Vagus Nerve & Inflammation--Radio program

[kangaSue]

One member here has a vagus nervus stimulator implanted.

There is a portable vagus nerve stimulator around, originally devised as a treatment for headaches, but is also undergoing clinical trials for gastrointestinal disorders and epilepsy.
http://www.electrocoremedical.com/electrocore-results-of-a-case-series-on-n on-invasive-vagus-nerve-stimulation-to-treat-severe-gastroparesis-with-the- gammacore-device-presented-at-the-british-society-of-gastroenterology-meeti ng-in-ma

 

[Mary]

This doesn't have to do with the vagus nerve, but at the University of Wisconsin they are doing research on electrical stimulation of the tongue to help recovery from traumatic brain injury and Parkinson's and MS, among other things https://tcnl.bme.wisc.edu/projects
I read an article about this and unfortunately cannot remember it very well, but the gist of it seemed to be that this electrical stimulation sort of re-booted the brain to start operating properly. It was fascinating (if only I could remember better!) but the above link will get you started for more info. If you look at the book shown on this link: https://tcnl.bme.wisc.edu/, The Brain's Way of Healing by Norman Doidge, there's a section on this therapy and the amazing results they're getting with TBI patients.

So I would not be entirely skeptical of vagus nerve stimulation being useful for various problems.

 

[Mary]

Vagus nerve stimulation might be as good as nurofen - if anyone tried it. I cannot see a trial on pubmed yet. Most of the papers are on rats - with the wrong type of arthritis. Not impressed so far.

Here's an article on a Dutch study, which used humans with RA: http://www.independent.co.uk/life-s...ts-leave-some-patients-pain-free-9941001.html

More than half of the participants had significant pain reduction, without negative side effects - I think this is well worth researching further.

 

[Jonathan Edwards]

Here's an article on a Dutch study, which used humans with RA: http://www.independent.co.uk/life-s...ts-leave-some-patients-pain-free-9941001.html

More than half of the participants had significant pain reduction, without negative side effects - I think this is well worth researching further.

So why is there no paper on PubMed I wonder? More than half pain reduction with something implanted in your neck would be fairly standard placebo response. I did not see mention of any change in the disease itself. Did the swelling reduce? Did the ESR go down? Did joint damage slow down? I am afraid that in terms of trials for RA this doesn't even begin to look like a useful treatment. We went through a phase of using nerve stimulators in the 1982s and gave them up after a year or two.

 

[Mary]

So why is there no paper on PubMed I wonder? More than half pain reduction with something implanted in your neck would be fairly standard placebo response. I did not see mention of any change in the disease itself. Did the swelling reduce? Did the ESR go down? Did joint damage slow down? I am afraid that in terms of trials for RA this doesn't even begin to look like a useful treatment. We went through a phase of using nerve stimulators in the 1982s and gave them up after a year or two.

I can't answer your questions, but I don't think that significant pain reduction in over 50% of participants should be written off as a placebo response. I'm not saying this is an effective treatment as it stands (although it might be!), but I do think this study and other research (some of which does involve mice or rats) are indicators that this is a good area to study in earnest. The only treatments for RA right now are toxic drugs. I doubt if this treatment is the same as the "nerve stimulators" which were used in the 1980's over 30 years ago.. And if all it does is pain reduction and doesn't affect ESR etc,, that would still be a very good thing as pain drugs are not without sometimes dangerous side effects.

 

[Jonathan Edwards]

I can't answer your questions, but I don't think that significant pain reduction in over 50% of participants should be written off as a placebo response. I'm not saying this is an effective treatment as it stands (although it might be!), but I do think this study and other research (some of which does involve mice or rats) are indicators that this is a good area to study in earnest. The only treatments for RA right now are toxic drugs. I doubt if this treatment is the same as the "nerve stimulators" which were used in the 1980's over 30 years ago.. And if all it does is pain reduction and doesn't affect ESR etc,, that would still be a very good thing as pain drugs are not without sometimes dangerous side effects.

I did actually find a paper from 2014 by Koopman et al on this study - or at least mentioning it. It is a review article and does not give a lot of important details. As far as I can see out of the first 8 patients 7 had a total of 21 adverse events - mild to moderate. A moderate adverse event is not trivial. And although the paper seems to be three years after the study started they do not mention any results on improvement - even on pain.

I would be very surprised if you got less than 50% people reporting significant improvement in pain after an implant in a trial. So my impression so far is that this is a very hyped non-event. But I am prepared to be proven wrong!

 

[lansbergen]

@anciendaze Do I remember correctly you looked for nervus vagus stimulation?

I did actually find a paper from 2014 by Koopman et al on this study - or at least mentioning it. It is a review article and does not give a lot of important details. As far as I can see out of the first 8 patients 7 had a total of 21 adverse events - mild to moderate. A moderate adverse event is not trivial. And although the paper seems to be three years after the study started they do not mention any results on improvement - even on pain.

I would be very surprised if you got less than 50% people reporting significant improvement in pain after an implant in a trial. So my impression so far is that this is a very hyped non-event. But I am prepared to be proven wrong!

 

[anciendaze]

@anciendaze Do I remember correctly you looked for nervus vagus stimulation?

I have had an implant for years, but it was not for pain. It seems to have improved the balance between sympathetic/parasympathetic activity, which makes a difference in being able to sleep at night without drugs. (For some people that alone could be a life saver. None of us are much over 48 hours away from hallucinations and dangerous behavior caused by lack of sleep.) I'm convinced that most such studies are either dealing with the wrong patients, or are measuring the wrong things.

I take my own results as supporting a diagnosis of dysautonomia, which continues to affect me via orthostatic intolerance. (When well-regarded doctors still don't know what Dr. Streeten did many years ago, and refuse to believe this, or to test for evidence, I don't have to look far for gaps in research protocols.) I don't think the implant is getting at the cause, but scarcely anyone seems to be doing much of anything that does affect possible causes.

The exceptions involve antivirals or rituximab. I believe most other therapies that show any effect are manipulating immune response, directly or indirectly, if they are not purely symptomatic. This is even true of some medications prescribed purely for symptomatic relief.

We still lack a mechanism for this pathology. Both classes of therapy I've mentioned are very general in their effects. Simply because a medication or therapy is done for particular indications is absolutely no evidence this is actually what it is treating. Example: Lithium salts used to treat AIDS-related dementia with mania didn't just calm patients, they actually lowered viral titers. Minocycline given for bacterial infections was also found to lower viral titers. In a rather different context, a substantial fraction of diabetics do not have low levels of insulin. I can recall when this was surprising news.

I remind people of the history of pyrotherapy for mental illness. The induced fever was a consequence of vigorous immune response to malaria, which happened to cross-react with treponema pallidum, the cause of syphilis, a well-known cause of dementia, among many other problems. Medical professionals managed to misinterpret this in multiple ways.

 

[girlinthesnow]

Thank you so much @anciendaze for your post, full of so many useful, intriguing and potentially life-saving pieces of information. You are a treasure.