Effectiveness and possible brain mechanisms of cervical invasive vagus nerve stimulation (iVNS) intervention for avoidant/restrictive food intake disorder: a case report

Abstract

Background: We reported a case of cervical invasive vagus nerve stimulation (iVNS) treatment for avoidant/restrictive food intake disorder (ARFID) in a patient with severe anxiety and depression. This patient was even given a critical illness notice during his hospitalization and all treatment efforts were failed.

Objective: We aimed to verfiy the effectiveness of iVNS in a patient with ARFID.

Methods: We first attempted to perform cervical iVNS in this case and then observed the changes in clinical scores. We also analyzed the alterations in brain magnetic resonance imaging characteristics before and after iVNS using multi-modal neuroimagings.

Results: After 18 days of iVNS (from 1 to 19 July 2023), the patient's clinical symptoms improved significantly and he rapidly gained 5 kg in weight. The brain functional characteristics of this patient tended toward those of the normal group. Functional connectivities of the medial of orbitalis prefrontal cortex returned to the normal range after iVNS.

Conclusion: This is a precedent for performing cervical iVNS in an ARFID patient. Brain neural activity can be modulated through iVNS. The observed improvements in clinical scores and positive changes in brain function validated the effectiveness of iVNS. This case study provides evidence that this intervention technique could be used to reduce the burden on more similar ARFID patients.

Keywords

avoidant/restrictive food intake disorder / invasive vagus nerve stimulation / brain magnetic resonance imaging / anxiety / depression / abdominal distension

Author contributions

Suping Cai (Writing - original draft), Yihan Wang (Investigation), Bofeng Zhao (Data curation, Methodology), Xiaoliang Li (Data curation, Methodology), Huan He (Validation), Kai Yuan (Validation), Qinxian Huang (Supervision), Qingchuan Zhao (Writing - review & editing), Bin Yang (Writing - review & editing), and Gang Ji (Funding acquisition)

Conflict of interest

None declared.

Acknowledgments

This work was supported by Shaanxi innovation ability support plan, Science and technology innovation team [2021TD-43], the Xidian university specially funded project for interdisciplinary exploration [grant No.TZJH2024017], the Fundamental Research Funds for the Central Universities [grant no. ZYTS24151], and the Key Research and Development Program of Shaanxi Province [Grant No. 2023-YBSF-204].

Ethics approval

We confirm that all experimental protocols were approved by the ethics committee of the Affiliated Hospital of the Fourth Military Medical University in China. Written informed consent was obtained from all participants or surrogates.

Ethics Approval Number/ID

KY20232181-F-1

Data, materials, and code availability

Send an email to Qinxian Huang ([e-mail]) to obtain freely.

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