Le basi della Neuromodulazione Auricolare · ABVN Auricle Branch of the Vagus GAN Great Auricular Nerve (C2-C3) ATN Auriculotemporal Nerve - Trigeminus ABVN GAN ATN Crus of helix

Le basi della Neuromodulazione AuricolareGiancarlo Bazzoni MD

ITALY GREECE CIPRUS SPAIN

Anxiety Attack Symptoms

Acute state of anxiety

Auricular Pressure

t - VNS Vagus Nerve Stimulation

Acute postoperative pain

Percutaneous Electrical

Stimulation

Electro Auricular Acupuncture

MigraineContinuous Auricular

Acupressure - Acupuncture

Auricular Acupuncture

Anatomia e istologia del

padiglione auricolare

Anatomia del padiglione auricolare

1 Hélix

2 Raiz del helix

3 Cola del helix

4 Antihelix

5 Raiz inferior del antielix.

6 Raiz superior del antielix

7 Fosa triangular

8 Fosa escafa

9 Cimba de la concha

10 Concha cava

11 Trago

12 Antitrago

13 Incisura intertrágica

14 Lóbulo


L'innervazione del padiglione auricolare

ABVN Auricle Branch of the Vagus

GAN Great Auricular Nerve (C2-C3)

ATN Auriculotemporal Nerve - Trigeminus

ABVN GAN ATN

Crus of helix 2 20% 80%

Spine of helix 1 9% 91%

Tail of helix 3 100%

Scapha 8 100%

Crura of anthelix 5, 6 9% 91%

Anthelix 4 73% 9% 18%

Antitragus 12 100%

Tragus 11 45% 46% 9%

Cymba conchae 9 100%

Cavity Conchae 10 45% 55%

Lobule of auricle 14 100%

The Nerve Supply of the Human AuricleElmar T. Peuker and Timm J. Filler

Clinical Anatomy (2002)

ABVN Auricle Branch of the Vagus Nerve


ATN Auriculotemporal Nerve of Trigeminus

The innervation of the external ear in humans and the musk shrew

N.Ueno, H. Sudo et al.

CJibiinkoka Gakkai Kaiho, 1993

The Nerve Supply of the Human AuricleElmar T. Peuker and Timm J. Filler

Clinical Anatomy (2002)

Stratified squamous

keratinized epithelium

Thin dermal layerFree nerve edings, myelinated

unmyelinated

Elastic cartilage

HypodermisLoose connective tissue

Thin dermal layer

Stratified squamous

keratinized epithelium

Histology of ear skinAnatomia microscopica del padiglione auricolare

Anatomia microscopica del padiglione auricolare

300 µm = 0.3 mm1000 µm = 1 mm

Cartilage

Dermis

Epidermis

Istologia della cute e aghi di agopuntura auricolare

I tre sistemi terapeutici: vagale, trigeminale espinale

Modern auricular acupuncture is defined as “a diagnostic and

treatment system based on normalizing the body’s by stimulating

acupuncture points on the external ear"

GORI e Fiorenzuoli, 2007

Gori L, Firenzuoli F

Ear acupuncture in European traditional medicine.

Evid Based Complement Alternat Med. 2007

Modern Auricular acupuncture (Auriculotherapy) is defined as

“a diagnostic and treatment system based on normalizing the

body’s by stimulating acupuncture points on the external ear”

Neuromodulazione AuricolareANM Auricular Neuromodulation ™

Il padiglione auricolare possiede tre sistemi terapeutici distinti in:

1) Vagale

2) Trigeminale

3) Spino cervicale

Differiscono tra loro per innervazione, struttura anatomico-microscopica, meccanismi neurobiologici che stanno alla base dell’az

I tre sistemi terapeutici: vagale,

trigeminale e spinale incidono su

aree specifiche del padiglione che

coincidono con la sua innervazione

sensoriale.

In una zona auricolare si possono

sovrapporre due o anche

tre diversi tipi di innervazione.


Il modello della neuro modulazione auricolare prevede che sul

padiglione esistano due tipi di zone/punti, distinti tra loro per le

informazioni che veicolano e per azione terapeutica.

