Pupil-Indexed Noninvasive Neuromodulation

Paresis Clinical Trial

Official title:

Transcutaneous Auricular Vagus Nerve Stimulation: Motor Learning & Mechanisms

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06282406
• Other study ID #: N4532-R
• Secondary ID: I0X1RX004532
• Status: Not yet recruiting
• Phase: N/A
• Start date: June 3, 2024
• Est. completion date: August 5, 2028

Study information

• Verified date: February 2024
• Source: VA Office of Research and Development
• Contact: Michael A Urbin, PhD
• Phone: (412) 688-6000
• Email: Michael.Urbin[@]va.gov
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Vagus nerve stimulation (VNS) is thought to activate neural pathways that release chemicals which promote plasticity and learning. Previous work has shown that the auricular branch of the vagus nerve innervates landmarks on the external ear. Work from the PI's laboratory has shown that electrical current applied to the external ear modulates physiological indexes of brain states implicated in the therapeutic effects of VNS. The broad objective of this project is to better understand physiological mechanisms modulated by auricular stimulation to support possible therapeutic effects in the form of motor learning.

Description:

Existing evidence supports the use of VNS to enhance the effects of traditional therapy on impairments due to neurological injury (Dawson et al., 2021). It is known that the vagus nerve forms contacts with neuromodulatory nuclei in the brainstem that release of chemicals shown to be critically involved in attentional control and memory formation (Follesa et al., 2007; Roosevelt et al., 2006). It is also known that the auricular branch of the vagus nerve innervates portions of the external ear (Safi et al., 2016; Butt et al., 2020) providing a possible means to engage similar neural pathways noninvasively via transcutaneous auricular vagus nerve stimulation (taVNS). Recent work from the PI's laboratory shows that electrical current applied to landmarks on the external ear elicits transient effects on pupil dilation (Urbin et al., 2021), an established physiological index of brain states that support learning. Given the ability to engage the biomarker, the investigators aim to further investigate physiological mechanisms modulated by taVNS and possible effects on learning.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 110
• Est. completion date: August 5, 2028
• Est. primary completion date: April 3, 2028
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

ALL PROSPECTIVE SUBJECTS:

1. 18-75 years of age

PROSPECTIVE SUBJECTS DIAGNOSED WITH STROKE:

2. Diagnosis of a single stroke resulting in hand impairment

3. Diagnosis of stroke at least six months prior to the time of participation Exclusion Criteria:

ALL PROSPECTIVE SUBJECTS:

1. History of vestibular disorders or dizziness

2. Difficulty maintaining alertness and/or remaining still

3. Pregnant or expecting to become pregnant

4. Diagnosis of neurological and/or musculoskeletal disorder(s) (other than stroke) that affect movement

5. Ocular disease and/or impairment in more than one eye

6. History of seizure and/or epilepsy

7. Implants, devices, or foreign objects in the brain/body that are incompatible with MRI

8. Body size that is incompatible with MRI scanner dimensions

9. Anyone already enrolled and actively participating in another greater than minimal risk study.

PROSPECTIVE SUBJECTS DIAGNOSED WITH STROKE:

10. Other impairments secondary to stroke (e.g., attention, cognition, etc.) that would interfere with the ability to understand study goals or follow simple instructions, as judged by the investigators.

Related Conditions & MeSH terms

• Paresis

Intervention

Other:
• Transcutaneous Electrical Stimulation
Electrical pulse trains applied to the skin overlying putative sites of auricular vagal innervation.
• Sham
Electrodes placed on the skin overlying putative sites of auricular vagal innervation but no current administered.

Locations

Country	Name	City	State
United States	VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA	Pittsburgh	Pennsylvania

Sponsors (1)

Lead Sponsor	Collaborator
VA Office of Research and Development

Country where clinical trial is conducted

United States, 

References & Publications (6)

Butt MF, Albusoda A, Farmer AD, Aziz Q. The anatomical basis for transcutaneous auricular vagus nerve stimulation. J Anat. 2020 Apr;236(4):588-611. doi: 10.1111/joa.13122. Epub 2019 Nov 19. — View Citation

Dawson J, Liu CY, Francisco GE, Cramer SC, Wolf SL, Dixit A, Alexander J, Ali R, Brown BL, Feng W, DeMark L, Hochberg LR, Kautz SA, Majid A, O'Dell MW, Pierce D, Prudente CN, Redgrave J, Turner DL, Engineer ND, Kimberley TJ. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. Lancet. 2021 Apr 24;397(10284):1545-1553. doi: 10.1016/S0140-6736(21)00475-X. — View Citation

Follesa P, Biggio F, Gorini G, Caria S, Talani G, Dazzi L, Puligheddu M, Marrosu F, Biggio G. Vagus nerve stimulation increases norepinephrine concentration and the gene expression of BDNF and bFGF in the rat brain. Brain Res. 2007 Nov 7;1179:28-34. doi: 10.1016/j.brainres.2007.08.045. Epub 2007 Aug 25. — View Citation

Roosevelt RW, Smith DC, Clough RW, Jensen RA, Browning RA. Increased extracellular concentrations of norepinephrine in cortex and hippocampus following vagus nerve stimulation in the rat. Brain Res. 2006 Nov 13;1119(1):124-32. doi: 10.1016/j.brainres.2006.08.048. Epub 2006 Sep 7. — View Citation

Safi S, Ellrich J, Neuhuber W. Myelinated Axons in the Auricular Branch of the Human Vagus Nerve. Anat Rec (Hoboken). 2016 Sep;299(9):1184-91. doi: 10.1002/ar.23391. Epub 2016 Jul 12. — View Citation

Urbin MA, Lafe CW, Simpson TW, Wittenberg GF, Chandrasekaran B, Weber DJ. Electrical stimulation of the external ear acutely activates noradrenergic mechanisms in humans. Brain Stimul. 2021 Jul-Aug;14(4):990-1001. doi: 10.1016/j.brs.2021.06.002. Epub 2021 Jun 18. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Force Control Change	Subjects will be tested on the same task used for training that involves controlling finger forces.	Pre, 1-week Post, 1-month Post