耳迷走神经电刺激对慢性意识障碍促醒的效果

doi:10.3969/j.issn.1006-9771.2025.03.011

Abstract

Abstract:

Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (ta-VNS) on the recovery of consciousness in patients with prolonged disorders of consciousness (pDoC).

Methods From January, 2023 to August, 2024, 50 patients with pDoC in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and observation group (n = 25). Both groups received conventional wakefulness-promoting treatment and Xingnao Kaiqiao acupuncture, and the observation group added ta-VNS treatment on the basis of the control group, for four weeks. Each group was further divided into unresponsive wakefulness syndrome/vegetative state (UWS/VS) and minimally consciousness state (MCS) types based on their initial the score of Coma Recovery Scale-Revised (CRS-R). They were assessed with Glasgow Coma Scale (GCS), CRS-R, EEG grading and upper limb somatosensory-evoked potentials (SSEP) before and four weeks after treatment.

Results Three in the observation group and five in the control group dropped down for transferring to other hospitals. There was no significant difference in all the indexes between two groups before treatment (P> 0.05). After treatment, the GCS score (|t| > 16.000, P < 0.001), CRS-R score (|t| > 14.318, P < 0.001) and N20 amplitude of SSEP (|t| > 5.247, P < 0.05) improved, the EEG grading was reduced (Z > 2.264, P < 0.05), and the N20 latency of SSEP was shortened (|t| > 2.884, P < 0.05) in both UWS/VS and MCS type patients in the observation group; and they were better in the observation group than in the control group for the same type (|t| > 1.883, |Z| > 2.244, P < 0.05).

Conclusion ta-VNS can significantly promote the awakening of patients with pDoC from UWS/VS and MCS, and improve the functional status of electroencephalogram activities and sensorimotor conduction pathways.

Key words: prolonged disorders of consciousness, transcutaneous auricular vagus nerve stimulation, acupuncture

CLC Number:

R741.041

HUA Longang, LAI Haifang, YANG Wei, LIU Yong, YE Xiangming. Effect of transcutaneous auricular vagus nerve stimulation on patients with prolonged disorders of consciousness[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 339-347.

