Treatment Prospects: Vagus Nerve Stimulation

[Markku]

News of Vagus Nerve Stimulation and how it stopped the ringing in rats hit the internet early this year.

Investigator paired tones with brief pulses of vagus nerve stimulation, eliminating the physiological and behavioral symptoms of tinnitus in noise-exposed rats.

Investigators were able to use vagus nerve stimulation (VNS) to restore neural activity to normal and reverse the pathology of tinnitus in a rat model, according to a paper published online Jan. 12 before the print edition of Nature.

Then the article goes on further to explain the current thought mechanism of many types of tinnitus and chronic pain and how it's believed irregular neural activity caused by nerve damage or cochlear trauma to have a part in the whole thing:

"Brain changes in response to nerve damage or cochlear trauma cause irregular neural activity believed to be responsible for many types of chronic pain and tinnitus," said the senior investigator Michael Kilgard, PhD, associate professor of neuroscience at the University of Texas at Dallas.

The brain maps in the somatosensory and auditory cortex are changed in response to the noise trauma and this generates pathological neural activity thought to be responsible for the tinnitus, the study author explained, adding that the severity of the tinnitus is correlated with the degree of map reorganization.

Tones paired with brief pulses of Vagus Nerve Stimulation eliminated physiological and behavioral symptoms of tinnitus in noise-exposed rats, it's also worth noting that VNS alone didn't eliminate tinnitus, only VNS paired with multiple tones:

"When we paired tones with brief pulses of VNS we eliminated the physiological and behavioral symptoms of tinnitus in noise-exposed rats," said the lead author Navzer D. Engineer, PhD, vice president of preclinical affairs at MicroTransponder and a former post-doctoral fellow in the Dr. Kilgard's laboratory. The animals were monitored for three weeks after the therapy and the changes remained constant. "Pairing sounds with VNS provides that precision by rewiring damaged circuits and reverses the abnormal activity that generates the phantom sound."

One might wonder how do the scientists tell if a rat has tinnitus or not:

Using animals to study tinnitus is challenging. The scientists used a "gap detection model," exposing the rats to loud noise for one hour under anesthesia and then testing their ability to respond to a quiet gap, a silent interval, in a tone near the tinnitus frequency. The noise-exposed rats showed a significant impairment in their ability to do this but they had a normal response when the gap was placed in a higher or lower tone. The Texas researchers said that this frequency-specific impairment in gap detection is a sign that noise-exposed rats experience a mid-frequency tinnitus 'ringing' that fills the silent gaps.

And three weeks later...

Three weeks after the therapy, the investigator studied the brains and identified an increase in the number of cells in the primary auditory cortex near the paired tone frequency, suggesting that the technique generated long-lasting changes in cortical organization. In other words, it reversed the abnormal brain changes that trigger tinnitus.

"The tinnitus was eliminated in the rats," said Dr. Engineer. They recorded the electrical activity and found that there was less excitability, less spontaneous firing of nerve cells and less synchrony. This synchrony is not a good thing because neurons fire together and most likely results in the ringing sensation.

"It seems to rewire abnormal brain circuits," he added. "Unfortunately, the brain lacks the ability to optimally repair itself after damage to the inner ear after exposure to loud sounds. The brain does not sit dormant either. Instead, these neurons generate abnormal activity that the patient perceives as a phantom sound."

You can read more about this study from the following links:
http://journals.lww.com/neurotodayo..._Stimulation_Helps_Resolve_Tinnitus_in.2.aspx
http://www.physorg.com/news/2011-01-rebooting-brain-tinnitus-rats.html


I think this treatment does look promising, but it's too early to tell how it works in humans and I don't even want to guess how long it'll take before this treatment comes widely available if it shows promise in humans.

We'll have to wait and see, but this is one of the more promising treatment prospects in my opinion.

 

[sinuses]

to be honest it sounds complicated but some news is better than no news at all

lets all hope this will become a viable treatmet option ! : )

 

[bob]

Just got done reading a story in our local newspaper that they tested this vagus nerve stimulation on rats and had great success. I have no idea how they gave the rats tinnitus. Just hoping for a miracle. Just google vagus nerve stimulation to get more info for this miracle.

 

[Karl]

Bob -
I have also heard about this. There is a company called MicroTransponder which is agressively seeking investers. They have lately gotten some press in Nature magazine, on television and radio.

