Neuromodulation of dyspnea - A literature review

Abstract

Dyspnea is a complex sensation resulting from the interplay between neural, biochemical, and mechanical pathways. Because dyspnea is a perception created and interpreted by the central nervous system, it could theoretically be targeted by neuromodulation approaches. This technique is used in pain to modulate the function of neuronal circuits. However, a safe surgical and/or non-invasive modus operandi is not established for refractory dyspnea. Nevertheless, the following literature review will discuss different neuromodulation techniques that may treat refractory dyspnea, even though the understanding of its pathophysiology is limited. More precisely, the diaphragm and its phrenic control, the ventral respiratory complexes (such as Kolliker-Fuse complex and the pre-Bötzinger complex), the vagal nerve, the periaqueductal gray, the insula, the cingular cortex, and the thalamus appear to play an important role in the pathophysiology of breathlessness. Consequently, deep brain stimulation, trigeminal nerve, spinal and vagal nerve stimulations are potentially effective approaches to diminish dyspnea. The discovery of useful dyspnea-reducing neuromodulation techniques could replace or be added to actual treatments like pulmonary rehabilitation, facial ventilators, oxygen, and opioids could be replaced, consequently enhancing the quality of life of dyspneic individuals.

Keywords: DBS; Dyspnea; Neuromodulation; Pathophysiology; Treatment; VNS.