Si distinguono in:

Zone/punti funzionali

Punti neuroriflessi.


Nell’ambito dei sistemi vagale e trigeminale si trovano

esclusivamente

Zone (Punti) zone funzionali

I punti funzionali si dispongono sul padiglione

senza alcuna somatotopia.

Nella classica Auricoloterapia / Agopuntura Auricolare

Corrispondono ai Master Points

(Shen Men p / Zero p / Relaxation p)

I principi fondanti della Neuromodulazione Auricolare

Neuromodulation

The alteration of nerve activity through the delivery of electrical stimulation

or chemical agents to targeted sites of the body.

Neuromodulation stimulate nerves - with pharmaceutical agents, electrical

signals, or other forms of energy - by modulating abnormal neural pathway

behaviour caused by the disease process.

The reversible therapy delivers stimulation to specific neural circuits

in the brain, spine, or peripheral nerves.

La Neuromodulazione Auricolare rappresenta l'evoluzione

scientifica moderna dell' Auricoloterapia (Agopuntura

Auricolare)

Diverse basi scientifiche, anatomiche, fisiologiche e cliniche

hanno portato il gruppo del CERNATEC a sottolineare gli

aspetti neuromodulatori della stimolazione, proponendo a

livello nazionale e internazionale il nome di Neuromodulazione

Auricolare

De la Auriculoterapia a la Neuromodulación Auricular

NEUROMODULAZIONE AURICOLAREANM AURICULAR NEUROMODULATION

È una forma di Neuromodulazione periferica che utilizza la stimolazione

del padiglione auricolare praticata con diverse metodiche.

Può essere definita anche “Neuromodulazione periferica vago,

trigemino, spinale”.

Nasce dall’integrazione dell’Auricoloterapia - Agopuntura Auricolare

(MC) con tecniche non invasive di stimolazione del padiglione auricolare,

quali la at-VNS (Auricular Transcutaneous Vagus Nerve Stimulation) e la

TNS (Trigeminal Nerve Stimulation) che si sono sviluppate più

recentemente nell’ambito della ricerca neurofisiologica di base e clinica.

Introduzione alla Neuromodulazione Auricolare

Neuromodulazione Auricolare ANM

Nasce dall’integrazione

dell’Auricoloterapia - Agopuntura

Auricolare (MC) con tecniche non invasive

di stimolazione del padiglione auricolare,

quali la at-VNS (Auricular Transcutaneous

Vagus Nerve Stimulation) e la TNS

(Trigeminal Nerve Stimulation) che si sono

sviluppate più recentemente nell’ambito

della ricerca neurofisiologica di base e

clinica.


Neuromodulación AuricularANM Auricular Neuromodulation

Por lo tanto, es una forma de dispositivo de neuromodulación

que utiliza la estimulación de la oreja se practica con

diferentes métodos. Se puede definir como :

“Neuromodulación periférica del vago, trigémino, espinal".

Nace por la integración de la Auriculoterapia - Acupuntura

Auricular (MC) con técnicas no invasivas de estimulación del

pabellón auricular, como la Transcutaneous Vagus Nerve

Stimulation y la Trigeminal Nerve Stimulation (TNS)

Il Sistema auricolare

spino-cervicale e la

mappa auricolare di

Nogier

Gori L, Firenzuoli F

Ear acupuncture in European traditional medicine.


Modern Auricular acupuncture (Auriculotherapy) is defined as

“a diagnostic and treatment system based on normalizing the

body’s by stimulating acupuncture points on the external ear”

L’Agopuntura auricolare (Auricular - Ear Acupuncture)

è una forma di Agopuntura che utilizza il padiglione auricolare a

scopo diagnostico e terapeutico.

La terapia prevede la stimolazione di zone ben definite del

padiglione auricolare avvalendosi dell’infissione cutanea di aghi

metallici filiformi e a semipermanenza, ma anche di microcorrenti

elettriche, laser, stimoli pressori e altri stimoli fisici.

Il NIH (1996) e l’WHO (2003) hanno inserito questa disciplina

nell’ambito dell’Agopuntura dei Microsistemi.