The device they are marketing stimulates the vagus nerve in the neck. They claim that the "neurostimulator" treats a variety of things, such as epilepsy, chronic pain. In one clinical study in Belgium, 7 out of 10 tinnitus sufferers reported a significant reduction in tinnitus using this device.

Here's a video:
http://www.youtube.com/watch?v=yMLbFwltBdc&list=UUNxd0x6YhKG-s2L8KBbTL2A&index=9&feature=plcp

I watched this video, and frankly I was turned off by how much they speculate what tinnitus sufferers are willing to pay for their device. Sure, businesses are in business to make money; but within the context of medicine, squeezing sufferers for as much money as they can get sucks. Whatever happened to scientists looking for a cure before looking at the bottom line? They also speak in generalities, saying this their neurostimulator will work for a broad range of ailments. They may be mixing up apples and oranges, in my opinion. I'm skeptical.

 

[Goodcheer]

Bob & Karl - thanks for this - interesting - not sure I fancy an implant though.

A quick look at a general item on Vagus Nerve Stimulation on Wikipedia found reference to transcutaneous vagus nerve stimulation via tens devices - and points to the concha of the ear as possible stimulation points - apparently there are nerve endings there that connect to the Vagus Nerve.

One could try this at no cost at all using the finger tip - or you can get small stimulation devices at reasonable cost (choose carefully there are some poor quality ones which don't work too well).

My wife and I use ours for drug free pain relief - and I use my for allergy control.

To be honest when I sent for mine I was not expecting anything much to come from it - and was surprised to find how effective it is.

I have just started using acupuncture points with the tens device for tinnitus. I have noticed a slight improvement following the application - which is encouraging - but only been doing it for a couple of days so far too early to draw conclusions - but I will feed back when I have more info.

 

[Karl]

Goodcheer -
Thanks for this information! I just may try what you are talking about. Perhaps I should try acupuncture?

The MicroTransponder people are accessing this market to maximize their profit. They say that some tinnitus patients would pay $50K for a device that would eliminate tinnitus.

 

[Goodcheer]

Karl...Hmmmm...

What would I spend 50k on ... I think I might try the finger in the ear for free and have fun with the change!

I have not used acupuncture via an acupuncturist - if you can afford it give it a go - it can't hurt! I know from my self treatment that stimulation via acupuncture points works.

My position with these diy treatments is a little skewed by the fact that I suffered a very bad prescription some 20 years ago - and ever since have reacted with visual disturbance and migraine to virtually all chemical medications. So I have to manage without prescription medication.

The outcome for me has been twofold - I take nothing on trust from any practitioner - medical or alternative - and check and double check any therapy and the practitioner as far as I possibly can.

And mostly I take care of myself - it is amazing just how much you can do and how much useful therapy there is. Of course you have to be streetwise - as we all know only too well there are zillions of phoney therapies and armies of "practitioners" touting them.

But it is liberating to be responsible for your own health and to make your own decisions.

Right now my back is to the wall with my allergy problem - the tinnitus is a bonus - but I have been there before and got out of it - so I guess I will again.

Forgive me if I am rambling - thought maybe it would be useful to give everyone some clarity as to where I am coming from.

 

[joe]

Here's The latest, I am a little down about this, I thought It would of had a higher success rate than 70 percent

http://www.willrosellini.com/microtransponders-q1-2012-newsletter/​

 

[Tha_b_man]

DOWN???? Every other remedy has basically a 0% success rate. 70% is great. There is progress being made.

 

[Molan]

Not 100% sure but wasn't there only 7 people in this study? Also what counts as a success? Does a mild reduction count as a success?

Personally I do not like this because I believe it focuses on the symptom not the actual problem itself which is damage to the structures of the inner ear.

 

[Jon Wayne]

Not 100% sure but wasn't there only 7 people in this study? Also what counts as a success? Does a mild reduction count as a success?

Personally I do not like this because I believe it focuses on the symptom not the actual problem itself which is damage to the structures of the inner ear.

tinnitus is not about the ear, it's all in the brain

 

[Molan]

Jon Wayne I have spent alot of time researching this issue and in my opinion the brain only seems to respond to damage in the inner ear. Due to the lowered auditory input from the ear to the brain, it seems to change things somehow possibly creating the conditions which leads to Tinnitus. I personally believe if the structures in the inner ear could be repaired and the brain then received normal input again I believe the Tinnitus would dissapear.

