Transcutaneous Vagus Nerve Stimulation (tVNS) in Autism.

Dr. Barış Ekici, Assistant Professor and Pediatric Neurologist, shares his insights and expertise on transcutaneous vagus nerve stimulation (tVNS) treatment.

Vagus nerve stimulation is a technique that stimulates the vagus nerve. It has been approved as a treatment for epilepsy since 1997 and for treatment-resistant depression since 2005. Vagus nerve stimulation creates a pulse that travels from the brainstem to the higher centers in the brain, carrying an electrical signal from the brainstem to the amygdala, hippocampus, and prefrontal cortex. Initially, devices implanted via surgery on the vagus nerve were used. The human ear contains a vast network of nerve stimulations. In particular, branches of the vagus nerve intensively travel to the brain in the concha, the hollow part of the ear. Using this device, we send some repeated stimulations at microampere levels and microsecond intervals to the ear, transmitting a signal from the brainstem to the brain.

Vagus nerve stimulation affects the chemicals in the brain and activates the GABAergic system, which we know functions poorly in children with autism. Studies have shown that after vagus nerve stimulation, levels of GABAergic metabolites increase, while glutamate decreases in the cerebrospinal fluid. It also stimulates and regulates serotonergic and noradrenergic systems. Additionally, it calms the brain and reduces neuroinflammation. With vagus nerve stimulation, we expect children with autism to be calmer, more focused, with improved sleep quality, reduced obsessions, and increased speech ability.

Our patients' feedback aligns with these expectations. Thanks to modern devices, we now have the opportunity to apply this method to children through the ear, and we have started to see positive effects after one month of stimulation. The good aspect is that, after planning the stimulation according to the child's electroencephalogram (EEG), the family can apply this method at home on their own. We do not observe many side effects. Mild side effects such as ear redness and occasional headaches have been reported. So far, our patients are satisfied with vagus nerve stimulation. Overall, we receive feedback from parents that their child has become calmer, more focused, and has increased speech ability. When activities increase in children with autism, you lose the ability to perform. Therefore, I believe that vagus nerve stimulation, which works from the brainstem to the brain and helps the child find their balance in a calming way, is very suitable for children with autism.