Instead of reaching for a cup of coffee during a cemetery shift, workers might one day hold a device the size of an electric razor to their necks. After a few minutes, they would emerge refreshed and awake from what might be known as a “vagus nerve hernia.”
Called the gammaCore, the device sends a series of vibrating low-voltage surges, each lasting a millisecond, to the side of the neck. It’s supposed to stimulate part of the vagus nerve, a connection between the brain and the body, and cause the release of alertness chemicals.
Research into a way to use electricity to keep people awake and alert began after scientists affiliated and signed with the Air Force discovered that participants who had electrodes placed on their scalp to deliver a current were in were able to reduce fatigue and improve their performance on attention tasks. This setup isn’t easy to recreate outside of a lab, but if it did it could offer an alternative to caffeine or amphetamine stimulants, also known as “go pills,” still prescribed to US Air Force soldiers.
The search for a more direct and side effect-free solution led the researchers to the vagus nerve. Surgical implants that stimulate the nerve have been used to prevent seizures in people with epilepsy since 1988, and some of these patients have found that the implant helped them manage their headaches and pain. Other studies have shown that implanted vagus nerve stimulation improves memory and cognition in both humans and animals.
New research confirms that hand-held vagus nerve stimulation does what scientists thought: gammaCore helped Air Force members perform better and feel less tired after all night long. The results of the study were published in the journal today Communication biology.
Many thought stimulating the vagus nerve without needles or surgery was impossible before the technology was invented a decade ago, says Peter Staats, chief medical officer and co-founder of the company that makes gammaCore called electroCore. The handheld device works by touching the conductive gel on the surface of the skin and was first approved in 2017 for the treatment of cluster headaches in adults. Since then, its use has expanded to include migraines in adults and adolescents, and it has received an emergency permit for asthma, which is made worse in adults by COVID-19. The device is when prescribing from several major pharmacy performance managers and the list price is $ 1,750, although the company says it has been offering it to all customers for $ 1,250 for the time being. (An electroCore spokesperson notes that the latest model can cost as little as $ 399 for a three-month treatment.)
Vagus nerve stimulation is a popular target in bioelectronic medicine because of the direct connections between the nerve and many body organs. Stephen Silberstein, professor of neurology at Thomas Jefferson University and director of the Jefferson Headache Center, compares the vagus nerve to a major transportation hub like Grand Central Terminal in New York City, where a train or subway can send a commuter anywhere in the metropolitan area. Similarly, different types of fibers travel to different locations, including a part of the brain called the locus coeruleus. It is there that the brain produces norepinephrine, a fight-or-flight chemical that increases alertness and decreases pain and fatigue.
In the study, researchers observed 40 soldiers on active duty at an air force base who stayed awake for 34 hours while completing cognitive tests and reporting their mood and level of fatigue. Half of the participants used gammaCore for eight minutes at the beginning of the test, while the other half received a fake device that looked and felt like the real thing, but did not deliver any electrical power. Those in the group who received true vagus nerve stimulation stuck to their output power more closely through the night and reported less fatigue over time than the other group.
“We are excited to see that they are not only performing better, but also perceiving that they are better and feeling less tired,” said Richard McKinley, co-author of the study and biomedical engineer at the Air Force Research Laboratory. He says improvements in mood and energy levels could motivate soldiers to use such a device outside of a paid study.
While the two groups performed similarly on some parts of the cognitive tests over time, hours later, participants using gammaCore showed less drop in performance on perceptual tasks – the ingestion and synthesis of audio, visual, or other types of information.
Previous research on stimulation of the gamma core and vagus nerves has targeted populations with chronic and often debilitating conditions such as rheumatoid arthritis, migraines, and epilepsy. This new work leads to the use of this therapy in healthy people to improve performance, say Staats and the study’s authors.
“A lot of what we do in Western medicine is: We try to help people who already have diseases,” says Staats. “We spend less effort thinking about health programs or ‘How do we avoid disease development?’ or ‘How do we optimize ourselves?’ “
Silberstein, who was not involved in the study, says this device could help a wide variety of sleep-deprived people, from Air Force pilots to doctors to college students writing last-minute papers.
Another group that could benefit from the research are astronauts. Lindsey McIntire, first author of the paper and a researcher at defense company Infoscitex, says NASA provided some of the study funding because astronauts often sleep in extreme and unfamiliar environments, resulting in less restful sleep. Finding a permanent solution to fatigue would make people happier, healthier, and more focused on their tasks in space.
Eric Chang, an assistant professor at the Feinstein Institute for Medical Research who was also not involved in the research, says his findings may not generalize to people who are not sleep deprived for 34 consecutive hours like the participants. He adds that the study reports a “specific, small result” that is consistent with other vagus nerve stimulation studies.
McIntire points out that differences in performance between the GammaCore and placebo groups, which may appear small – as in the multitasking test – can have a big impact. “The performance of the active group was down 5 percent, but to 15 percent for percent [the placebo group]“She says,“ Those are mistakes, and in certain areas like medicine, the military, and transportation, life can mean life. ”The authors also plan to conduct research to examine the effects on people who are more mildly sleep deprived.
McIntire says future studies must be conducted before gammaCore can be recommended to soldiers and workers for off-label use, including testing against caffeine and other conventional stimulants. McKinley adds that concurrent animal studies are re-examining the mechanism of action, and he’s also preparing to come up with research on vagus nerve stimulation to boost learning rates and memory.
GammaCore owes its invention to the relatively new field of bioelectrical medicine, a discipline that uses electricity to hack into the body’s signaling system to treat disease. Bioelectronic medicine has shown promise in treating autoimmune diseases such as lupus through vagus nerve stimulation. Fatigue, pain, inflammation – future “vagus nerve hernias” could target them all.