This is obviously just my opinion though but I believe the Vagus nerve stuff is focusing on the symptom not the cause of the problem.

 

[Goodcheer]

Hi

I promised to come back with the results of my test - so here we go!

From the information I picked up on this thread I have been experimenting with stimulating nerve endings leading to the vagus nerve with an acupuncture pen (electronic stimulation device with a pointed probe) - applied to the concha of the ears - 2 applications to each ear - 2 or 3 times a day for 90 seconds. Until the application of this device my tinnitus had been constant and unremitting - loud. If we called the original level 100% then I would estimate that it has been reduced to a constant 20-25% for most of the time. There are occasional reversions - but never to the original level.

The psychological benefit has been enormous - knowing that you have some control is a profound relief - and currently, whilst I still have a distinctly audible tinnitus I don't notice it too much. The cause of my tinnitus is unknown but does not stem from damage or exposure to loud noise.

People have been discussing low intensity laser therapy on another thread. It is probably worth me reporting that I used low intensity laser therapy for a severe food and inhalant allergy for a period of about 4 years.

It was extremely successful enabling an 85% recovery in weeks from a problem that had been intractable for 17 years- and as I say, I was well for 4 years. Eventually I became accommodated to it and it no longer worked for me - stemming from frequent use, accommodation is a problem to be aware of - possibly if I had been more alert I could have avoided it.

I suspect that low intensity laser therapy will work as well if not better than the acupuncture pen. Unfortunately I am not able to trial it for tinnitus myself as I am accommodated to it so it no longer works for me. I am not sure whether there are safety issues using it around the head and obviously one would want to go into this carefully. Lasers are extremely dangerous to the eyes and must be used with eye protection and very great care.

There seem to be dozens of inexpensive units around which I suspect are underpowered and may be of very limited value, I bought a professional physiotherapists setup at an eye watering price - but it was worth it for what it did for me.

I can recommend both devices wholeheartedly. I have used them for a variety of problems on myself, family and friends with very good results.

As with the laser - the very cheapest acupuncture pens are poor quality and not worth buying.

Obviously It would be good if we could gather together a few more reports - I would be very interested to hear if anyone else is using these devices and whether they are getting results similar to mine.

 

[David King]

I've had my eyes on a German medical company, called Cerbomed, for a while now. They also use vagus nerve stimulation, just like MicroTransponder, however they have developed a device that does not have to be implanted. They call their method t-VNS, which stands for transcutaneous Vagus Nerve Stimulation, which means stimulation through the skin. It works by stimulating a branch of the vagus nerve that goes behind the ear, which sends signals deeper into the nerve. From what I remember this is used in conjunction with auditory stimulus, just as in the case of MicroTransponder. This is currently being tested in a clinical trial that ends in July.

 

[joe]

Microtransponder vagus nerve stimulation consists of stimulating the 7th cranial nerve whilst playing a 4khz and 19khz tone.

 

[erik]

From Today July 19, 2012: The University of Texas at Dallas neuroscientists showed that they could alter the speed at which the brain works in laboratory animals by pairing stimulation of the vagus nerve with fast or slow sounds. A team led by Dr. Robert Rennaker and Dr. Michael Kilgard looked at whether repeatedly pairing vagus nerve stimulation with a specific movement would change neural activity within the laboratory rats' primary motor cortex. To test the hypothesis, they paired the vagus nerve stimulation with movements of the forelimb in two groups of rats. The results were published in a recent issue of Cerebral Cortex. After five days of stimulation and movement pairing, the researchers examined the brain activity in response to the stimulation. The rats who received the training along with the stimulation displayed large changes in the organization of the brain's movement control system. The animals receiving identical motor training without stimulation pairing did not exhibit any brain changes, or plasticity. People who suffer strokes or brain trauma often undergo rehabilitation that includes repeated movement of the affected limb in an effort to regain motor skills. It is believed that repeated use of the affected limb causes reorganization of the brain essential to recovery. The recent study suggests that pairing vagus nerve stimulation with standard therapy may result in more rapid and extensive reorganization of the brain, offering the potential for speeding and improving recovery following stroke, said Rennaker, associate professor in The University of Texas at Dallas' School of Behavioral and Brain Sciences

