TOPLINE:

Cervical noninvasive vagus nerve stimulation (nVNS) at least four times daily for 3 months along with standard care was associated with significant reductions in headaches, cognitive impairment, dizziness, and depression or sadness in patients with long-standing mild traumatic brain injury (TBI), a new observational retrospective study showed.

METHODOLOGY:

• Researchers conducted a single-center retrospective cohort study between 2021 and 2024, which involved 102 patients with mTBI (mean age, 41 years; 65% men).
• All patients self-administered 2-minute stimulations of cervical nVNS at least four times daily and as needed, in addition to receiving standard-of-care therapies (mean time from injury to treatment initiation, 171 days).
• Supplementary self-reported instruments included the Pain Catastrophizing Scale, Generalized Anxiety Disorder seven-item scale (GAD-7), Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (PCL-5), and Patient Health Questionnaire (PHQ-9) for depression and somatic symptoms.
• The primary outcome was change in Neurobehavioral Symptom Inventory (NSI) total and item scores for 22 symptoms. Secondary analyses examined correlations between NSI outcomes and supplementary instruments, responder rates (≥ 30% alleviation in symptoms), and the effect of time since injury on symptom severity.

TAKEAWAY:

• From baseline to after treatment, the mean total NSI score was reduced from 45.8 to 36.1 (P = .0000002). The most significant individual changes in NSI scores were for posttraumatic headache (-0.79), difficulty concentrating (-0.59), dizziness (-0.47), and depression or sadness (-0.47; all comparisons, P < .0001).
• NSI scores for affective symptoms such as anxiety (Pearson correlation coefficient [r] = 0.6) and depression or sadness (r = 0.6) were strongly correlated with GAD-7 scores; depression or sadness (r = 0.7) with PHQ-9 scores; and depression or sadness (r = 0.5), anxiety (r = 0.5), and feeling easily overwhelmed (r = 0.4) with PCL-5 scores.
• Overall, 34% of patients met the responder criteria for 11 or more of the 22 NSI domains, and 90% met criteria for at least one of the domains. Symptoms with the most responders were posttraumatic headache (49%), dizziness (45%), loss of balance (45%), and difficulty falling asleep (44%).
• Time since injury did not significantly affect treatment effectiveness, and no treatment-related adverse events were reported.

IN PRACTICE:

“Adjunctive noninvasive vagus nerve stimulation was associated with clinically meaningful improvements in postconcussive symptoms across cognitive, affective, somatic, and vestibular domains” in participants with mild TBI, the investigators wrote. 

“These findings build on a growing body of evidence supporting nVNS as a safe, mechanistically targeted, and broadly applicable intervention for neurologic dysfunction,” they added. 

SOURCE:

The study was led by Michael Ament, MD, Cherry Creek Neurology, Denver. It was published online on August 26 in Frontiers in Neurology.

LIMITATIONS:

The retrospective design limited the ability to establish causal inferences, and the lack of a control group introduced potential placebo effects. The study was further limited by heterogeneity in comorbidities, treatment adherence, and concurrent therapies that may have introduced variability that the available data could not fully capture.

DISCLOSURES:

Two investigators reported being employed by electroCore, Inc. Ament and the other investigators reported having no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.