Trigeminal Nerve Stimulation (TNS) for Generalized Anxiety Disorder: A Case Study

Trevizol, Alisson Paulino; Shiozawa, Pedro; Sato, Isa Albuquerque; Calfat, Elie Leal de Barros; Alberto, Rodrigo Lancelote; Cook, Ian A.; Medeiros, Heloisa H.; Cordeiro, Quirino

doi:10.1016/j.brs.2014.12.009

Cited by 19 publications

(11 citation statements)

References 7 publications

(13 reference statements)

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“…Peripheral stimulation techniques can be used acutely or chronically to, respectively, abort or prevent pathological symptoms (Fanselow et al 2000;Faingold 2008a, b;DeGiorgio et al 2011). In particular, TNS has been proved effective to terminate symptoms that are impending or actively occurring (Moseley and DeGiorgio 2014;Shiozawa et al 2014;Trevizol et al 2015). This finding is supported by the evidence, reported in animal models of epilepsy (Faingold 2008a, b), that a direct stimulation within the "disease network," particularly at high frequencies, can result in disruptive effects on the network, and that this stimulation may also modulate, simultaneously or sequentially, another network which can compete with the "disease network."…”

Section: Sites Of Action and Possible Mechanismsmentioning

confidence: 99%

“…Trigeminal nuclei are also connected to brain areas such as the nucleus tractus solitarii (NTS) and the LC which are thought to modulate the reticular formation (Foote et al 1983;Aston-Jones et al 1991;Van Bockstaele et al 1999;Fanselow 2012) and disseminate neuromodulatory compound in the central nervous system, since they profoundly affect its excitability at virtually all levels (Moruzzi and Magoun 1949;Foote et al 1983;Vertes 1991;Vertes et al 1999;Ruffoli et al 2011;Fanselow 2012). In addition, the LC and the NTS are believed to play a key role in mediating the clinical benefits observed following TNS in several neurological and neuropsychiatric disorders (Faingold 2008a;Fanselow 2012;Shiozawa et al 2014;Trevizol et al 2015).…”

Section: Sites Of Action and Possible Mechanismsmentioning

confidence: 99%

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Transcutaneous trigeminal nerve stimulation induces a long-term depression-like plasticity of the human blink reflex

et al. 2015

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The beneficial effects of trigeminal nerve stimulation (TNS) on several neurological disorders are increasingly acknowledged. Hypothesized mechanisms include the modulation of excitability in networks involved by the disease, and its main site of action has been recently reported at brain stem level. Aim of this work was to test whether acute TNS modulates brain stem plasticity using the blink reflex (BR) as a model. The BR was recorded from 20 healthy volunteers before and after 20 min of cyclic transcutaneous TNS delivered bilaterally to the infraorbital nerve. Eleven subjects underwent sham-TNS administration and were compared to the real-TNS group. In 12 subjects, effects of unilateral TNS were tested. The areas of the R1 and R2 components of the BR were recorded before and after 0 (T0), 15 (T15), 30 (T30), and 45 (T45) min from TNS. In three subjects, T60 and T90 time points were also evaluated. Ipsi- and contralateral R2 areas were significantly suppressed after bilateral real-TNS at T15 (p = 0.013), T30 (p = 0.002), and T45 (p = 0.001), while R1 response appeared unaffected. The TNS-induced inhibitory effect on R2 responses lasted up to 60 min. Real- and sham-TNS protocols produced significantly different effects (p = 0.005), with sham-TNS being ineffective at any time point tested. Bilateral TNS was more effective (p = 0.009) than unilateral TNS. Acute TNS induced a bilateral long-lasting inhibition of the R2 component of the BR, which resembles a long-term depression-like effect, providing evidence of brain stem plasticity produced by transcutaneous TNS. These findings add new insight into mechanisms of TNS neuromodulation and into physiopathology of those neurological disorders where clinical benefits of TNS are recognized.

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Section: Sites Of Action and Possible Mechanismsmentioning

confidence: 99%

Section: Sites Of Action and Possible Mechanismsmentioning

confidence: 99%

Transcutaneous trigeminal nerve stimulation induces a long-term depression-like plasticity of the human blink reflex

et al. 2015

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“…32,33 In this light, an increasing number of studies have shown that TNS is beneficial for seizure control, depression, and migraine, and, very recently, the FDA approved a clinical trial for TNS treatment of Lennox-Gastaut syndrome. 34 In addition to epilepsy and depression, researchers have proposed a clinical application for VNS and TNS for treating variety of disorders, such as migraine, 35 anxiety, 36 cognitive impairment, 37,38 Alzheimer's disease, 39 autism, 40 tinnitus, 41,42 poststroke symptoms, [43][44][45] post-traumatic stress disorder, 46 eating disorders 47 and obesity. 48 Although clinical trials on the topic are accumulating, most of them are preliminary proof-ofconcept pilot studies obtained with limited sample sizes.…”

Section: Clinical Applications Of Vagus-and Trigeminal-nerve Stimulatmentioning

confidence: 99%

Anatomo-Physiologic Basis for Auricular Stimulation

Mercante

Ginatempo

Manca

et al. 2018

Medical Acupuncture

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Stimulation of cranial nerves modulates central nervous system (CNS) activity via the extensive connections of their brainstem nuclei to higher-order structures. Clinical experience with vagus-nerve stimulation (VNS) demonstrates that it produces robust therapeutic effects, however, posing concerns related to its invasiveness and side-effects. Trigeminal nerve stimulation (TNS) has been recently proposed as a valid alternative to VNS. The ear presents afferent vagus and trigeminal-nerve distribution; its innervation is the theoretical basis of different reflex therapies, including auriculotherapy. An increasing number of studies have shown that several therapeutic effects induced by invasive VNS and TNS, can be reproduced by noninvasive auricular-nerve stimulation. However, the sites and neurobiologic mechanisms by which VNS and TNS produce their therapeutic effects are not clear yet. Accumulating evidence suggests that VNS and TNS share multiple levels and mechanisms of action in the CNS.

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“…The authors found significant interaction between the mean percentage change in depressive symptoms in the two groups over time with mean reduction of 6.32 points in the Hamilton Depression Rating Scale (HDRS17); p=0.002 [11]. The same protocol was further used for anxiety disorders with promising results for symptoms ameliorations in post-traumatic stress disorder [12] and generalized anxiety disorder [13]. Regarding tVNS, its use in clinical research is still scant.…”

Section: Editorialmentioning

confidence: 99%

Transcutaneous Vagus and Trigeminal Nerve Stimulation: A New Perspective in the Treatment of Psychiatric Disorders

Trevizol¹,

Barros²,

Liquidatto³

et al. 2015

Brain Disord Ther

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Trigeminal Nerve Stimulation (TNS) for Generalized Anxiety Disorder: A Case Study

Cited by 19 publications

References 7 publications

Transcutaneous trigeminal nerve stimulation induces a long-term depression-like plasticity of the human blink reflex

Transcutaneous trigeminal nerve stimulation induces a long-term depression-like plasticity of the human blink reflex

Anatomo-Physiologic Basis for Auricular Stimulation

Transcutaneous Vagus and Trigeminal Nerve Stimulation: A New Perspective in the Treatment of Psychiatric Disorders

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