Vagus nerve stimulation improves recovery after stroke

61NIh NIMH vagus-nerve-stimulation-public
Vagus nerve stimulation by a wireless device implanted subcutaneously. License: PD. Credit: NIH/NIMH

A stroke is a serious medical condition that is characterized by the death of brain cells following bleeding in the brain or lack of blood supply to those cells. Three quarters of the survivors have weakness in the arm which can be permanent. Physical therapy helps, but not much.

Dawson et al. (2015) report a novel way to increase arm mobility after stroke. Previous findings in animal studies showed promising results by stimulating the vagus nerve (VNS). This nerve is the tenth out of the twelve cranial nerves and has many functions, primarily heart and digestive control. The authors implanted a small wireless device in the neck of nine stroke survivors and delivered very short (half a second) mild (0.8 mA) electrical pulses during rehabilitation therapy. Ten matched controls received rehab therapy only.

The authors measured motor recovery by several tests, one of which is Fugl–Meyer assessment-UE. At this test, the rehab only group improved by 3 points and the VNS + rehab group by about 9 points and this difference was statistically significant (I believe this scale’s upper limit is 66, but I’m not 100% sure).

Although the authors offer a possible mechanism through which VNS might produce cortical plasticity (through release of acetylcholine and norepinephrine driven by activation of nucleus tractus solitarius) the truth is that we don’t really know how it works. Nevertheless, it seems that VNS paired with rehab is better than rehab alone, and that in itself certainly warrants further studies, perhaps the next step being a fully double-blind experiment.

Reference: Dawson J, Pierce D, Dixit A, Kimberley TJ, Robertson M, Tarver B, Hilmi O, McLean J, Forbes K, Kilgard MP, Rennaker RL, Cramer SC, Walters M, & Engineer N. (Epub 8 Dec 2015). Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke. Stroke. 2016; 47:00-00. DOI: 10.1161/STROKEAHA.115.010477. Article | FREE FULLTEXT PDF

By Neuronicus, 11 December 2015