Experimental Nuromodulation

While psychotherapeutic concepts are specifically developed and adapted for children and adolescents, only a limited number of medications are available for this age group. In treatment guidelines for adults with psychaitric disorders, methods of neurostimulation are considered, alongside psychotherapy and pharmacotherapy. These involve device-based techniques to directly modify brain or nerve function, primarily using magnetic or electrical impulses. Invasive procedures (e.g., deep brain stimulation [DBS], vagus nerve stimulation [VNS]) are generally reserved for patients unresponsive to conventional therapy (psychotherapy and pharmacotherapy). Non-invasive methods include transcranial electrical stimulation (tES) and repetitive transcranial magnetic stimulation (rTMS). Variants like transcranial random noise stimulation (tRNS) exist Other methods, such as median nerve stimulation (MNS), trigeminal nerve stimulation (TNS), and transcutaneous vagus nerve stimulation (tVNS), are gaining increasing attention. Among minimally invasive techniques, electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) have the longest history in psychiatry. While evidence on the efficacy and tolerability of neurostimulation in adults is well-established, with over 200 randomized controlled trials, there is a significant lack of primary studies in children and adolescents despite promising findings from case studies findings. Beyond the lack of primary studies and meta-analytic evidence, there is limited awareness and significant skepticism about neurostimulation among clinicians and patients. Efforts to change this situation are crucial for developing scalable, personalized approaches to meet the high demand for psychiatric care in children and adolescents. At our lab, we study different (mainly) minimal-invasive and non-invasive methods of neuromodulation, including transcranial electrical stimulation (TES), transcranial magnetic stimulation (TMS), and have a speical focus on transcutaneous vagus nerve stimulation (tVNS).

Transcranial electrical stimulation (TES) 

Transcranial electrical stimulation (TES) applies weak constant currents (transcranial direct current stimulation, tDCS), constantly alternating currents (transcranial alternating current stimulation, tACS), or currents oscillating at random frequencies (transcranial random noise stimulation, tRNS) through cortical electrodes to achieve neuromodulation.

Selected Empirical Paper:

  • Vöckel J, Kühnel A, Rossberg R, Geist N, Sigrist C, Pokorny L, Koenig J, Kroemer N, Bender S. Transcranial direct current stimulation enhances effort maintenance in ADHD. Brain Stimul. 2024; 17(4):899-906. DOI: 10.1016/j.brs.2024.07.018 [PubMed]

Systematic Reviews/Meta-Analysis on the Topic:

  • Vöckel J, Spitznagel N, Markser A, Sigrist C, Koenig J. A paucity of evidence in youth: The curious case of transcranial direct current stimulation for depression. Asian J Psychiatr. 2024; 91:103838. doi: 10.1016/j.ajp.2023.103838 [PubMed]

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) excites or inhibits brain areas, by inducing a magnetic field with electrical currents through a magnetic coil. There are specific forms or repetetive TMS (rTMS) that apply patterns of pulsed stimulation (e.g. Theta-burst stimulation (TBS)).

 

Systematic Reviews/Meta-Analysis:

  • Sigrist C, Vöckel J, MacMaster FP, Farzan F, Croarkin PE, Galletly C, Kaess M, Bender S, Koenig J. Transcranial magnetic stimulation in the treatment of adolescent depression –A systematic review and meta-analysis of aggregated and individual patient data from uncontrolled studies. European Child & Adolescent Psychiatry, 2022; 31(1): 1501-1525, DOI: 10.1007/s00787-022-02021-7 [PubMed]

 

Transcutaneous vagus nerve stimulation (tVNS)

Transcutaneous vagus nerve stimulation (tVNS) aims to modulate vagal activity. Our lab is leading in the development of transcutaneous auricular vagus nerve stimulation (taVNS) for children and adolescents with psychiatric disorders. We have led international efforts to formulate Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation. We are working towards standardized clinical protocols in the treatment of pediatric patients. Further, we are interested in the validation of different biomarkers of taVNS, including heart rate variability, salivary alpha amylase, or cortex oxygenation. We are part of the European Research Network on tVNS, funded by the Research Foundation – Flanders (FWO) via the Scientific Research Networks Grant. 

