Transcutaneous Vagus Nerve Stimulation: Novel Treatment Strategies

Electrical vagus nerve stimulation (VNS) was initially clinically approved for the adjunctive treatment of medically refractory seizures in 1997. In 2005, the FDA expanded its approval of VNS for treatment of chronic recurrent depression. Both therapeutic indications require surgical implantation of an electrical pulse generator. Obvious disadvantages to this approach include the high cost and invasive nature of surgery with potential risks of pain, bleeding, and infection. Moreover, replacement of the pulse generator battery is necessary approximately every 5–10 years. Recent innovations in electrical nerve stimulation, however, may facilitate introduction of novel approaches that avoid these limitations. In this chapter, we explore the role of non-invasive, transcutaneous vagus nerve stimulation (tVNS). It is important to note that non-invasive or tVNS is currently under investigation in the United States and is not FDA approved.