Figures/Tables 7

Table 1

Figure 1

Figure 2

Table 2

Table 3

Table 4

Table 5

References 31

[1]	FERRE F, HEINE L, NABOULSI E, et al. Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state[J]. Front Hum Neurosci, 2023, 17: 1145253.
[2]	SANZ L, THIBAUT A, EDLOW B L, et al. Update on neuroimaging in disorders of consciousness[J]. Curr Opin Neurol, 2021, 34(4): 488-496. doi: 10.1097/WCO.0000000000000951 pmid: 34054109
[3]	蒙象强, 熊琪, 陈庚发, 等. 经颅磁刺激联合正中神经电刺激干预不同年龄段慢性意识障碍的效果[J]. 中国康复理论与实践, 2023, 29(8): 940-947. doi: 10.3969/j.issn.1006-9771.2023.08.011
	MENG X Q, XIONG Q, CHEN G F, et al. Effects of transcranial magnetic stimulation combined with median nerve electrical stimulation on chronic consciousness disorders in different ages[J]. Chin J Rehabil Theory Pract, 2023, 29(8): 940-947.
[4]	康君伟, 董晓阳, 汤运梁, 等. 迷走神经电刺激治疗慢性意识障碍的临床疗效及潜在机制研究进展[J]. 中国康复医学杂志, 2022, 37(8): 1137-1141.
	KANG J W, DONG X Y, TANG Y L, et al. Research progress on the clinical effect and potential mechanism of vagus nerve electrical stimulation in the treatment of chronic consciousness disorder[J]. Chin J Rehabil Med, 202, 37(8): 1137-1141.
[5]	王茸, 许军峰. 从醒脑开窍针刺法探针刺治神之内涵[J]. 浙江中医药大学学报, 2024, 48(8): 982-985.
[6]	NOÉ E, FERRI J, COLOMER C, et al. Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness[J]. Brain Stimul, 2020, 13(2): 427-429. doi: S1935-861X(19)30476-0 pmid: 31866491
[7]	SEEL R T, SHERER M, WHYTE J, et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research[J]. Arch Phys Med Rehabil, 2010, 91(12): 1795-1813.
[8]	LIU Y S, LIU Z B, YANG Z, et al. Clinical efficacy of hyperbaric oxygen combined with different timings of right median-nerve electrical stimulation in patients with brain injury-induced disorders of consciousness[J]. Brain Behav, 2022, 12(9): e2716.
[9]	MOSHAYEDI P, ELMER J, Habeych M, et al. Evoked potentials improve multimodal prognostication after cardiac arrest[J]. Resuscitation, 2019, 139: 92-98. doi: S0300-9572(19)30125-X pmid: 30995538
[10]	ABE H, SHIMOJI K, NAGAMINE Y, et al. Predictors of recovery from traumatic brain injury-induced prolonged consciousness disorder[J]. Neural Plast, 2017, 2017: 9358092.
[11]	SHEN L, HUANG Y, LIAO Y, et al. Effect of high-frequency repetitive transcranial magnetic stimulation over M1 for consciousness recovery after traumatic brain injury[J]. Brain Behav, 2023, 13(5): e2971.
[12]	SAIF M, SHARBATTI S A, NEMMAR A, et al. Outcomes of neurorehabilitation among patients with prolonged disorders of consciousness[J]. Cureus, 2023, 15(5): e38816.
[13]	黄永志, 吴佳柔, 许敏鹏, 等. 慢性意识障碍相关颅内电生理特征研究进展[J]. 生物医学工程学杂志, 2024, 41(4): 826-832.
	HUANG Y Z, WU J R, XU M P, et al. Research progress of intracranial electrophysiological characteristics related to chronic consciousness disorders[J]. J Biomed Eng, 2019, 41(4): 826-832.
[14]	PORCARO C, NEMIROVSKY I E, RIGANELLO F, et al. Diagnostic developments in differentiating unresponsive wakefulness syndrome and the minimally conscious state[J]. Front Neurol, 2021, 12: 778951.
[15]	YAN D, SIMEI L, HONG Z B, et al. Prognosis of patients with prolonged disorders of consciousness after brain injury: a longitudinal cohort study[J]. Front Public Health, 2024, 12: 1421779.
[16]	冯珍, 白洋. 多模态评估技术在慢性意识障碍患者预后预测中的应用[J]. 中国康复医学杂志, 2023, 38(11): 1481-1484.
	FENG Z, BAI Y. Application of multimodal assessment technique in prognosis prediction of patients with chronic consciousness disorder[J]. Chin J Rehabil Med, 2019, 38(11): 1481-1484.
[17]	陈茜茜, 周芷晴, 赵敬军, 等. 耳迷走神经刺激的作用机制与脑疾病临床应用研究进展[J]. 中国康复医学杂志, 2023, 38(10): 1474-1479.
	CHEN Q X, ZHOU Z Q, ZHAO J J, et al. Research progress on the mechanism of otovagus nerve stimulation and its clinical application in brain diseases[J]. Chin J Rehabil Med, 2023, 38(10): 1474-1479.
[18]	JANG S H, CHO M J. Transcutaneous auricular vagus nerve stimulation in disorders of consciousness: a mini-narrative review[J]. Medicine (Baltimore), 2022, 101(50): e31808.
[19]	YU Y T, YANG Y, WANG L B, et al. Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: the first case report[J]. Brain Stimul, 2017, 10(2): 328-330.
[20]	SHIOZAWA P, SILVA M E, CARVALHO T C, et al. Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review[J]. Arq Neuropsiquiatr, 2014, 72(7): 542-547.
[21]	HAKON J, MOGHISEH M, POULSEN I, et al. Transcutaneous vagus nerve stimulation in patients with severe traumatic brain injury: a feasibility trial[J]. Neuromodulation, 2020, 23(6): 859-864. doi: 10.1111/ner.13148 pmid: 32227429
[22]	VITELLO M M, BRIAND M M, LEDOUX D, et al. Transcutaneous vagal nerve stimulation to treat disorders of consciousness: protocol for a double-blind randomized controlled trial[J]. Int J Clin Health Psychol, 2023, 23(2): 100360.
[23]	HAYS S A, RENNAKER R L, KILGARD M P. Targeting plasticity with vagus nerve stimulation to treat neurological disease[J]. Prog Brain Res, 2013, 207: 275-299. doi: 10.1016/B978-0-444-63327-9.00010-2 pmid: 24309259
[24]	TANG Y, DONG X, CHEN G, et al. Vagus nerve stimulation attenuates early traumatic brain injury by regulating the NF-kappaB/NLRP3 signaling pathway[J]. Neurorehabil Neural Repair, 2020, 34(9): 831-843.
[25]	KUNII N, KOIZUMI T, KAWAI K, et al. Vagus nerve stimulation amplifies task-induced cerebral blood flow increase[J]. Front Hum Neurosci, 2021, 15: 726087.
[26]	WANG L, GAO F, WANG Z, et al. Transcutaneous auricular vagus nerve stimulation in the treatment of disorders of consciousness: mechanisms and applications[J]. Front Neurosci, 2023, 17: 1286267.
[27]	BRIAND M M, GOSSERIES O, STAUMONT B, et al. Transcutaneous auricular vagal nerve stimulation and disorders of consciousness: a hypothesis for mechanisms of action[J]. Front Neurol, 2020, 11: 933.
[28]	应明军, 陈晟, 吕志灵, 等. 醒脑开窍针刺法结合高压氧治疗颅脑损伤意识障碍患者的临床观察[J]. 中国中医急症, 2023, 32(2): 307-310.
	YING M J, CHEN S, LÜ Z L, et al. Clinical observation of Xingnaokaiqiao acupuncture combined with hyperbaric oxygen in the treatment of patients with brain injury and consciousness disorder[J]. J Emerg Tradit Chin Med, 2019, 32(2): 307-310.
[29]	YIFEI W, YI Y, YU W, et al. Transcutaneous auricular vague nerve stimulation improved brain connection activity on patients of disorders of consciousness: a pilot study[J]. J Tradit Chin Med, 2022, 42(3): 463-471. doi: 10.19852/j.cnki.jtcm.2022.03.012
[30]	ZHOU S, ZOU G, XU J, et al. Dynamic functional connectivity states characterize NREM sleep and wakefulness[J]. Hum Brain Mapp, 2019, 40(18): 5256-5268. doi: 10.1002/hbm.24770 pmid: 31444893
[31]	YANG Y, DAI Y, HE Q, et al. Altered brain functional connectivity in vegetative state and minimally conscious state[J]. Front Aging Neurosci, 2023, 15: 1213904.