Viene chiamata anche Auricoloterapia (Scuola francese),

Auricolo Agopuntura, Auricoloriflessoterapia.


Il sistema spinale e la mappa auricolare di Nogier

With permission of T. Oleson P.D.

P. Nogier the father of Auriculotherapy - Auricular acupuncture1904 -1996

AuricoloterapiaNasce in Francia nei primi

anni 50 per opera del

medico lionese P. Nogier

Arriva in Cina nel 1957

e viene ribattezzata

Agopuntura Auricolare

Dal 1980, dopo i lavori dello

statunitense T. Oleson

partendo da Francia e Cina

questa terapia si diffonde

in numerosi paesi Nel 2011 viene messa a

punto da neurofisiologi

tedeschi la t-VNS

transcutaneous

Vagus Nerve Stimulation

Per la terapia di

Epilessia e Depressione

non rispondente

ai farmaci

In Italia nel 2012

per la prima volta

viene presentata la

NEUROMODULAZIONE

AURICOLARE

Auricular

Neuromodulation

1

1

2

3

4

5

Dall’Auricoloterapia alla Neuromodulazione Auricolare

Sistema Spinale Cervicale - Mappa Auricolare

Map of the Chinese schoolMap of the French school

Sistema Spinale Cervicale - Mappa AuricolareLa costruzione della mappa auricolare

Palpeur black 125 g/mm2

Palpeur blue 250 g/mm2

Pain pressure test

Diagnosi palpatoria (baroestesica)

Level 1 - 4

1. low-level tenderness

2. medium level tenderness

3. high level tenderness

4. extremely high level tenderness (Grimace)

(Oleson 1980)

Pain pressure test


Sistema Spinale Cervicale - Mappa AuricolarePain pressure test


P. Nogier Treatise of Auriculotherapy [in French]. Maisonneuve, 1969

12


SHOULDER

ELBOW

ANKLE

HAND

KNEE

HIP

WRIST

Rappresentazione (Somatotopic) Isomorfica


SHOULDER

ELBOW

WRIST


Activation nociceptors of Knee

Transmission and

elaboration of the pain

signal to the brain

Nocicezione e punti neuroriflessi.

Knee

Punti neuroriflessi e sostanza reticolare

Neuroreflex pointPressure pain test

Activation nociceptors of Knee

Transmission and

elaboration of the pain

signal to the brain

Knee

Nocicezione e punti neuroriflessi.

La mappa auricolare è una rappresentazione del dolore

L’attivazione dei nocicettori superficiali e profondi, (somatici e viscerali) determina sul padiglione la formazione di zone o punti attivi (neuroriflessi)

Questi punti si distribuiscono con una rappresentazione isomorfa alla topografia della nocicezione (1° ordinatore)

La loro rappresentazione dipende anche dal tipo di dolore - classificazione eziopatogenetica del dolore(2° ordinatore)

Classificazione del dolore e rappresentazione auricolare

ABVN Auricle Branch of the Vagus Nerve


ATN Auriculotemporal Nerve of Trigeminus

Il sistema trigemino-vagale

MISURAZIONE DELLA IMPEDENZA CUTANEA: GLI STRUMENTI

ELECTRICAL SKYN RESISTANCE TEST

Knob +

Knob -

Gold

Silver

MISURAZIONE DELL’IMPEDENZA CUTANEA DIFFERENZIALE


3 mm

1 mm



SHOULDER

ELBOW

ANKLE

HAND

KNEE

HIP

WRIST


SM / SV

5

6

2

3

2. Shen Men p. TF SHEN MEN area

3. Heart p. IC HEART area

5. Tranquilizer p. TG ANXIOLYTIC area

6. Relaxation p. TF ANXYOLITIC area

Punti/aree funzionali

SM / SV

5

6

2

3


Functional area / point

TG ANXIOLYTIC area

TF SHEN MEN area

IC HEART area


J. Thayer, R. Lane, 2008

Heart area / point

Auricular Transcutaneous


(at-VNS)

