Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke

Dawson, Jesse; Pierce, David M.; Dixit, Anand; Kimberley, PT Teresa J; Robertson, Michele; Tarver, Brent; Hilmi, Omar; McLean, John M.; Forbes, Kirsten; Kilgard, Michael P.; Rennaker, Robert L.; Cramer, Steven C.; Walters, Matthew

doi:10.1161/strokeaha.115.010477

Cited by 225 publications

(275 citation statements)

References 30 publications

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“…In this open-label study, patients who received VNS paired with rehabilitation demonstrated 3-fold greater improvement in Upper Extremity Fugl-Meyer score compared to patients who received rehabilitation without VNS (Dawson et al, 2015), providing an initial demonstration that VNS may improve post-stroke recovery. The present preclinical study provides additional proof-of-concept support and suggests that VNS therapy may provide benefits for elderly patients as it translated to the broader clinical population of stroke patients.…”

Section: Discussionmentioning

confidence: 92%

Vagus nerve stimulation during rehabilitative training enhances recovery of forelimb function after ischemic stroke in aged rats

Hays

Ruiz

Bethea

et al. 2016

Neurobiology of Aging

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Advanced age is associated with a higher incidence of stroke and worse functional outcomes. Vagus nerve stimulation (VNS) paired with rehabilitative training has emerged as a potential method to improve recovery after brain injury but to date has only been evaluated in young rats. Here, we evaluated whether VNS paired with rehabilitative training would improve recovery of forelimb function after ischemic lesion of the motor cortex in rats 18 months of age. Rats were trained to perform the isometric pull task, an automated, quantitative measure of volitional forelimb strength. Once proficient, rats received an ischemic lesion of the motor cortex and underwent rehabilitative training paired with VNS for 6 weeks. VNS paired with rehabilitative training significantly enhances recovery of forelimb function after lesion. Rehabilitative training without VNS results in a 34% ± 19% recovery, whereas VNS paired with rehabilitative training yields a 98% ± 8% recovery of prelesion of forelimb function. VNS does not significantly reduce lesion size. These findings demonstrate that VNS paired with rehabilitative training enhances motor recovery in aged subjects in a model of stroke and may suggest that VNS therapy may effectively translate to elderly stroke patients.

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Section: Discussionmentioning

confidence: 92%

Vagus nerve stimulation during rehabilitative training enhances recovery of forelimb function after ischemic stroke in aged rats

Hays

Ruiz

Bethea

et al. 2016

Neurobiology of Aging

Self Cite

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“…Based on these studies, Dawson et al [67,68] evaluated VNS paired with physical rehabilitation in a pilot study in stroke patients. Although designed as a safety study, VNS was paired with several typical rehabilitative tasks over the course of 6 weeks of physical rehabilitation.…”

Section: Preclinical and Clinical Studies For Ischemic Strokementioning

confidence: 99%

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Hays

2016

Neurotherapeutics

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Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

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“…35 A recent RCT of vagal nerve stimulation to augment upper-limb rehabilitation following stroke was shown to be safe and feasible. 40 Further prospective studies are necessary to evaluate the efficacy of this modality.…”

Section: Cerebellar Stimulationmentioning

confidence: 99%

Neurorestoration after stroke

Azad¹,

Veeravagu²,

Steinberg³

2016

FOC

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Recent advancements in stem cell biology and neuromodulation have ushered in a battery of new neurorestorative therapies for ischemic stroke. While the understanding of stroke pathophysiology has matured, the ability to restore patients' quality of life remains inadequate. New therapeutic approaches, including cell transplantation and neurostimulation, focus on reestablishing the circuits disrupted by ischemia through multidimensional mechanisms to improve neuroplasticity and remodeling. The authors provide a broad overview of stroke pathophysiology and existing therapies to highlight the scientific and clinical implications of neurorestorative therapies for stroke.

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Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke

Abstract: Supplemental Digital Content is available in the text.

Cited by 225 publications

References 30 publications

Vagus nerve stimulation during rehabilitative training enhances recovery of forelimb function after ischemic stroke in aged rats

Vagus nerve stimulation during rehabilitative training enhances recovery of forelimb function after ischemic stroke in aged rats

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation

Neurorestoration after stroke

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