t-VNS to treat disorders of behaviour in Prader-Willi Syndrome and in people with other neurodevelopmental conditions

This paper proposes that tVNS has the potential to be a new treatment for some of the behaviour difficulties that may affect people with intellectual disabilities and/or autism, particularly those people born with specific neurodevelopmental syndromes. Behaviours, such as emotional outbursts, physical aggression, and self-injury are a relative common occurrence in these groups and have a significant impact on wellbeing and quality of life for the individuals and their families. Such behaviours have generally been understood through the lens of learning theory, the likelihood of their occurrence being shaped and reinforced by the responses of others. However, when vagus nerve stimulation has been used to treat epilepsy improvements in cognition, behaviour, and general wellbeing have been noted suggesting that with these behaviours other causal mechanisms are also important. More recently incidental findings from a proof of concept study where vagus nerve stimulation was given, using an implanted device, to people with the genetically determined neurodevelopmental disorder, Prader-Willi Syndrome (PWS), findings of benefit supported the above view. A second study, this time using tVNS, reported a similar result. In this paper we review the evidence for the use of tVNS for behavioural problems, consider the challenges when conducting trials in this population, and reflect on what the preliminary observations in people with PWS tell us about the possible mechanisms that underpin such behaviours.