Transcutaneous vagus nerve stimulation and the realm of its therapeutic hopes and physiologic enigmas

  • Max J. Hilz
    Corresponding author at: University of Erlangen-Nuremberg, Schlossplatz 4, D-91054 Erlangen, Germany; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany

    Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  • Armin Bolz
    tVNS Technologies GmbH, Ebrardstr. 31, 91054 Erlangen, Germany
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Published:September 27, 2022DOI:


      Vagus nerve stimulation (VNS) is an established treatment option for patients with treatment resistant epilepsy and depression. However, the procedure is invasive and has side-effects. Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive alternative. Particularly transcutaneous stimulation at the outer ear is gaining increasing interest. While the scope of therapeutic tVNS applications is expanding, there are still questions regarding the optimal stimulation parameters and site as well as the physiology and pathways of auricular tVNS. This Special Issue of Autonomic Neuroscience: Basic & Clinical provides an introduction and overview on basic aspects as well as special topics of tVNS.


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        • Baig S.S.
        • Kamarova M.
        • Ali A.
        • Su L.
        • Dawson J.
        • Redgrave J.N.
        • Majid A.
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        • van Beekum C.J.
        • Willis M.A.
        • von Websky M.W.
        • Sommer N.P.
        • Kalff J.C.
        • Wehner S.
        • Vilz T.O.
        Electrical vagus nerve stimulation as a prophylaxis for SIRS and postoperative ileus.
        Auton. Neurosci. 2021; 235102857
        • Bolz A.
        • Bolz L.O.
        Technical aspects and future approaches in transcutaneous vagus nerve stimulation (tVNS).
        Auton. Neurosci. 2022; 239102956
        • Carandina A.
        • Rodrigues G.D.
        • Di Francesco P.
        • Filtz A.
        • Bellocchi C.
        • Furlan L.
        • Carugo S.
        • Montano N.
        • Tobaldini E.
        Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease.
        Auton. Neurosci. 2021; 236102893
        • Diedrich A.
        • Urechie V.
        • Shiffer D.
        • Rigo S.
        • Minonzio M.
        • Cairo B.
        • Smith E.C.
        • Okamoto L.E.
        • Barbic F.
        • Bisoglio A.
        • Porta A.
        • Biaggioni I.
        • Furlan R.
        Transdermal auricular vagus stimulation for the treatment of postural tachycardia syndrome.
        Auton. Neurosci. 2021; 236102886
        • Hilz M.J.
        Transcutaneous vagus nerve stimulation - a brief introduction and overview.
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        • Holland A.
        • Manning K.
        T-VNS to treat disorders of behaviour in Prader-Willi syndrome and in people with other neurodevelopmental conditions.
        Auton. Neurosci. 2022; 239102955
        • Höper S.
        • Kaess M.
        • Koenig J.
        Prefrontal cortex oxygenation and autonomic nervous system activity under transcutaneous auricular vagus nerve stimulation in adolescents.
        Auton. Neurosci. 2022; 241103008
        • Jackowska M.
        • Koenig J.
        • Vasendova V.
        • Jandackova V.K.
        A two-week course of transcutaneous vagal nerve stimulation improves global sleep: findings from a randomised trial in community-dwelling adults.
        Auton. Neurosci. 2022; 240102972
        • Keute M.
        • Gharabaghi A.
        Brain plasticity and vagus nerve stimulation.
        Auton. Neurosci. 2021; 236102876
        • Ko D.W.K.
        Transcutaneous vagus nerve stimulation (tVNS) as a potential therapeutic application for neurodegenerative disorders - a focus on dysautonomia in Parkinson's disease.
        Auton. Neurosci. 2021; 235102858
        • Komisaruk B.R.
        • Frangos E.
        Vagus nerve afferent stimulation: projection into the brain, reflexive physiological, perceptual, and behavioral responses, and clinical relevance.
        Auton. Neurosci. 2022; 237102908
        • Ludwig M.
        • Wienke C.
        • Betts M.J.
        • Zaehle T.
        • Hammerer D.
        Current challenges in reliably targeting the noradrenergic locus coeruleus using transcutaneous auricular vagus nerve stimulation (taVNS).
        Auton. Neurosci. 2021; 236102900
        • Machetanz K.
        • Berelidze L.
        • Guggenberger R.
        • Gharabaghi A.
        Transcutaneous auricular vagus nerve stimulation and heart rate variability: analysis of parameters and targets.
        Auton. Neurosci. 2021; 236102894
        • Neuhuber W.L.
        • Berthoud H.R.
        Functional anatomy of the vagus system - emphasis on the somato-visceral interface.
        Auton. Neurosci. 2021; 236102887
        • Redgrave J.
        • Day D.
        • Leung H.
        • Laud P.J.
        • Ali A.
        • Lindert R.
        • Majid A.
        Safety and tolerability of transcutaneous vagus nerve stimulation in humans; a systematic review.
        Brain Stimul. 2018; 11: 1225-1238
        • Sinkovec M.
        • Trobec R.
        • Meglic B.
        Cardiovascular responses to low-level transcutaneous vagus nerve stimulation.
        Auton. Neurosci. 2021; 236102851
        • Straube A.
        • Eren O.
        tVNS in the management of headache and pain.
        Auton. Neurosci. 2021; 236102875
        • von Wrede R.
        • Surges R.
        Transcutaneous vagus nerve stimulation in the treatment of drug-resistant epilepsy.
        Auton. Neurosci. 2021; 235102840
        • Zaehle T.
        • Galazky I.
        • Krauel K.
        The LC-NE system as a potential target for neuromodulation to ameliorate non-motor symptoms in Parkinson's disease.
        Auton. Neurosci. 2021; 236102901