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Transcutaneous Auricular Vagus Nerve Stimulation (Tavns): Development, Safety, Parametric Optimization, and Neurophysiological Effects

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Transcutaneous Auricular Vagus Nerve Stimulation (Tavns): Development, Safety, Parametric Optimization, and Neurophysiological Effects Medical University of South Carolina MEDICA MUSC Theses and Dissertations 2017 Transcutaneous Auricular Vagus Nerve Stimulation (taVNS): Development, Safety, Parametric Optimization, and Neurophysiological Effects Bashar W. Badran Medical University of South Carolina Follow this and additional works at: https://medica-musc.researchcommons.org/theses Recommended Citation Badran, Bashar W., "Transcutaneous Auricular Vagus Nerve Stimulation (taVNS): Development, Safety, Parametric Optimization, and Neurophysiological Effects" (2017). MUSC Theses and Dissertations. 70. https://medica-musc.researchcommons.org/theses/70 This Dissertation is brought to you for free and open access by MEDICA. It has been accepted for inclusion in MUSC Theses and Dissertations by an authorized administrator of MEDICA. For more information, please contact [email protected]. Truman R Brown © 2017 Bashar W. Badran ALL RIGHTS RESERVED To my loving parents – Huda and Wadih To my brothers – Karam and Alan To my best friends – Chris, Greg, Joe, Josh, Thomas To my mentor – Dr. George iii ACKNOWLEDGMENTS My early interest in brain stimulation stemmed from working with Dr. William Stubbeman, an engineer, psychiatrist, and good friend who I credit with encouraging me to meditate more and pursue my Ph.D. Logan Dowdle, who I have shared an office with for over four years and who taught me more than I can imagine when it comes to imaging. He played an integral role in helping analyze my imaging experiments. Chloe Glusman, Nick LaBette, Caroline Summer, Philip Summers, and Alan Badran all helped with executing the complicated physiological trials described in Chapters 2 and 3. My mentor Dr. Mark George and committee members: Drs. Truman Brown, Colleen Hanlon, Jeffrey Borckardt, Lisa McTeague, and Donna Roberts. All experts in their field and a team of scientists willing to spend their time making sure I could follow in their footsteps. I am grateful to the MUSC Brain Stimulation Lab in Charleston SC, which not only supported my research and education, but also supported me as a maturing young scientist. It is wonderful place full of friendly gracious individuals, especially my colleagues and friends William DeVries, Dr. Xiangbao Li, Dr. Baron Short, and Dr. Greg Sahlem. MUSC Center for Biomedical Imaging for their development time offering and the staff, especially Jayce and James and Jimmy. Jimmy stayed late nights with me scanning for my last chapter of this dissertation and without, him the imaging trial could not have been completed. Lastly, none of the studies conducted would be possible without Minnie Dobbins. She keeps the lab ticking. iv TABLE OF CONTENTS ACKNOWLEDGMENTS ........................................................................................................... iv LIST OF TABLES .................................................................................................................... viii LIST OF FIGURES ..................................................................................................................... ix KEY TO SYMBOLS OR ABBREVIATION .............................................................................. x ABSTRACT .............................................................................................................................. xiii CHAPTER 1 ................................................................................................................................. 1 OVERVIEW OF VAGUS NERVE STIMULATION (VNS) ..................................................... 1 HumAn AnAtomy oF the VAgus Nerve .......................................................................................... 1 Cranial Nerve X ................................................................................................................................................ 1 Peripheral Targets .......................................................................................................................................... 3 Afferent Brain Targets .................................................................................................................................. 5 EarLy Vagus Nerve StimuLAtion ..................................................................................................... 7 Initial Animal Trials Exploring VNS ........................................................................................................ 7 VNS for Epilepsy in Humans .................................................................................................................... 10 Modern VAgus Nerve StimuLAtion .............................................................................................. 12 Implantation and Programming ............................................................................................................ 12 Parameters ...................................................................................................................................................... 15 VNS for Resistant Depression ................................................................................................................. 17 Key VNS Functional Neuroimaging Trials ......................................................................................... 19 Recent Strides in VNS ..................................................................................................................... 21 Promising Animal Trials ........................................................................................................................... 21 Noninvasive Vagus Nerve Stimulation (nVNS) ............................................................................... 25 CHAPTER 2 .............................................................................................................................. 29 STUDY 1: A CONTROLLED TRIAL EXPLORING THE SAFETY, FEASIBILITY and HEART RATE EFFECTS oF tAVNS ....................................................................................... 29 Study Summary ................................................................................................................................ 29 Introduction ...................................................................................................................................... 30 Autonomic nervous system ..................................................................................................................... 30 The Effect of Cervically Implanted VNS on HR ................................................................................ 31 Rationale Behind Study 1 ......................................................................................................................... 33 Methods .............................................................................................................................................. 34 v Overview .......................................................................................................................................................... 34 Participants and Inclusion Criteria ...................................................................................................... 34 taVNS Stimulation System and Parameters ...................................................................................... 35 Ear Stimulation Targets ............................................................................................................................ 37 Safety and Tolerability Reporting ......................................................................................................... 38 HR Data Acquisition, Preprocessing, Statistics ............................................................................... 40 ResuLts ................................................................................................................................................ 41 Participants, Perceptual Thresholds (PT), and Stimulation Current ..................................... 41 Adverse Events and Pain Ratings .......................................................................................................... 41 Overall Effect of Stimulation Condition on HR (HR) ..................................................................... 45 Multivariate Analysis of HR to Determine Parametric Effects ................................................. 48 Discussion ......................................................................................................................................... 52 Limitations ...................................................................................................................................................... 56 ConcLusion ......................................................................................................................................... 57 CHAPTER 3 .............................................................................................................................. 58 STUDY 2: DETERMINING THE OPTIMAL taVNS PARAMTER WHICH ACTIVATES THE PARASYMPATHETIC NERVOUS SYSTEM .............................................................. 58 Study Summary ................................................................................................................................ 58 Introduction ...................................................................................................................................... 59 Study Aim 1 Findings .................................................................................................................................
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