Non-Invasive Neuromodulation Using Time-Varying Caloric Vestibular Stimulation

Robert D Black, Lesco L Rogers, Kristen K Ade, Heather A Nicoletto, Heather D Adkins, Daniel T Laskowitz, Robert D Black, Lesco L Rogers, Kristen K Ade, Heather A Nicoletto, Heather D Adkins, Daniel T Laskowitz

Abstract

Caloric vestibular stimulation (CVS) to elicit the vestibulo-ocular reflex has long been used in clinical settings to aid in the diagnosis of balance disorders and to confirm the absence of brainstem function. While a number of studies have hinted at the potential therapeutic applications of CVS, the limitations of existing devices have frustrated that potential. Current CVS irrigators use water or air during short-duration applications; however, this approach is not tenable for longer duration therapeutic protocols or home use. Here, we describe a solid-state CVS device we developed in order to address these limitations. This device delivers tightly controlled time-varying thermal waveforms, which can be programmed through an external control unit. It contains several safety features, which limit patients to the prescribed waveform and prevent the potential for temperature extremes. In this paper, we provide evidence that CVS treatment with time-varying, but not constant temperature waveforms, elicits changes in cerebral blood flow physiology consistent with the neuromodulation of brainstem centers, and we present results from a small pilot study, which demonstrate that the CVS can safely and feasibly be used longitudinally in the home setting to treat episodic migraine. Together, these results indicate that this solid-state CVS device may be a viable tool for non-invasive neuromodulation.

Keywords: Caloric vestibular stimulation; brainstem; cerebral blood flow; migraine; neuromodulation.

Figures

FIGURE 1.
FIGURE 1.
CVS device headset and control unit.
FIGURE 2.
FIGURE 2.
(a) Exploded view of CVS headset. (b) Schematic showing the principal elements of the earpiece.
FIGURE 3.
FIGURE 3.
Infrared thermographs show the temperatures of the earpiece and heat sink during a square wave thermal waveform with a minimum temperature of 15 °C and a maximum temperature of 42 °C. Black is cold, white is hot.
FIGURE 4.
FIGURE 4.
Example of target and actual thermal profiles of the sawtooth time-varying thermal waveform used in this study.
FIGURE 5.
FIGURE 5.
(a) PI time course, (b) PI power spectrum, (c) HR time course and (d) HR power spectrum show physiological effects of time-varying CVS treatment when the subject is supine on a 22° wedge pillow. (e) Time course data for time-varying CVS in the supine position shows an anti-phase relationship between PI (purple) and HR (green), with oscillations in PI occurring first. (f) PI time course and (g) PI power spectrum when the subject is bent forward in a null position. The subject did not complete the entire post CVS time course during this recording. (h) PI time course and (i) PI power spectrum for constant temperature CVS (17 °C) when the subject is supine on a 22° wedge pillow. For panels a-d and f-i, baseline (black), CVS treatment (red), post-CVS treatment (blue).
FIGURE 6.
FIGURE 6.
The number of headaches reported over the course of the treatment and post-treatment observation periods binned into 2 week intervals.

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