Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke.

Author: Kimberley TJ1,2, Pierce D3, Prudente CN2,3, Francisco GE4,5, Yozbatiran N4,5, Smith P6, Tarver B3, Engineer ND3, Alexander Dickie D7, Kline DK2, Wigginton JG6,8, Cramer SC9, Dawson J7
Affiliation: <sup>1</sup>From the School of Health and Rehabilitation Sciences, Department of Physical Therapy, Massachusetts General Hospital Institute for Health Professions, Boston (T.J.K.). <sup>2</sup>Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis (T.J.K., C.N.P., D.K.K.). <sup>3</sup>MicroTransponder, Inc, Austin, TX (D.P., C.N.P., B.T., N.D.E.). <sup>4</sup>Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston McGovern Medical School (G.E.F., N.Y.). <sup>5</sup>The NeuroRecovery Research Center at TIRR Memorial Hermann (G.E.F., N.Y.). <sup>6</sup>Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (P.S., J.G.W.). <sup>7</sup>Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary, and Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, United Kingdom (D.A.D., J.D.). <sup>8</sup>Tx Biomedical Device Center at The University of Texas at Dallas (J.G.W.). <sup>9</sup>Department of Neurology, University of California, Irvine (S.C.C.).
Conference/Journal: Stroke.
Date published: 2018 Nov
Other: Volume ID: 49 , Issue ID: 11 , Pages: 2789-2792 , Special Notes: doi: 10.1161/STROKEAHA.118.022279. , Word Count: 210


Background and Purpose- We assessed safety, feasibility, and potential effects of vagus nerve stimulation (VNS) paired with rehabilitation for improving arm function after chronic stroke. Methods- We performed a randomized, multisite, double-blinded, sham-controlled pilot study. All participants were implanted with a VNS device and received 6-week in-clinic rehabilitation followed by a home exercise program. Randomization was to active VNS (n=8) or control VNS (n=9) paired with rehabilitation. Outcomes were assessed at days 1, 30, and 90 post-completion of in-clinic therapy. Results- All participants completed the course of therapy. There were 3 serious adverse events related to surgery. Average FMA-UE scores increased 7.6 with active VNS and 5.3 points with control at day 1 post-in-clinic therapy (difference, 2.3 points; CI, -1.8 to 6.4; P=0.20). At day 90, mean scores increased 9.5 points from baseline with active VNS, and the control scores improved by 3.8 (difference, 5.7 points; CI, -1.4 to 11.5; P=0.055). The clinically meaningful response rate of FMA-UE at day 90 was 88% with active VNS and 33% with control VNS ( P<0.05). Conclusions- VNS paired with rehabilitation was acceptably safe and feasible in participants with upper limb motor deficit after chronic ischemic stroke. A pivotal study of this therapy is justified. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02243020.

KEYWORDS: motor cortex; neuromodulation; plasticity; rehabilitation; stroke; upper extremity; vagus nerve

PMID: 30355189 DOI: 10.1161/STROKEAHA.118.022279