Research Reports - Non-invasive vagal nerve stimulation effects on hyperarousal and autonomic state in Patients with Posttraumatic Stress Disorder and History of mild traumatic brain injury

Front Med (Lausanne). 2017 Jul 31;4:124. doi: 10.3389/fmed.2017.00124.
eCollection 2017.

Lamb DG(1)(2)(3)(4), Porges EC(2)(4), Lewis GF(5)(6)(7), Williamson

Posttraumatic stress disorder (PTSD) is a reaction to trauma that results in a
chronic perception of threat, precipitating mobilization of the autonomic nervous
system, and may be reflected by chronic disinhibition of limbic structures. A
common injury preceding PTSD in veterans is mild traumatic brain injury (mTBI).
This may be due to the vulnerability of white matter in these networks and such
damage may affect treatment response. We evaluated transcutaneous vagal nerve
stimulation (tVNS), a non-invasive, low-risk approach that may alter the
functions of the limbo-cortical and peripheral networks underlying the
hyperarousal component of PTSD and thus improve patient health and well-being. In
this single visit pilot study evaluating the impact of tVNS in 22 combat
veterans, we used a between-subjects design in people with either PTSD with
preceding mTBI or healthy controls. Participants were randomized into stimulation
or sham groups and completed a posturally modulated autonomic assessment and
emotionally modulated startle paradigm. The primary measures used were
respiratory sinus arrhythmia (high-frequency heart rate variability) during a
tilt-table procedure derived from an electrocardiogram, and skin conductance
changes in response to acoustic startle while viewing emotional images
(International Affective Picture System). The stimulation was well tolerated and
resulted in improvements in vagal tone and moderation of autonomic response to
startle, consistent with modulation of autonomic state and response to stress in
this population. Our results suggest that tVNS affects systems underlying
emotional dysregulation in this population and, therefore, should be further
evaluated and developed as a potential treatment tool for these patients.

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