New approaches in multi-punctual percutaneous stimulation of the auricular vagus nerve

Electrical stimulation of the cervical vagus nerve is an established treatment for therapy refractory epilepsy and, more recently, for depression and congestive heart failure. To overcome risks in implantation of neurostimulation devices as well as to extend application areas, less invasive techniques have been developed affecting the auricular branch of the vagus nerve (ABVN). This includes transcutaneous and percutaneous stimulation at the concha, antihelix, or tragus region of the auricle. Current areas of treatment include epilepsy, mood disorders, chronic pain, and cardiovascular diseases. This paper discusses new methodological approaches in percutaneous ABVN stimulation applying adaptive stimulation patterns controlled by biofeedback. The biofeedback is established by the use of the heart rate variability, blood perfusion index, and muscle tone, all objective measures for therapeutic efficiency. Preliminary results provide evidence that these new approaches may lead to more effective treatment for chronic pain, chronic wounds, and movement disorders.