WOW! Extreme lack of knowledge demonstrated here.
Mechanisms of Vagus Nerve Stimulation in Improving Motor Dysfunction After Stroke
Authors Cai X, Jiang J, Zhou G, Zhang Y
Received 18 August 2024
Accepted for publication 16 December 2024
Published 21 December 2024 Volume 2024:20 Pages 2593—2601
DOI https://doi.org/10.2147/NDT.S492043
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Rakesh Kumar
Xiaohu Cai,1,* Jiayao Jiang,2,* Guochao Zhou,3,* Yelei Zhang4
1Department
of Rehabilitation Medicine, Xishan People’s Hospital of Wuxi City, Wuxi
Branch of Zhongda Hospital Southeast University, Wuxi, People’s
Republic of China; 2Department of Orthopedics, The 904th
Hospital of the Joint Logistics Support Force of the PLA, Wuxi, Jiangsu,
People’s Republic of China; 3Department of Orthopedics, The Army 947th Hospital, Kashgar, People’s Republic of China; 4Department
of Neurosurgery, Xishan People’s Hospital of Wuxi City, Wuxi Branch of
Zhongda Hospital Southeast University, Wuxi, People’s Republic of China
*These authors contributed equally to this work
Correspondence:
Yelei Zhang, Department of Neurosurgery, Xishan People’s Hospital of
Wuxi City, Wuxi Branch of Zhongda Hospital Southeast University, Wuxi,
People’s Republic of China, Email Zhangyelei2019@163.com
Abstract:
Patients with stroke would have persistent functional deficits despite
undergoing physiotherapy and rehabilitation training. Recently(WRONG! Since July 2012! and you DIDN'T KNOW THAT? My God, you're incompetent!), vagus
nerve stimulation (VNS), a newly emerging neuroregulatory technique, has
been shown to improve motor dysfunction after stroke. Evidence from
clinical and preclinical studies has proven the safety, feasibility, and
efficacy of invasive and noninvasive VNS. It has been reported that the
positive effect may be related to anti-inflammatory effects, mediating
neuroplasticity, increasing blood–brain barrier integrity, promoting
angiogenesis and reducing spreading depolarization. However, the
underlying mechanism remains poorly understood. In this review, we have
summarized the potential molecular mechanisms by which VNS promotes
stroke prognosis. We believe(It's already been proven for over a decade!) that VNS combined with upper-extremity
rehabilitation can improve impairment and function among moderately to
severely impaired stroke survivors. The applications and further
exploration are discussed to provide new insights into this novel
therapeutic technique.
Keywords: vagus nerve stimulation, stroke, neuroinflammatory response, brain plasticity
Introduction
Stroke is the leading cause of long-term disability worldwide, with 80% of patients suffering from motor dysfunction on one side of the body, which seriously affects their quality of life.1 According to the pathophysiology, stroke could be identified into two principal categories: ischemic and hemorrhagic stroke. Ischemic stroke occurred when blood flow is insufficient and unable to satisfy the brain tissue’s needs for oxygen and nutrients. In contrast, hemorrhagic stroke is due to the rupture of a blood vessel and represented by blood in the cerebral parenchyma, which can accumulate and press on the adjacent parenchyma.2 Similarly, both ischemic and hemorrhagic stroke would be associated with neurological dysfunction. Despite receiving physiotherapy and rehabilitation training, many patients still have persistent functional deficits, which would limit the quality of their lives and carry a huge economic burden on families and society.3 Therefore, novel therapeutic strategies are needed to better promote the improvement of damaged neurological function following stroke.
Vagus nerve stimulation (VNS) is a newly emerged neuroregulatory technique in recent years that has been widely used for the treatment of multiple neurological diseases such as refractory epilepsy, migraines, and refractory depression. An increasing number of studies have shown that VNS combined with rehabilitation can significantly reduce the size of post-stroke cerebral infarctions, reduce neurological symptoms, and improve limb motor function following stroke.4 VNS is commonly classified as invasive VNS (iVNS) or noninvasive VNS (nVNS). The nVNS containing auricular VNS in the ear (ta-VNS) and cervical VNS in the neck (tc-VNS) exhibited central nervous system (CNS) activation, similar to invasive VNS. However, the role of VNS in post-stroke motor function has not yet been elucidated and the mechanisms remain unclear. Given that the vagus nerve (VN) plays pivotal roles in the CNS regulating inflammatory responses and emerging evidence link inflammatory processes with VNS, the anti-inflammatory potential of VNS has been discovered.5 VNS has also been demonstrated to ameliorate gut microbiota dysbiosis and modulate microbiota-gut-brain axis to promote functional recovery after stroke.6,7 In this study, we summarized the anatomical, pre-clinical, and clinical evidence of VNS. We further emphasized the possible mechanism of VNS in improving motor dysfunction after stroke based current evidence and analyzed future challenges for its clinical application.
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