1997 US Food and Drug Administration (FDA) “approved VNS as

adjunctive therapy for reducing the frequency of seizures in patients

> 12 years with partial-onset seizures refractory to antiepilectic medications”

2005 US Food and Drug Administration (FDA) “adjunctive long term

treatment for chronic recurrent depression in patients 18 years of age or

older who are experiencing a major depressive episode and have not had an

adequate response to four or more adequate antidepressant treatments”

Vagus Nerve stimulation VNS

Auricular Transcutaneous Vagus Nerve stimulation

at-VNS

Vagus Nerve stimulation

VNS

Dalla VNS alla at-VNS

Vagus nerve stimulation

Vagus nerve

Auriculovagal afferent pathway (AVAP)

Ruffoli R, Giorgi FS et al.

The chemical neuroanatomy

of vagus nerve stimulationJ Chem Neuroanat. 2011

Chemical neuroanatomy of vagus nervi stimulation

The nucleus of the solitary tract (NST)

Nieuwenhuys et al. The human central nervous system, Springer, 2008

Medial reticular

formation of the

medulla (RF)

Nucleus ambiguus

(NA)

Nucleus tractus

solitarius (NTS)

Spinal trigeminal

nucleus (STN)

Area postrema

Dorsal motor nucleus

of the vagus

(NMV)

Locus Coeruleus (LC)

Hypothalamus (HYT)

Raphe nuclei (RN)

Peri-acqueductal gray

(PAG)

Parabranchial

nucleus (PBN)

Carebellum

Inferior Olive (IO)

Thalamus (THA)

Other

Hippocampus

Amygdala (AMY)

Anterior insula (RN)

Lateral prefrontal

cortex (LPC)

Vestibular nuclei

Zona incerta

Other

VNS

Vagus Nerve Stimulation (VNS)

A ANTI-EDEMA POST-STROKE EFFECTHYPPOCAMPUS NEOCORTEX

B COGNITIVE PROCESSES LEARNING AND MEMORYANTIDEPRESSANT EFFECTHYPPOCAMPUS NEOCORTEX

C STROKE VOLUME D NEUROPLASTICITY

NEURON SURVIVAL AND GROWTH

E ANTI-SEIZURES EFFECTHYPPOCAMPUS

F MIGRAINE ANTINOCICEPTION DORSAL RAPHE NUCLEUS

LOCUS COERULEUS

G MEMORY AND MOODHYPPOCAMPUS

H ANTIFLAMMATION - IMMUNITYI METHABOLISM

EATING - SATIETY HYPOTHALAMUS

L ANTIDEPRESSANT EFFECTANTI SEIZURE EFFECTMOOD ANXIETYBASOLATERAL AMYGDALAPREFRONTAL CORTEXHYPPOCAMPUSTHALAMUSLYMBIC and PARALYMBIC SYSTEM

ANTI SEIZURE EFFECT

Wasade VS, Schultz L, Mohanarangan K et al. Long-term seizure and psychosocial outcomes of vagus nerve stimulation forintractable epilepsy. Epilepsy Behav. 2015

Orosz I, McCormick D, Zamponi Net al. Vagus nerve stimulation for drug-resistant epilepsy: a European long-term studyup to 24 months in 347 children.Epilepsia. 2014

Morris GL , Gloss D, Buchhalter J et al. Evidence-based guideline update: vagus nerve stimulation for the treatment ofepilepsy: report of the Guideline Development Subcommittee of the AmericanAcademy of Neurology. Neurology. 2013

ANTI DEPRESSION EFFECT

Albert U, Maina G, Aguglia A et al. Vagus nerve stimulation for treatment-resistant mood disorders: along-term naturalistic study. BMC Psychiatry. 2015

Conway CR, Chibnall JT, Gebara MA et al. Association of cerebral metabolic activity changes with vagus nerve stimulation antidepressant response in treatment-resistant depression. Brain Stimul. 2013

Berry SM, Broglio K, Bunker M et al. A patient-level meta-analysis of studies evaluating vagus nerve stimulation therapy for treatment-resistant depression. Med Devices (Auckl). 2013

