
Vagus nerve stimulation significantly reduces rheumatoid arthritis symptoms - HillaryBriss
https://www.northwell.edu/about/news/breakthrough-first-human-study-shows-vagus-nerve-stimulation-significantly-reduces
======
ofcrpls
[http://ntsconference.com/wp-
content/uploads/2015/04/NTS_agen...](http://ntsconference.com/wp-
content/uploads/2015/04/NTS_agenda_051816_web_full.pdf)

My wife came out of this conference saying, everyone is just throwing
everything at the wall and see what sticks with vagal nerve stimulation.
Controls are minimal to none in most studies. Of course her perspective is
from the regulatory side.

~~~
cpncrunch
That was my conclusion when reading this study. There is basically no control
at all. They say the placebo effect couldn't have affected the results when
the patients were under general anaesthetic. That is certainly true, but
waiting 4 hours to measure TNF could certainly have had an effect.

Given that vagus nerve stimulation has failed in a placebo controlled trial
for depression, I think we should be cautious about this and wait for some
proper science.

It irks me when people do shoddy science like this, which basically tells us
nothing.

~~~
ars
> They say the placebo effect couldn't have affected the results when the
> patients were under general anaesthetic. That is certainly true,

Is it? It doesn't seem certainly true to me.

The non-conscious part of the mind can tell that "something" is being done to
it, and can draw comfort from that alone.

~~~
cpncrunch
Yes, good point. I think it's wise to be skeptical about any study that isn't
placebo controlled.

------
crazydoggers
So given that the mammalian diving reflex also stimulates the vagus nerve, is
anybody researching its effects on inflammation? Seems like it might be
preferable to suggest swimming therapy rather than immediately jumping to
surgical implants. (plus the exercise probably can't hurt) Or does the
surgical implant provide stimulation in a different amount/manner than the
diving reflex would?

~~~
artifaxx
Especially given the cost! There are a lot cheaper ways to stimulate the vagus
nerve. They could have spent more on implementing proper control groups and
still saved money.

------
tosseraccount
PNAS journal link here :
[http://www.pnas.org/content/early/2016/06/30/1605635113.full...](http://www.pnas.org/content/early/2016/06/30/1605635113.full?sid=d6b4d596-f61b-41b0-a472-cfdaa7d717e2)
: "Vagus nerve stimulation inhibits cytokine production and attenuates disease
severity in rheumatoid arthritis".

 _" In one circuit, termed “the inflammatory reflex,” action potentials
transmitted in the vagus nerve inhibit the production of tumor necrosis factor
(TNF), an inflammatory molecule that is a major therapeutic target in RA.
Although studied in animal models of arthritis and other inflammatory
diseases, whether electrical stimulation of the vagus nerve can inhibit TNF
production in humans has remained unknown. The positive mechanistic results
reported here extend the preclinical data to the clinic and reveal that vagus
nerve stimulation inhibits TNF and attenuates disease severity in RA
patients._"

------
stevebmark
Interesting: "Vagus nerve stimulation inhibits cytokine production".

Cytokines are "any of a number of substances...that are secreted by certain
cells of the immune system"

Rheumatoid arthritis is an inflammation of the joints causing pain.
Inflammation is caused by your immune system to heal a problem, like a cut or
an infection. This vagus nerve technique works by suppressing your immune
system.

I don't really know what I'm talking about here, but maybe a better path to a
cure is to stop the underlying cause of the inflammation?

"Doctors don’t know exactly what causes RA. It may be a combination of genes
and environment" \- WebMD. The body is attacking itself, finding out why
sounds important to me.

~~~
kirrent
As someone with pretty bad RA, it'd be nice if they could do that.
Unfortunately, the ultimate causes behind RA are pretty obscure at the moment.
While they don't work particularly well for me, cytokine inhibitors such as
abatacept are one of the gold standard treatments at the moment.

------
MrZongle2
Vagus nerve stimulation has also been used to treat some forms of epilepsy
since the late 90s, and is being researched as a treatment for a wide variety
of other illnesses and conditions:
[https://en.wikipedia.org/wiki/Vagus_nerve_stimulation](https://en.wikipedia.org/wiki/Vagus_nerve_stimulation)

~~~
etjossem
It's important to remember that this was never a first-choice treatment for
seizures. VNS was only viewed as a worthwhile course to pursue after trying an
exhaustive list of drugs.

