When two people use the same VNS device at the same intensity, it sounds as if they are receiving the same dose. They may not be.
The number shown on the device describes the electrical output, but not which nerve fibers were activated or what changed in the body.
The vagus nerve is not a single electrical cable. It contains multiple bundles of fibers connected to different organs and carrying different signals. Which fibers are activated depends on the person’s anatomy, electrode position, waveform, and device design.
This means two people using the same settings may not actually be receiving the same stimulation.
That is one of the most useful findings to emerge from the NIH SPARC program, which has invested more than $350 million in mapping peripheral nerves and developing more precise forms of neuromodulation.
Researchers found substantial differences between human, pig, and rat vagus nerves. Human vagus nerves also vary considerably from person to person, including nerve diameter, fascicle number, fascicle position, and the thickness of tissue surrounding the fibers.
Computer models suggest these differences can change which fibers an electrical pulse reaches. The same current and pulse width may stimulate one combination of fibers in one person and a different combination in someone else.
For someone using or comparing VNS devices, this has several practical implications:
- The intensity displayed by the device is not the same as the dose received by the nerve.
- A stronger sensation does not necessarily mean more effective vagus nerve recruitment.
- Tingling or muscle contraction shows that electricity reached tissue, but not which nerve fibers were activated.
- Copying another person’s settings may not reproduce their physiological response.
- “Level 5” on one device may not be comparable to “level 5” on another device.
- Increasing intensity may recruit additional fibers, including fibers associated with unwanted effects.
SPARC researchers are now combining human nerve maps, computational simulations, implanted VNS data, and physiological recordings to connect three things that are usually discussed separately:
What stimulation was delivered, which fibers were recruited, and what changed in the body.
That could move neuromodulation away from trial-and-error programming.
A future closed-loop system might monitor heart rate, breathing, digestion, neural activity, or another relevant signal. It could then adjust stimulation according to the measured response instead of repeatedly delivering one fixed program.
The biggest shift is conceptual. The true dose of neuromodulation may not be the number shown on the device. It may be the specific neural and physiological response produced in that individual.
The next major advance in VNS may not be a stronger stimulator. It may be a way to verify which fibers were actually stimulated and what changed in the body.
Reference
Patel, B., Pikov, V., Damaser, M. S., et al. (2026). Accelerating the development of bioelectronic medicine: Outcomes and innovations from the NIH SPARC initiative. Bioelectronic Medicine, 12, 20. https://doi.org/10.1186/s42234-026-00213-z
SPARC Data and Resource Center: https://sparc.science