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A newly published study in Neurological Sciences examined the use of transcutaneous auricular vagus nerve stimulation (taVNS) in patients with hypermobile Ehlers-Danlos syndrome (hEDS) experiencing disabling dysautonomia.
Dysautonomia is common in hEDS and can contribute to symptoms including orthostatic intolerance, gastrointestinal dysfunction, vasomotor instability, fatigue, and other multisystem complaints. The researchers investigated whether non-invasive stimulation of the vagus nerve could help improve autonomic symptoms and quality of life.
Vagus Nerve Stimulation and Autonomic Regulation
The vagus nerve plays an important role in autonomic regulation and communication between the nervous, immune, cardiovascular, and gastrointestinal systems.
Transcutaneous auricular vagus nerve stimulation provides a non-invasive method of engaging vagal pathways through the auricular branch of the vagus nerve. Previous research suggests that taVNS may influence autonomic balance, sympathetic activity, and inflammatory signaling.
For this pilot study, 14 female patients with hEDS and disabling dysautonomia received 60-minute taVNS sessions once a week for eight weeks. Stimulation was delivered to the left cymba conchae in a hospital-based VNS center under clinical supervision.
Improvements in Dysautonomia Symptoms
Researchers measured autonomic symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31).
After eight weeks of taVNS, the mean COMPASS-31 score decreased from 44.6 to 28.3, representing a 36.5% reduction. Five of the 14 participants also fell below the study’s clinical threshold for disabling dysautonomia by the end of treatment.
Improvements were observed across several autonomic symptom areas, with gastrointestinal symptoms showing a statistically significant improvement after correction for multiple comparisons. Orthostatic intolerance, vasomotor symptoms, and pupillomotor symptoms also improved nominally, although these findings did not remain statistically significant after correction.
Quality of Life and Safety
Quality of life was assessed using the SF-36 Health Survey. The overall SF-36 score increased from 30.3 at baseline to 38.7 after eight weeks, although the overall improvement did not reach statistical significance. Several individual measures, including physical functioning, physical role functioning, and mental health, showed improvements before correction for multiple comparisons.
taVNS was also well tolerated. All 14 participants completed the eight-week protocol, and researchers reported no cardiovascular or neurological adverse effects attributable to the treatment. Five participants reported mild, temporary sensations such as tingling or warmth.
An Emerging Area of Research
The findings provide preliminary evidence that non-invasive vagus nerve stimulation may have potential for addressing autonomic dysfunction associated with hEDS.
However, the researchers emphasize several important limitations. This was a small, open-label pilot study without a sham-control group, which means the results cannot establish efficacy or exclude placebo effects. The study also relied primarily on self-reported measures.
Larger randomized, sham-controlled studies incorporating objective autonomic measurements and neuroimmune biomarkers will be needed to better understand the effects of taVNS in this population.
Looking Ahead
The study highlights the potential role of vagal neuromodulation in conditions involving complex interactions among the autonomic nervous system, immune signaling, and the gut-brain axis.
The authors conclude that these exploratory findings warrant further investigation and suggest that vagal neuromodulation may represent a promising non-invasive strategy for dysautonomia in hEDS.
Original article:
Azabou E, Bao G, Pillot A, et al. Transcutaneous auricular vagus nerve stimulation improves dysautonomia in patients with hypermobile Ehlers-Danlos syndrome. Neurological Sciences. 2026;47:817. DOI: 10.1007/s10072-026-09420-7.
This article summarizes emerging research and is intended for educational purposes. The findings come from a small, open-label pilot study and require confirmation in larger randomized controlled trials.
