Transcutaneous Vagus Nerve Stimulation

After the Dysautonomia International Conference in 2020, I had some serious FOMO about Transcutaneous (through the skin- noninvasive) Vagus Nerve Stimulation (tVNS). It was a hot topic and seemed like a viable option. So, I researched the crap out of it, asked my doctor if it was okay, and went for it.

Disclaimer

If you are considering using a tVNS device, please consult your doctor. In most cases, if something is strong enough to work, then it is strong enough to cause harm if used improperly. Also, as I mention in my sidebar (or bottom bar if you’re on a mobile device), I am not a medical professional.

How tVNS relates to POTS and ME

Certain brands of POTS and ME can be characterized by a hyperadrenergic state. This means that the body is perpetually in fight-or-flight, or functioning with primarily sympathetic nervous system activity (this is also called Central Sensitization). Our bodies are not meant to function this way. This can eventually lead to a disruption of autonomic nervous system (Dysautonomias like POTS). Certain types of ME are thought to have similar origins. You can check out my article on Vagus Nerve Stimulation to read more about the link between VNS and POTS and ME as well as natural ways to stimulate the vagus nerve.

Transcutaneous VNS devices stimulate the vagus nerve which increases the parasympathetic nervous system activity (and therefore decreases the sympathetic nervous system activity). By addressing part of the underlying pathophysiology of the disease, tVNS could be a promising treatment.

Completed studies on tVNS (and VNS) and relevant diseases

So far, there are not many completed studies that demonstrate the effectiveness of tVNS or VNS on relevant diseases. Here is a rundown of the studies I found:

• Transcutaneous VNS demonstrated promise in lowering immune responses which correlated with lower fatigue scores in subjects with primary Sjogren’s syndrome.
• A POTS patient had a VNS device surgically implanted for her epilepsy. Her POTS ended up improving as well. Although this patient used an implanted device, I still felt it was worth mentioning because it related specifically to POTS.

Studies in progress on tVNS in relevant diseases

• Dr. Furlan is studying the effects of the NEMOS device on POTS. He and his research partner Dr. Dipaola presented their preliminary findings at the Dysautonomia International Conference last year (I talk about this here). To sum it up, the small study was showing promising effects on heart rate variability (an indication of parasympathetic nervous system activity) and a few other markers as well as reported symptoms by the subjects.
• Dr. Kem and Dr. Stavrakis are studying the use of the Parasym device on POTS including on how it impacts the presence of certain autoantibodies found in POTS.
• Dr. Kovacic is studying the use of the IB-Stim device on POTS.
• Dr. Gauthey is measuring the impacts of tVNS on heart rate variability and muscle sympathetic nerve activity.
• Dr. Zanos is studying the effects of tVNS on autonomic nervous system function.
• Dr. Kong is studying the impact of tVNS on pain in fibromyalgia.
• Dr. Biaggioni is studying the use of tVNS alone and in conjunction with Mestinon and galantamine on POTS.
• Dr. Paccione is studying the impact of tVNS vs. deep breathing on fibromyalgia.
• Dr. Alptekin is studying the use of tVNS in fibromyalgia.

An interesting side note- as I was scanning ClinicalTrials.gov for this information, there are already several studies underway looking at the use of tVNS in COVID-19.

tVNS devices

There are several available tVNS devices, depending on your country. Some require a doctor’s prescription, some companies will provide the script themselves via an on-hand practitioner, and others are available without restrictions.

Here are a few examples:

• Parasym
• InTENSity devices
• CES Ultra
• IB-STIM
• Cerbomed (tVNS Technologies GmbH) NEMOS. The website it in German and I don’t sprechen ze deutsche, so I can’t tell what the new name of this device is.
• Fisher Wallace
• Gammacore
• Alpha-Stim

Some of the devices use ear clip electrodes. These can be placed on the ear lobes or the tragus of the ear. The NEMOS device (or whatever it is called now) uses electrodes on the superior concha of the ear. Others like the IB-STIM access the vagus nerve through the neck. I do not know which electrode placement is the most effective. There doesn’t seem to be a consensus among the companies or research articles. To my understanding, the mechanics of these devices are basically the same and they differ based on placement options. So, to choose one, I would go off of which electrode placement option you prefer (as well as price and availability, of course).

I will not disclose which specific device I used for ethical reasons. My evaluation of the device is partially outside the scope of the product’s claims, which is unfair. I hope you all understand and respect my reasoning. However, I will note that it was one of the ear clip electrode devices as that information is useful.

First experiences

In the beginning, I was absolutely terrified and worried that I would harm myself. There was a weird pressure sensation in my chest the first several sessions. In retrospect, it was probably anxiety.

After I got over the anxiety, I worked up to two 45-minute sessions per day. I clipped the left electrode to the tragus and the right electrode to my ear lobe. To find the right setting I would slowly increase the intensity to where I would feel it, and then back it down to where I could no longer feel the tingle.

Did it help?

Unfortunately, tVNS did not produce any positive effects for me. I used the device every single day for a little over two months. It did not even help with anxiety, which surprised me because there is a fairly robust amount of research to support this tVNS benefit. I was bummed about my lack of improvement. I try not to get my hopes up about new treatments, but I thought this would be a slam dunk because it targets the excess sympathetic nervous system activity that contributes to POTS and ME.

Side effects

I did not experience any side effects except for stressing myself out about it. It is possible that the device gave me a minor headache a couple times, but I suspect that was stress-induced.

Side effects can include: minor headaches, vertigo, and local skin irritation. Studies demonstrate that these side effects are pretty rare and some can be minimized by lowering the setting on the device.

Thoughts

I wonder if vagus nerve stimulation is a solid no-go for me, or if the electrode placement I used wasn’t specific enough to the vagus nerve. In the future, I would be curious to try out a superior concha or neck electrode placement as it seems that is the route that most clinical trials are going. I would be especially interested in trying the superior concha placement because the neck scares me without direct doctor supervision.

I also wonder if the future of vagus nerve stimulation will lie in external devices or in the surgically implanted ones. Although the external devices are noninvasive, easy to use, and bear less risks, they are less specific to the vagus nerve than surgically implanted devices.

Have you tried tVNS? How did it work for you?

Disclaimer: I am not a medical professional. Statements on this site are not meant to be taken as medical advice. These statements reflect my personal experiences having mild-ish post-viral POTS and ME. Due to the wide spectrum of these diseases, comorbidities, and everyone being different, your experiences may be very different than mine.

Note: If you post a comment, this site does NOT have a feature to notify you of responses to your comment. I have not found a good solution for that yet. However, I usually respond to every comment in a timely manner, so be sure to check back.