Anatomo-Physiologic Basis for Auricular Stimulation

Anatomo-Physiologic Basis for Auricular Stimulation

Beniamina Mercante, PhD,* Francesca Ginatempo, MSc,* Andrea Manca, PhD,* Francesco Melis, MD, PhD, Paolo Enrico, PhD, and Franca Deriu, MD, PhD

ABSTRACT Introduction: Stimulation of cranial nerves modulates central nervous system (CNS) activity via the extensive connections of their brainstem nuclei to higher-order structures. Clinical experience with vagus-nerve stimulation (VNS) demonstrates that it produces robust therapeutic effects, however, posing concerns related to its invasiveness and side-effects. Discussion: Trigeminal nerve stimulation (TNS) has been recently proposed as a valid alternative to VNS. The ear presents afferent vagus and trigeminal-nerve distribution; its innervation is the theoretical basis of different reflex therapies, including auriculotherapy. An increasing number of studies have shown that several therapeutic effects induced by invasive VNS and TNS, can be reproduced by noninvasive auricular-nerve stimulation. However, the sites and neurobiologic mechanisms by which VNS and TNS produce their therapeutic effects are not clear yet. Conclusions: Accumulating evidence suggests that VNS and TNS share multiple levels and mechanisms of action in the CNS.

Keywords: vagus nerve stimulation, trigeminal nerve stimulation, auricular stimulation, neuromodulation, brainstem, forebrain, central nervous system

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