Effect and Safety of Transcutaneous Auricular Vagus Nerve Stimulation on Recovery of Upper Limb Motor Function in Subacute Ischemic Stroke Patients: A Randomized Pilot Study

Abstract

Background. Transcutaneous auricular vagus nerve stimulation (taVNS) is regarded as a potential method for recovery in stroke. The effectiveness of taVNS in acute and subacute stroke should be further discussed as previously, only a few small-scale trials have focused on chronic stroke patients. The objective of this study is to investigate the effect and safety of taVNS on upper limb motor function in subacute ischemic stroke patients. Methods. Twenty-one subacute ischemia stroke patients with single upper limb motor function impairment were enrolled and randomly assigned to conventional rehabilitation training with real or sham taVNS, delivered for 15 consecutive days. Electrodes were fixed to the cymba conchae of the left ear with or without electrical stimulation. Conventional rehabilitation training was performed immediately after the end of real or sham taVNS by the same therapists. Baseline assessments were performed on day 0 of enrollment, and posttreatment evaluations were performed at 15 days, 4 weeks, and 12 weeks after the first intervention. The assessment included the upper limb Fugl-Meyer assessment (FMA-U), the Wolf motor function test (WMFT), the Functional Independence Measurement (FIM), and Brunnstrom stage. Heart rate (HR) and blood pressure (BP) were measured before and after each taVNS intervention. At the same time, any adverse effects were observed during the procedure. Outcomes were assessed by a blind evaluator. Results. There were no significant differences in FMA-U, WMFT, FIM, and Brunnstrom scores between the two groups at baseline (P>0.05). At the endpoint, the FMA-U, WMFT, and FIM scores were significantly higher than before treatment (P<0.05), and there was a significantly greater improvement of those measurements in taVNS group compared with sham-taVNS group (P<0.05). Significant improvements in FMA-U score were found between groups at follow-up. Only one case of skin redness occurred during the study. Conclusions. This study revealed that taVNS appeared to be beneficial to the recovery of upper limb motor function in subacute ischemia stroke patients without obvious adverse effects. Trial registration. This trial is registered with ChiCTR1800019635 on 20 November 2018 (http://www.chictr.org.cn/showproj.aspx?proj=32961).

Non-invasive Vagus Nerve Stimulation in Cerebral Stroke: Current Status and Future Perspectives

“…Among which, four studies included chronic stroke patients ( Capone et al, 2017 ; Redgrave J.N. et al, 2018 ; Baig et al, 2019 ; Zhao B. et al, 2019 ) except one study included subacute ischemic stroke patients ( Wu et al, 2020 ). Here, we summarized the mainly functional improvement, parameters, side effects and future directions of nVNS in clinical studies on stroke.…”

“…Researchers recently published a randomized pilot study exploring the safety and effectiveness of taVNS in treating patients with subacute ischemic stroke. In this study, 21 patients with strokes in the acute or subacute phase (between 0.5 and 3 months post onset) were included ( Wu et al, 2020 ). At the endpoint, there were significantly greater improvements in FMA-U, FIM, and WMFT scores in the taVNS group compared with the sham-taVNS group.…”

“…It has been shown that the nVNS was safe and well-tolerated, and those adverse events were very rare ( Capone et al, 2017 ; Redgrave J.N. et al, 2018 ; Baig et al, 2019 ; Zhao B. et al, 2019 ; Wu et al, 2020 ). Redgrave J. et al (2018) published a systematic review of the safety and tolerability of taVNS.…”

Vagus nerve stimulation accelerates motor learning through cholinergic modulation

“…Alternatively, direct brain stimulation of targets, such as the basal forebrain, could be used to provide more specific neuromodulation to achieve key therapeutic results. Lastly, less invasive techniques, such as auricular VNS might still be able to convey therapeutic benefits if their stimulation protocols and target activation within the central nervous system is optimized 95,96 . The data presented here provide a framework for dissecting the role of VNS within specific therapeutic indications, with the ultimate goal of improving therapeutic delivery and patient outcomes.…”

Use of Transcutaneous Auricular Vagus Nerve Stimulation as an Adjuvant Therapy for the Depressive Symptoms of COVID-19: A Literature Review

“…To date, clinical and laboratory research demonstrated that taVNS can improve lung function (19,20). In addition, taVNS is commonly used to treat encephalopathy, encephalitis, ischemic infarcts, cerebral venous thrombosis, as well as peripheral nervous system pathologies [i.e., muscle injuries, and peripheral neuropathies; (21)(22)(23)(24)(25)(26)].…”