ANTI-INFLAMMATORY EFFECT

Yi C, Zhang C, Hu X, Li Y et al. Vagus nerve stimulation attenuates myocardial ischemia reperfusion injury byinhibiting the expression of interleukin-17A.Exp Ther Med. 2016

Levine YA, Koopman FA, Faltys M et al. Neurostimulation of the cholinergic anti-inflammatory pathway ameliorates disease in rat collagen-induced arthritis. PLoS One. 2014

Kox M, Pickkers P. Modulation of the Innate Immune Response through the Vagus Nerve. Nephron. 2015

NEUROPROTECTIVE EFFECT (POST STROKE, NEUROPLASTICITY)

Inoue T, Abe C, Sung SJ et al. Vagus nerve stimulation mediates protection from kidney ischemia-reperfusion injury through α7nAChR+ splenocytes.J Clin Invest. 2016

Dawson J, Pierce D, Dixit A E Kimberley TJ et al. Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke. Stroke. 2016

Jiang Y, Li L, Liu B et al. Vagus nerve stimulation attenuates cerebral ischemia and reperfusion injury via endogenous cholinergic pathway in rat.PLoS One. 2014

NEUROPROTECTIVE EFFECT (POST STROKE, NEUROPLASTICITY)

Hays SA, Khodaparast N, Hulsey DR et al. Vagus nerve stimulation during rehabilitative training improves functional recovery after intracerebral hemorrhage. Stroke. 2014

Cai PY, Bodhit A, Derequito R et al. Vagus nerve stimulation in ischemic stroke: old wine in a new bottle. Front Neurol. 2014

MEMORY and MOOD

Deng ZD, McClintock SM, Oey NE et al. Neuromodulation for mood and memory: from the engineering bench to the patient bedside. Curr Opin Neurobiol. 2015

Albert U, Maina G, Aguglia A et al. Vagus nerve stimulation for treatment-resistant mood disorders: along-term naturalistic study. BMC Psychiatry. 2015

Peña DF, Childs JE, Willett S et al. Vagus nerve stimulation enhances extinction of conditioned fear and modulates plasticity in the pathway from the ventromedial prefrontal cortex to the amygdala. Front Behav Neurosci. 2014

VAGUS NERVE STIMULATION

Yamamoto T. Vagus nerve stimulation therapy: indications, programing, and outcomes. Neurol Med Ch. 2015

De Couck M, Mravec B, Gidron Y.You may need the vagus nerve to understand pathophysiology and to treat diseases. Clin Sci 2012

Integrative model: vagal activity as a protective factor in the risk and prognosis of CVD, cancer and AD .

De Couck M, Mravec B, Gidron Y.You may need the vagus nerve to understand pathophysiology and to treat diseases. Clin Sci 2012

VAGUS NERVE IN THE PREVENTION OF CHRONIC DISEASES

CDC (Coronary Artery Diseases) particularly in Atherosclerosis

Oxidative stress of LDL (Low-Density Lipoprotein)-cholesterol and promotion of inflammation

in the atherosclerotic plaques of coronary arteries.

Inflammation manifested by recruitment of immune cells to arterial lesions, promotes factors

that lead to plaque rupture, such as plaque destabilization and elevated blood pressure, and

promotes thrombosis.

Excessive SNS activity plays roles in CVD by contributing to vascular wall injury due to

inducing vasoconstriction and increasing blood pressure, eventually contributing to

atherosclerosis and ischaemia.


Cancer

Oxidative stress is pivotal in transformation of cells to malignant ones as it contributes to DNA

mutations, especially if key tumour suppressor genes and pro-oncogenes are affected induces

neuronal apoptosis.

Inflammation promotes escape from apoptosis by inhibiting tumour suppressors at early

stages, and promotes angiogenesis (via vascular endothelial growth factor) and metastasis

(via matrix metalloproteinases and adhesion molecules) at later stages..

Excessive SNS activity In cancer, sympathetic neurotransmitters influence the direction of the

metastatic pathway and their blockade may slow down metastasis.


Alzheimer Diseases Stroke

Oxidative stress induces neuronal apoptosis.