组别	类型	n	性别(男/女)/n	年龄/岁	病程/d	损伤原因(脑外伤/脑卒中/缺血缺氧性脑病/其他)/n
对照组	UWS/VS	13	8/5	46.77±10.15	121.62±61.28	5/4/3/1
对照组	MCS	7	4/3	35.29±7.02	135.86±60.89	2/2/2/1
观察组	UWS/VS	16	10/6	44.63±10.11	137.94±62.27	7/4/4/1
观察组	MCS	6	3/3	44.67±10.98	132.83±68.02	2/2/1/1

组别	类型	n	测试	$\bar{x}±s$	t值	P值
对照组	UWS/VS	13	前测	5.23±1.17	-10.198	< 0.001
			后测	7.23±1.36
	MCS	7	前测	8.29±1.11	-15.000	< 0.001
			后测	10.43±0.98
观察组	UWS/VS	16	前测	5.25±1.29	-19.365	< 0.001
			后测	9.00±1.71
	MCS	6	前测	8.17±0.98	-16.000	< 0.001
			后测	13.50±1.22
	治疗前两组UWS/VS均值差			0.02±0.46	0.042	0.967
	治疗后两组UWS/VS均值差			1.77±0.59	3.024	0.005
	治疗前两组MCS均值差			-0.12±0.59	-0.203	0.843
	治疗后两组MCS均值差			3.07±0.61	5.037	< 0.001

组别	类型	n	测试	$\bar{x}±s$	t值	P值
对照组	UWS/VS	13	前测	5.85±1.46	-7.268	< 0.001
			后测	8.85±2.01
	MCS	7	前测	9.43±1.13	-6.584	0.001
			后测	11.86±1.68
观察组	UWS/VS	16	前测	6.38±1.89	-18.482	< 0.001
			后测	11.06±1.77
	MCS	6	前测	9.67±0.82	-14.318	< 0.001
			后测	16.50±1.87
	治疗前两组UWS/VS均值差			0.53±0.64	0.826	0.416
	治疗后两组UWS/VS均值差			3.29±0.70	4.696	< 0.001
	治疗前两组MCS均值差			0.24±0.56	0.427	0.678
	治疗后两组MCS均值差			4.64±0.98	4.722	0.001

组别	类型	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	UWS/VS	13	前测	4(4,5)	-2.887	0.004
			后测	4(3,4)
	MCS	7	前测	3(3,4)	-2.000	0.046
			后测	3(2,4)
观察组	UWS/VS	16	前测	4(4,5)	-3.624	< 0.001
			后测	3(2,3)
	MCS	6	前测	3.5(2.75,4)	-2.264	0.024
			后测	1(1,2)
	治疗前两组UWS/VS均值差				-0.695	0.487
	治疗后两组UWS/VS均值差				-2.318	0.020
	治疗前两组MCS均值差				-0.155	0.877
	治疗后两组MCS均值差				-2.244	0.025