From an FDA hearing on VNS: "there were patients who were very good
responders, becoming essentially seizure-free, as well as patients who were
poor responders, having 100 percent or greater increase in their seizure
frequency," and it was very difficult to predict how a given patient would
respond. [1]

[1]
[http://www.fda.gov/ohrms/dockets/AC/97/transcpt/3299t1.pdf](http://www.fda.gov/ohrms/dockets/AC/97/transcpt/3299t1.pdf)
p127

------
dspeyer
Is there a good reason for making day 42 (out of 84) the primary endpoint? Did
they at least decide to do that before looking at the data?

------
djrogers
Is it just me or is this a press release?

~~~
cpncrunch
Yes, it's the great HN tradition of posting flashy press releases claiming
that someone is about to change the world, based on dubious science.

I think this is the actual study:

[http://www.pnas.org/content/early/2016/06/30/1605635113.full](http://www.pnas.org/content/early/2016/06/30/1605635113.full)

------
carbocation
Generally, when I see people with vagal stimulators for painful or
uncomfortable conditions, it's a sign to me that they have been through many
different treatments that have not been effective for them. I've never seen
anyone receive these for any indication that has convinced me they are
effective.

------
medymed
Neurological manipulation to manage inflammatory condition may have a
promising future, and may be a good avenue to pursue for some patients (like
people not responding to immunomodulation). At a conference I overheard of
botox injection reducing psoriasis plaques in otherwise unresponsive patients
(just hearsay), and it is known that patients with onset of types of
neurologic damage (e.g. Parkinsons) have increased risk of another
inflammation-related condition seborrheic dermatitis (just correlation).
Teasing apart causal mechanisms at work could be quite a task.

~~~
joe_the_user
Well,

If the electrical stimulation is effective, I would say it would probably be
preferable to most drug therapies since just about all drugs have serious
side-effects when taken over a lifetime - certainly mainstream rheumatoid
arthritis drugs like Prednisone can have horrific side-effects.

~~~
tosseraccount
Anti-TNF biologics are a thing:
[https://en.wikipedia.org/wiki/TNF_inhibitor](https://en.wikipedia.org/wiki/TNF_inhibitor)

~~~
c0g
They definitely do cause issues - higher risk of exciting cancers and a
generally more sickly existence. Studies in IBD have their efficacy at 20-30%
of patients in remission after a year so they're only somewhat effective (vs
half that for placebo). Anecdotally (from my own experience, and from talking
to my doctors) quality of life can be poor - mind crushing fatigue is fairly
common. Admittedly the fatgue may be the cocktail of other crap in my body!

Something new with few side effects might help lots of people avoid surgery.

~~~
matheweis
Sorry to hear of your experience, but wanted to say for others that autoimmune
diseases and the associated medications are complex beasts and ymmv...

I have been on a TNF-a inhibitor for over a year and the results thus far have
been literally life changing - for the better. I haven't been this healthy or
had this much energy since before adulthood.

------
Jerry2
Dr Kevin Tracey, pioneer and inventor of these methods, gave a fascinating TED
talk on this topic not so long ago. If you have 15 min to spare, give it a
watch... it's amazing:

[http://www.tedmed.com/talks/show?id=526203](http://www.tedmed.com/talks/show?id=526203)

------
hiccupss
Does this have anything to do with getting The Hiccups?

------
sctb
We updated the link from
[https://www.sciencedaily.com/releases/2016/07/160704223410.h...](https://www.sciencedaily.com/releases/2016/07/160704223410.htm),
which points to this.

