Transcutaneous auricular vagus nerve stimulation during movement modulates motor neural circuitry without widespread cortical or autonomic activation

Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising neuromodulatory approach for treating neurological disorders, with growing interest in its potential to support motor rehabilitation. Yet, its mechanisms of action, potentially influenced by behavioral context, remain elusive. This sham-controlled study investigated transient taVNS interactions with movement in healthy adults, focusing on autonomic, neuromodulatory, and motor circuits. During a finger-tapping paradigm, heart rate (HR), galvanic skin response (GSR), pupil diameter, and electroencephalography (EEG) were recorded to probe movement-dependent stimulation effects. This study first identified a novel physiological dissociation: all measures responded to movement, but taVNS did not significantly alter HR, GSR, or general EEG spectral slope; taVNS increased pupil diameter in both conditions, but enhanced sensorimotor EEG spectral slope solely during movement. This context-specific effect on motor systems was further supported by a transcranial magnetic stimulation (TMS) experiment demonstrating increased corticospinal excitability during taVNS. These findings provide mechanistic insights into how taVNS may selectively enhance motor system responsiveness during active states, supporting future exploration of behaviorally paired stimulation protocols for neurorehabilitation.