变量	组别	类型	n	测试	$\bar{x}±s$	t值	P值
潜伏期/ms	对照组	UWS/VS	13	前测	24.25±3.41	3.240	0.007
				后测	21.15±1.94
		MCS	7	前测	26.54±3.92	2.698	0.036
				后测	22.33±1.85
	观察组	UWS/VS	16	前测	24.27±3.23	5.229	< 0.001
				后测	18.74±1.89
		MCS	6	前测	25.81±2.83	2.884	0.034
				后测	17.91±1.34
		治疗前两组UWS/VS均值差			0.02±1.24	0.012	0.990
		治疗后两组UWS/VS均值差			-2.41±0.71	-3.380	0.002
		治疗前两组MCS均值差			-0.75±1.93	-0.381	0.710
		治疗后两组MCS均值差			-4.42±0.91	-4.851	< 0.001
振幅/µV	对照组	UWS/VS	13	前测	1.07±0.30	-1.060	0.310
				后测	1.26±0.37
		MCS	7	前测	1.11±0.24	-3.119	0.021
				后测	1.49±0.28
	观察组	UWS/VS	16	前测	1.10±0.23	-7.027	< 0.001
				后测	1.62±0.28
		MCS	6	前测	1.21±0.34	-5.247	0.003
				后测	1.70±0.37
		治疗前两组UWS/VS均值差			-0.01±0.09	-0.121	0.905
		治疗后两组UWS/VS均值差			0.44±0.14	3.152	0.004
		治疗前两组MCS均值差			0.14±0.18	0.812	0.434
		治疗后两组MCS均值差			0.24±0.19	1.883	0.023

Effect of transcutaneous auricular vagus nerve stimulation on patients with prolonged disorders of consciousness

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 31

Related Articles 15

Metrics

Comments

Recommended 0

[1]	MU Zichen, TANG Qiang, SHI Yunqiu, WANG Yan, ZHU Shuwei, ZHUANG Ya'nan, XU Danshuang, LI Hongyu, LI Baolong, ZHANG Chunyan, YUAN Mengke. Effect of enriched environment combined with acupuncture at head points on behavior in rats with autism spectrum disorder [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 176-182.
[2]	MA Erhao, SHEN Yan, WANG Shangquan, DONG Jige. Effect of suspension combined with acupuncture on chronic non-specific neck pain [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 232-237.
[3]	XU Fangyuan, HU Peijia, YE Yu, DAI Fan, CHENG Hongliang. Effect of acupuncture and moxibustion on post-stroke dysphagia from 1994 to 2023: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(11): 1299-1310.
[4]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[5]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[6]	ZHENG Li, BAO Zhicheng, ZHANG Qi, REN Xuyan, SU Min. Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 691-696.
[7]	WANG Yan, JIN Longtao. Effect of acupuncture on children with attention deficit hyperactivity disorder [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 615-620.
[8]	ZHANG Xiaofeng, LIU Yong, JIN Zhenhua. Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 280-285.
[9]	YUAN Huiping, FENG Xiaojun, JIANG Dongsheng, CHE Xingwang, FAN Lianbin. Effect of hyperbaric oxygen combined with dynamic scalp acupuncture on motor function for stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1208-1213.
[10]	QIN Yanqiang, DONG Hao, SUN Yingchun, CHENG Xiankuan, YAO Haijiang. Effects of different acupuncture schemes on neurotransmitters and related inflammatory factors in rats with post-stroke depression [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 30-37.
[11]	ZHANG Li,WU Shanhong,ZHAO Lele,WANG Yan. Role of Netrin-1 and Slit2 in regulating the imbalance of Rho GTPases after Jiaji electroacupuncture combined with nerve mobilization for sciatic nerve injury in rabbits [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(8): 914-926.
[12]	TANG Qiang,WANG Xue,MU Zichen,ZHANG Shiqiang,ZHU Luwen. Effects of acupuncture and rehabilitation therapy on lower limb motor function after stroke: an fNIRS study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 32-37.
[13]	DING Yanyi,ZHANG Shenghang,LIU Yulu,YU Yan,YANG Minguang,LIANG Shengxiang,LIU Weilin,TAO Jing. Effect of electroacupuncture on regional homogeneity of brain function in rats with vascular cognitive impairment [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 55-61.
[14]	Yan LIU,He BA,Deng ZHAO,Li LIU,Jian-fei LI,Jian WANG,Li LI. Effect of Music Therapy Based on Scalp Acupuncture on Post-stroke Depression: Study with Resting-state Functional Magnetic Resonance Imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 282-289.
[15]	Qiong-fen WANG,Feng-bo WANG,Ke WANG,Yong-qiang ZHONG,Jiao-jiao WANG. Effect of Electroacupuncture at Fengchi on Astrocytes and Neurons in Rats with Acute Cerebral Infarction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 302-309.