de estimulaçäo cerebral (ECMI) e das pesquisas e aplicações terapêuticas em psiquiatria