"Our goal is to use the brain's natural neuromodulatory systems to enhance the effectiveness of standard therapies," Rennaker said. "Our studies in sensory and motor cortex suggest that the technique has the potential to enhance treatments for neurological conditions ranging from chronic pain to motor disorders. Future studies will investigate its effectiveness in treating cognitive impairments." Since vagus nerve stimulation has an excellent safety record in human patients with epilepsy, the technique provides a new method to treat brain conditions in which the timing of brain responses is abnormal, including dyslexia and schizophrenia. In another paper in the journal Experimental Neurology, Kilgard led a team that paired vagus nerve stimulation with audio tones of varying speeds to alter the rate of activity within the rats' brains. The team reported that this technique induced neural plasticity within the auditory cortex, which controls hearing. "Our goal is to use the brain's natural neuromodulatory systems to enhance the effectiveness of standard therapies," Dr. Rennaker said. The UT Dallas researchers are working with a device developed by MicroTransponder, a biotechnology firm affiliated with the University. MicroTransponder currently is testing a vagus nerve stimulation therapy on human patients in Europe in hopes of reducing or eliminating the symptoms of tinnitus, the debilitating disorder often described as "ringing in the ears." "Understanding how brain networks self-organize themselves is vitally important to developing new ways to rehabilitate patients diagnosed with autism, dyslexia, stroke, schizophrenia and Alzheimer's disease," said Kilgard, a professor of neuroscience. Treatment of neurological disease is currently limited to pharmacological, surgical or behavioral interventions. But this recent research indicates it may be possible to effectively manipulate the plasticity of the human brain for a variety of purposes. Patients then could benefit from brain activity intentionally directed toward rebuilding lost skills. If subsequent studies confirm the UT Dallas findings, human patients may have access to more efficient therapies that are minimally invasive and avoid long-term use of drugs.

Read more at:http://www.utdallas.edu/news/2012/7...imulation-Can-Help-Reorgani_article-wide.html


http://medicalxpress.com/news/2012-07-brain-tinnitus-treatments.html

 

[mock turtle]

erik

yeah the vagus nerve is quite amazing...i read it got its name because it wanders all over the body. among other functions, it is the brain gut connection...or the entric nervous system so to speak and has been implicated in everything from reflux disease, to GAD (anxiety) to epilepsy.... and vns ( v nerve stim) has even been shown to sometimes alleviate depression...there seems to be no end in sight

 

[erik]

I hear you Mock, this T is puzzling and there are so, so many variables. The human brain and body is one complex organism.

 

[Meecat]

Talking to a guy who runs a lab and has contact with Kilgard, unofficial word is about 40% of patients respond to VNS. I didn't ask too much but I'm not sure whether thats in terms of improvement of tinnitus volume or the dreaded tinnitus handicap score/inventory. Either way, this is promising in that at unlike decades ago, there are actual potential avenues for tinnitus treatment. We live in exciting times, I just wish the pace in research was much faster

 

[Aaron]

VNS Trial invitation

www.trial-vns-tinnitus-dallas.org

 

[II Packy II]

Submitted myself to UT Dallas. Live a few hours from there so hopefully that plays a role.

 

[Hudson]

I do know that the University of Iowa Tinnitus Clinic will be the PI on this study... at least that's what they told me when I was there.

 

[II Packy II]

All that matters is people have broader chance :0

 

[Champ]

I want to sign up for this (yay, guinea pig!) but I'm too far away...

 

[Jeff M.]

Submitted myself to UT Dallas. Live a few hours from there so hopefully that plays a role.

REALLY interested in hearing how it goes!! Thank you for your willingness to be a part of the study !! I pray it is successful! Keep us posted please!

 

[II Packy II]

Already got an email from them saying they will call me in the next week!

 

[II Packy II]

REALLY interested in hearing how it goes!! Thank you for your willingness to be a part of the study !! I pray it is successful! Keep us posted please!

Will do. I have long believed this method has all the potential in the world.

 

[II Packy II]

Just hope my family takes it seriously like I do! T is awful lately

 

[NeoM]

Already got an email from them saying they will call me in the next week!

That's great. Hope it works out for you.

 

[matthew heafield]

Keep us all posted mate