Inflammation may mediate the detrimental effects of ft-amyloid peptides on brain

neurons, leading to neurodegeneration.

Excessive SNS activity reduces cerebral blood flow.

Frangos E, Ellrich J, Komisaruk BR.

Non-invasive access to the Vagus Nerve Central Projections via

Electrical Stimulation of the external ear: fMRI evidence

Humans. Brain Stimul. 2015


Non-invasive Access to the Vagus Nerve Central Projections via Electrical

Stimulation of the External Ear: fMRI Evidence


Cymba conchae ipsilateral NTS Activation of

Spinal trigeminal nucleus (bilateral) - Dorsal raphe

Locus coeruleus

Parabranchial area (bilateral), Amygdala, Nucleus accumbens

Paracentral lobule (bilateral)

Deactivation of: Hippocampus (bilateral) – Hypothalamus

Classical Central Vagal Projections

La stimolazione trigeminale



(at-VNS)

La stimolazione trigeminale

Trigeminal transcutaneous

Nerve Stimulation

(TNS)


Non-invasive Access to the Vagus Nerve Central Projections via

Electrical Stimulation of the External Ear: fMRI Evidence


Riederer F, Penning S, Schoenen J.

Transcutaneous Supraorbital NerveStimulation (t-SNS) with the

Cefaly(®) Device for Migraine Prevention: A Review of the Available

Data. Pain Ther. 2015

Trevizol A, Bonadia B, Gomes JS et al.

Integrity of cognitive functions in trigeminal nerve stimulation trials in

neuropsychiatry.

Trends Psychiatry Psychother. 2016

Shiozawa P, Silveira JG, Soares A et al.

Electroencephalographic changes following a trigeminal nerve

stimulation (TNS)protocol: Assessing a novel depression treatment.

Epilepsy Behav. 2016

Trevizol AP, Taiar I, Malta RC et al.

Trigeminal nerve stimulation (TNS) for social anxiety disorder: A case

study.


Shiozawa P, Duailibi MS, da Silva ME et al.

Trigeminal nervestimulation (TNS) protocol for treating major

depression: an open-label proof-of-concept trial.


Shiozawa P, Silva ME, Carvalho TC et al.

Transcutaneous vagus and trigeminal nerve stimulation for

neuropsychiatric disorders: a systematic review.

Arq Neuropsiquiatr. 2014

Shiozawa P, da Silva ME, Cordeiro Q et al.

Trigeminal nerve stimulation (TNS) for fibromyalgia: a case study.


Seizure

Depression

Memory and Mood

Attention-Deficit/Hyperactivity Disorder (ADHD)

Vagus -Trigeminal Stimulation

Anti-inflammatory

Sympathetic-parasympathetic tone modulation

Antidepressant

Antiepileptic

Analgesic

Immunomodulatory

Anxiolytic

Cognitive and memory processes

Tinnitus

Migraine

Attention-Deficit / Hyperactivity Disorder

Vagus -Trigeminal Stimulation

Anti-insomnia action

Anti-nausea action

Control of visceral functions

Clinical applications of Transcutaneous Trigeminal – Vagus Nerve Stimulation

Auricular Stimulation od functional points


Electro Nerve Stimulation Auricular Acupressure

Electro Auricular Acupuncture EAAc

Auricular Transcutaneous Electrical Nerve Stimulation ATENS

Non invasive Electro-Auriculotherapy

Auricular Transcutaneous Vagus Nerve Stimulation (at-VNS)

Stimolazione elettrica del padiglione auricolare

Stimolazione elettrica del padiglione auricolare

Auricular Neuromodulation

and regulation of

Autonomic Nervous System

(ANS)

He W, Wang X et al.

Auricular acupuncture and vagal regulation.


Gao XY, Wang L et al.

Brain-modulated effects of auricular

acupressure on the regulation of autonomic

function in healthy volunteers.


Yeh ML, Chang YC et al.

A randomized controlled trial of auricular

acupressure in heart rate variability and quality

of life for hypertension.

Complement Ther Med. 2015

Wang L, Cheng W et al.

Ear acupressure, heart rate, and heart rate

variability in patients with insomnia.


