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Review
. 2020 Aug;23(6):784-788.
doi: 10.1111/ner.13172. Epub 2020 May 12.

The Use of Non-invasive Vagus Nerve Stimulation to Treat Respiratory Symptoms Associated With COVID-19: A Theoretical Hypothesis and Early Clinical Experience

Peter Staats  1 , Georgios Giannakopoulos  2 , Justyna Blake  1 , Eric Liebler  1 , Robert M Levy  3
Affiliations
Review

The Use of Non-invasive Vagus Nerve Stimulation to Treat Respiratory Symptoms Associated With COVID-19: A Theoretical Hypothesis and Early Clinical Experience

Peter Staats et al. Neuromodulation. 2020 Aug.

Abstract

Objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic with no specific therapeutic agents and substantial mortality, and finding new treatments is critical. Most cases are mild, but a significant minority of patients develop moderate to severe respiratory symptoms, with the most severe cases requiring intensive care and/or ventilator support. This respiratory compromise appears to be due to a hyperimmune reaction, often called a cytokine storm. Vagus nerve stimulation has been demonstrated to block production of cytokines in sepsis and other medical conditions. We hypothesize that non-invasive vagus nerve stimulation (nVNS) might provide clinical benefits in patients with respiratory symptoms similar to those associated with COVID-19.

Materials and methods: Information on two case reports was obtained via email correspondence and phone interviews with the patients.

Results: Both patients reported clinically meaningful benefits from nVNS therapy. In case 1, the patient used nVNS to expedite symptomatic recovery at home after hospital discharge and was able to discontinue use of opioid and cough suppressant medications. In case 2, the patient experienced immediate and consistent relief from symptoms of chest tightness and shortness of breath, as well as an improved ability to clear his lungs.

Conclusions: Preliminary observations and a strong scientific foundation suggest that nVNS might provide clinical benefits in patients with COVID-19 via multiple mechanisms.

Keywords: COVID-19; Cholinergic anti-inflammatory pathway; cytokine storm; neuromodulation; non-invasive vagus nerve stimulation; respiratory symptoms.

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Conflict of interest statement

Conflict of Interest: Peter Staats, is an employee and was cofounder of electroCore, Inc., and receives stock ownership. Justyna Blake and Eric Liebler are employees of electroCore, Inc., and receive stock ownership. Georgios Giannakopoulos owns stock in electroCore, Inc. In the previous three years, Robert Levy has served as a consultant for Abbott, Saluda, Nalu, and Mainstay Medical and has stock options with Nalu and Saluda.

Figures

Figure 1
Figure 1
Treatment with non-invasive vagus nerve stimulation. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

Comment in

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