Selected Empirical Paper:

  • Koenig J, Parzer P, Haigis N, Liebemann J, Jung T, Resch F, Kaess M. Effects of Acute Transcutaneous Vagus Nerve Stimulation on Emotion Recognition in Adolescent Depression. Psychological Medicine2021: 51(3):511-520; DOI: 10.1017/S0033291719003490 [PubMed]
  • Höper S, Kaess M, Koenig J. Prefrontal Cortex Oxygenation and Autonomic Nervous System Activity under Transcutaneous Auricular Vagus Nerve Stimulation in Adolescents. Autonomic Neuroscience, 2022 ;241:103008, DOI: 10.1016/j.autneu.2022.103008  [PubMed]
  • Jackowska M, Koenig J, Vasendova V, Jandackova VK. A two-week course of transcutaneous vagal nerve stimulation improves global sleep: Findings from a randomised trial in community-dwelling adults. Auton Neurosci. 2022; 240:102972. DOI: 10.1016/j.autneu.2022.102972 [PubMed]
  • Cibulcova V, Koenig J, Jackowska M, Jandackova VK. Influence of a 2-week transcutaneous auricular vagus nerve stimulation on memory: findings from a randomized placebo controlled trial in non-clinical adults. Clin Auton Res 2024; 34(4):447-462. doi: 10.1007/s10286-024-01053-0 [PubMed]

Systematic Reviews/Meta-Analysis:

  • Sigrist C, Torki B, Bolz L, Jeglorz T, Bolz A, Koenig J. Transcutaneous Auricular Vagus Nerve Stimulation in Pediatric Patients – A Systematic Review of Clinical Treatment Protocols and Stimulation Parameters. Neuromodulation, 2023; 26(3):507-517 DOI: 10.1016/j.neurom.2022.07.007 [PubMed]
  • Wolf V, Kühnel A, Teckentruo V, Koenig J, Kroemer NB. Does non-invasive vagus nerve stimulation affect heart rate variability? A living and interactive Bayesian meta-analysis. Psychophysiology, 2021;58(11):e13933 DOI:10.1111/psyp.13933 [PubMed]
  • Giraudier M, Ventura-Bort C, Burger AM, Claes N, D'Agostini M, Fischer R, Franssen M, Kaess M, Koenig J, Liepelt R, Nieuwenhuis S, Sommer A, Usichenko T, Van Diest I, von Leupoldt A, Warren CM, Weymar M. Evidence for a modulating effect of transcutaneous auricular vagus nerve stimulation (taVNS) on salivary alpha-amylase as indirect noradrenergic marker: A pooled mega-analysis. Brain Stimul. 2022; 15(6):1378-1388. DOI: : 10.1016/j.brs.2022.09.009 [PubMed]
  • Giraudier M, VenturaBort, C, Burger AM, Claes N, D’Agostini M, Fischer R, Franssen M, Kaess M, Koenig J, Liepelt R, Nieuwenhuis S, Sommer A, Usischenko T, Van Diest I, von Leupoldt A, Warren C, Weymar M. Evidence for a modulating effect of transcutaneous auricular vagus nerve stimulation on salivary alpha-amylase as indirect noradrenergic marker: a pooled mega-analysis. Brain Stimulation, 2022; 15(6):1378-1388, DOI: 10.1016/j.brs.2022.09.009 [PubMed]
  • tVNS Consensus Group - Farmer AD, Strzelczyk A, Finisguerra A, Gourine AV, Gharabaghi A, Hasan A, Burger A, Jaramillo AM, Mertens A, Majid A, Verkuil B, Badran BW, Ventura-Bort C, Gaul C, Beste C, Warren CM, Quintana D, Hämmerer D, Freri E, Frangos E, Tobaldini E, Kaniusas E, Rosenow F, Capone F, Panetsos F, Ackland G, Kaithwas G, O’Leary GH, Genheimer H, Jacobs H, Van Diest I, Schoenen J, Redgrave J, Fang J, Deuchars J, Széles JC, Thayer JF, More K, Vonck K, Steenbergen L, Vianna L, McTeague LM, Ludwig M, Veldhuizen MG, De Couck M, Casazza M, Keute M, Bikson M, Andreatta M, D’Agostini M, Weymar M, Betts M, Prigge M, Kaess M, Roden M, Thai M, Schuster NM, Montano N, Hansen N, Kroemer NB, Rong P, Fischer R, Howland RH, Sclocco R, Sellaro R, Garcia RG, Bauer S, Gancheva S, Stavrakis S, Kampusch S, Deuchars SA, Wehner S, Laborde S, Usichenko T, Polak T, Zähle T, Borges U, Teckentrup V, Jandackova VK, Napadow V, Koenig J. International Consensus Based Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Frontiers in Human Neuroscience, Brain Imaging and Stimulation, 2021; 14:568051; DOI: 10.3389/fnhum.2020.568051 [PubMed]

last update 2024 11 08

Wir benötigen Ihre Zustimmung zum Laden der Übersetzungen

Wir nutzen einen Drittanbieter-Service, um den Inhalt der Website zu übersetzen, der möglicherweise Daten über Ihre Aktivitäten sammelt. Bitte überprüfen Sie die Details in der Datenschutzerklärung und akzeptieren Sie den Dienst, um die Übersetzungen zu sehen.