The Effects Of Vagus Nerve Stimulation

On Decision-Making

Coleman O.M.,. Denburg N.L, Tranel D., Granner M.A. & Bechara A.
Cortex, 2004
The advantage of the emotions is that they lead us astray,
and the advantage of science is that it is not emotional.

Oscar Wilde
The Picture of Dorian Gray, 1891
 Study objective

• According to Somatic Markers Hypothesis we are guided by somatic

feelings in decision-making.

• Vagus nerve may serve as a main route for somatic afferent signals in
decision making process.

• In this study the authors wondered whether individual performance in

adaptive decision making task may be improved by the direct electric
stimulation of vagus nerve.
Vagus Nerve
• The longest of the cranial nerves

• Starts in the brainstem (within the

medulla oblongata) and extends, to
abdomen, where it contributes to the
innervation of the vicera

• Besides output to the various organs in

the body the vagus nerve conveys
sensory information about the state of
the body organs to the CNS

• ~ 80% of the fibers – afferent

• An extraganglial integrator of the

autonomic nervous system
 Evidence in favor of Vagus Nerve
involvement in decision making:

• Peripheral neuropathies involving authonomic fibers impair adaptive

decision making at IGT (Bechara et al., 1998). (The vagus is an autonomic
nerve)

• Left vagus stimulation (VNS) causes increased blood flow in bilateral

thalamus, hypothalamus, anterior insula, orbital frontal cortex, inferior
frontal gyrus, and inferior parietal lobule (Henry et al., 1998)

• Vagus nerve stimulation improves human memory (Clark et al., 1999;

Cahil & McGaugh, 1998)
 Other possible routes by which
somatic information can feedback
to the brain and influence cognition:

• Spinal cord ?
subjects with spinal cord injury between the 2nd and 6th cervical
vertebra did not show impairments in IGT (North and O’Carroll,
2001). It is known that Sympathetic signals enter and exit the spinal
cord at and below the first thoracic level,

• Endocrine route ?
too slow
 Present study

In this study authors implied the electromagnetic stimulation of the left

vagus nerve to explore further the role of somatic (bodily) feedback in
the adaptive decision making at gambling task.
 Subjects
• Medically refractory epileptic patients with implanted vagus nerve
stimulators
• 1 female, 7 male
• Neuropsychological profile:

Underlined scores represent defective performances

Therapeutic intermittent stimulation was deactivated. To allow external control
of the device, it was programmed to respond to a magnetic pulse by delivering
60 seconds of 0.5 mA left vagus nerve stimulation.
 Decision-making assessment

Adaptive decision-making assessed with Iowa gambling task (Bechara,

Damasio, 1994)

Participants performed the task twice with the disadvantageous decks given
different labels and repositioned to different screen locations on the second
trial.

Between two trials participants underwent neuropsychological testing

 Design

* Mixed * Counterbalanced
* Participants blind as to when stimulation occurred
 3 way (2 × 2 × 5) ANOVA #1:
Independent Variables:

1. task order (on-first versus off-first) - between group comparison

2. stimulation state (on versus off) - within group comparison

3. The 5 blocks of 20 cards from the 100 trials of the gambling task (a
within group comparison)

Dependent variable:

IGT net score (ratio of “good” vs “bad” choices) by block

 3 way (2 × 2 × 5) ANOVA #1:

• By and large, VNS participants performed more poorly than healthy

participants with similar demographic characteristics (previous studies)
• Statistically significant interaction of stimulation state (on versus off) and
block [F (4, 24) = 3.92; p < .01].
• No significant main effect of order, of stimulation condition, of blocks,
nor any other significant interaction.
 3 way (2 × 2 × 5) ANOVA #1:

• Interestingly, the participants showed opposite learning patterns in two

stimulation conditions:
“on” condition – improved performance during the game, except block 5
“off” condition – performance deteriorated during the game, except block 5
 3 way (2 × 2 × 5) ANOVA #2:
Independent Variables:

1. task order (on-first versus off-first) - between group comparison

2. stimulation state (on versus off) - within group comparison

3. The 5 blocks of 20 cards from the 100 trials of the gambling task (a
within group comparison)

Dependent variable:

change in IGT net score relative to block 1

 3 way (2 × 2 × 5) ANOVA #2:

• Significant main effect of stimulation condition [F (1, 6) =9.9; p < .02]

• No main effect of order of stimulation, blocks, or any interaction .
• Newman-Keuls post hoc testing revealed significant differences in
performance between stimulation states for blocks 2, 3 (p < 0.03)
and 4 (p < 0.001). There was a statistical trend for a difference between
stimulation states of block 5 (p < 0.1)
 Conclusions:

• The results suggest that VNS influences decision-making, thus

supporting the hypothesis that the vagus nerves may be a critically
important peripheral substrate for the process of decision-making

• Another line of evidence in favor of the Somatic Marker Hypothesis.

• Vagus nerve stimulation is a promising instrument for the

neuroscience research
 Thanks

Authors VNS Inventors Health professionals