Gao XY, Zhang Spet al.

Investigation of specificity of auricular

acupuncture points in regulation of autonomic

function in anesthetized rats.

Auton Neurosci. 2008

Wang YJ, Hsu CC et al.

Auricular acupressure to improve menstrual pain

and menstrual distress and heart rate variability

for primary dysmenorrhea in youth with stress.


Yeh ML, Chang YC te al.

A randomized controlled trial of auricular

acupressure in heart rate variability and quality

of life for hypertension.

Complement Ther Med. 2015

Clancy JA, Mary DA et al.

Non-invasive vagus nerve stimulation in healthy

humans reduces sympathetic nerve activity.

Brain Stimul. 2014


Non-invasive vagus nerve stimulation in healthy

humans reduces sympathetic nerve activity.

Brain Stimul. 2014

Gao XY Wang L, Gaischek I et al. Brain-modulated effects of auricular acupressure on the regulation

of autonomic function in healthy volunteers.


There is a significant

decrease in LF/HF ratio

during active t-VNS

(p=0.026) whereas there

is no significant change

during sham tVNS.

Active at-VNS (n 1⁄4 34) was applied continuously for 15 min with a pulse width of 200 ms and pulse frequency of 30 Hz.Amplitude was adjusted to the level

of sensory threshold (10 - 50 mA)


Non-invasive vagus nerve stimulation in healthy humans reduces

sympathetic nerve activity

Brain Stimul. 2014

t-VNS

P Frequency = 30 Hz

P Width = 200 ms

Amplitude = 10 - 50 mA

15 min


Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic

nerve activity

Brain Stimul. 2014


Non-invasive vagus nerve stimulation in healthy humans reduces

sympathetic nerve activity

Brain Stimul. 2014

Auricular acupressure

Arai YC et al.

Auricular acupuncture at the "shenmen" and "point zero" points

induced parasympathetic activation.


Transcutaneous Electrical (t-VNS)


Non-invasive vagus nerve stimulation (t-VNS)in healthy

humans reduces sympathetic nerve activity.Brain Stimul. 2014t‐VNS (25 Hz, 250 µs)

Principali punti funzionali

Zero Point 1

Shen Men 2

Parasimpaticotonica

Antinfiammatoria - Immunomodulante

Analgesica

Ansiolitica

TR Anxiety – Insomnia zone 3 Tranquilizer p

Ansiolitica (Stait - Trait anxiety)

TF State Anxiety zone 4Relaxation p

Ansiolitica

Superior Concha Vagus Zone 5Azione vagale

Parasimpaticotonica

Antinfiammatoria - Immunomodulante

Analgesica

Antidepressiva

Altre

Punti / Zone funzionali

2

3

4

5

1

1

3

4

5

Heart 6

Parasimpaticotonica

Regolazione psichica

Thalamus 7

INFERIOR CONCHA VAGUS ZONE

Analgesica

6

8

9 10

7

Punti / Zone funzionali

2

Azione parasimpaticotonica/simpaticolitica

Stimolazione meccanico pressoria

Arai YC et al. Auricular acupuncture at the "shenmen" and "point

zero" points induced parasympathetic activation.


Elettrica Transcutanea (t-VNS)

Clancy JA, Mary DA et al. Non-invasive vagus nerve stimulation in

healthy humans reduces sympathetic nerve activity. (t‐VNS (25

Hz, 250 µs)

Brain Stimul. 2014

DX SN

Zona2. Shenmen6. Heart5. Emiconca sup 3. Tranquilizer4. Anterior lobe zone

6

NPY 0.3

SM / SV

4

2

5

122

Modulazione Simpatico - Parasimpatico

DX SN

Zona2. Shenmen6. Heart5. Emiconca sup 3. Tranquilizer

6

NPY 0.3

SM / SV

3

2

5

123

Stimolazione Parasimpatico Vagale

Documents

Le basi della Neuromodulazione Auricolare · ABVN Auricle Branch of the Vagus GAN Great Auricular Nerve (C2-C3) ATN Auriculotemporal Nerve - Trigeminus ABVN GAN ATN Crus of helix