Noninvasive Cervical Vagal Nerve Stimulation Alters Brain Activity During Traumatic Stress in Individuals With Posttraumatic Stress Disorder

• Type of Material: Article
• Authors: Matthew T Wittbrodt, Emory University; Nil Z Gurel, Georgia Institute of Technology; Jonathon Nye, Emory University; Md Mobashir H Shandhi, Georgia Institute of Technology; Asim H Gazi, Georgia Institute of Technology; Amit Shah, Emory University; Bradley Pearce, Emory University; Nancy Murrah, Emory University; Yi-An Ko, Emory University; Lucy H Shallenberger, Emory University; Viola Vaccarino, Emory University; Omer T Inan, Georgia Institute of Technology; James Bremner, Emory University
• Language: English
• Date: 2021-11-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 by the American Psychosomatic Society
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PSY.0000000000000987
• Title of Journal or Parent Work: PSYCHOSOMATIC MEDICINE
• Volume: 83
• Issue: 9
• Start Page: 969
• End Page: 977
• Grant/Funding Information: This work was sponsored by the Defense Advanced Research Projects Agency (DARPA) Biological Technologies Office (BTO) Targeted Neuroplasticity Training (TNT) program through the Naval Information Warfare Center (NIWC) Cooperative Agreement No. N66001-16-4054. MTW was also sponsored by TL1TR002382 and UL1TR002378 during preparation of this manuscript.
• Keywords: BA = Brodmann area; Hippocampus; tcVNS = transcutaneous cervical vagal nerve stimulation; PTSD; DOUBLE-BLIND; WOMEN; ACTIVATION; vagal nerve stimulation; METAANALYSIS; ABUSE; Psychiatry; ANTERIOR CINGULATE CORTEX; anterior cingulate; DSM = Diagnostic and Statistical Manual of Mental Disorders; trauma; PTSD = posttraumatic stress disorder; Science & Technology; ELECTRICAL-STIMULATION; taVNS = transcutaneous auricular vagal nerve stimulation; Psychology, Multidisciplinary; VNS = vagal nerve stimulation; Social Sciences; ANXIETY; POSITRON-EMISSION-TOMOGRAPHY; Psychology; SPM = statistical parametric mapping; HR-PET = high-resolution positron emission tomography; Life Sciences & Biomedicine

Abstract

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a disabling condition affecting a large segment of the population; however, current treatment options have limitations. New interventions that target the neurobiological alterations underlying symptoms of PTSD could be highly beneficial. Transcutaneous cervical (neck) vagal nerve stimulation (tcVNS) has the potential to represent such an intervention. The goal of this study was to determine the effects of tcVNS on neural responses to reminders of traumatic stress in PTSD. METHODS: Twenty-two participants were randomized to receive either sham (n = 11) or active (n = 11) tcVNS stimulation in conjunction with exposure to neutral and personalized traumatic stress scripts with high-resolution positron emission tomography scanning with radiolabeled water for brain blood flow measurements. RESULTS: Compared with sham, tcVNS increased brain activations during trauma scripts (p < .005) within the bilateral frontal and temporal lobes, left hippocampus, posterior cingulate, and anterior cingulate (dorsal and pregenual), and right postcentral gyrus. Greater deactivations (p < .005) with tcVNS were observed within the bilateral frontal and parietal lobes and left thalamus. Compared with tcVNS, sham elicited greater activations (p < .005) in the bilateral frontal lobe, left precentral gyrus, precuneus, and thalamus, and right temporal and parietal lobes, hippocampus, insula, and posterior cingulate. Greater (p < .005) deactivations were observed with sham in the right temporal lobe, posterior cingulate, hippocampus, left anterior cingulate, and bilateral cerebellum. CONCLUSIONS: tcVNS increased anterior cingulate and hippocampus activation during trauma scripts, potentially indicating a reversal of neurobiological changes with PTSD consistent with improved autonomic control.Trial Registration: No. NCT02992899.