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

What more needs to be done on vagus nerve stimulation before a fucking stroke protocol is written up on it?  I've written 12 posts on this back to July 2012. This is a perfect example of NO fucking stroke leadership.
http://stroke.ahajournals.org/content/47/1/143.full?sid=44bf82cc-c46f-4cd0-bec3-1d782258960c

1. Jesse Dawson, MD;
2. David Pierce, MSEE;
3. Anand Dixit, MD;
4. Teresa J. Kimberley, PhD;
5. Michele Robertson, BSc;
6. Brent Tarver, BSEE;
7. Omar Hilmi, FRCS;
8. John McLean, PhD;
9. Kirsten Forbes, MD;
10. Michael P. Kilgard, PhD;
11. Robert L. Rennaker, PhD;
12. Steven C. Cramer, MD;
13. Matthew Walters, MD;
14. Navzer Engineer, PhD

+ Author Affiliations

1. From the Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences (J.D., M.W.) and Robertson Centre for Biostatistics (M.R.), University of Glasgow, Western Infirmary, Glasgow, United Kingdom; MicroTransponder, Inc., Austin, TX (D.P.); University of Texas at Dallas, Richardson (D.P., B.T., N.E.); Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (A.D.); Programs in Physical Therapy and Rehabilitation Science, Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis (T.J.K.); Department of Otolaryngology, Glasgow Royal Infirmary (O.H.) and Neuroradiology, Institute of Neurological Sciences, NHS (J.M., K.F.), Greater Glasgow and Clyde, Glasgow, United Kingdom; School of Behavioral and Brain Sciences (M.P.K., R.L.R.) and Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science (M.P.K.), University of Texas at Dallas, Richardson; and the Sue & Bill Gross Stem Cell Research Center, and Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine (S.C.C.).

1. Correspondence to Jesse Dawson, MD, College of Medical, Veterinary and Life Sciences, Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom. E-mail jesse.dawson@glasgow.ac.uk

 

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Abstract

Background and Purpose—Recent animal studies demonstrate that vagus nerve stimulation (VNS) paired with movement induces movement-specific plasticity in motor cortex and improves forelimb function after stroke. We conducted a randomized controlled clinical pilot study of VNS paired with rehabilitation on upper-limb function after ischemic stroke.

Methods—Twenty-one participants with ischemic stroke >6 months before and moderate to severe upper-limb impairment were randomized to VNS plus rehabilitation or rehabilitation alone. Rehabilitation consisted of three 2-hour sessions per week for 6 weeks, each involving >400 movement trials. In the VNS group, movements were paired with 0.5-second VNS. The primary objective was to assess safety and feasibility. Secondary end points included change in upper-limb measures (including the Fugl–Meyer Assessment-Upper Extremity).

Results—Nine participants were randomized to VNS plus rehabilitation and 11 to rehabilitation alone. There were no serious adverse device effects. One patient had transient vocal cord palsy and dysphagia after implantation. Five had minor adverse device effects including nausea and taste disturbance on the evening of therapy. In the intention-to-treat analysis, the change in Fugl–Meyer Assessment-Upper Extremity scores was not significantly different (between-group difference, 5.7 points; 95% confidence interval, −0.4 to 11.8). In the per-protocol analysis, there was a significant difference in change in Fugl–Meyer Assessment-Upper Extremity score (between-group difference, 6.5 points; 95% confidence interval, 0.4 to 12.6).

Conclusions—This study suggests that VNS paired with rehabilitation is feasible and has not raised safety concerns. Additional studies of VNS in adults with chronic stroke will now be performed.

Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT01669161.