Abstract
Objective
To evaluate the effectiveness of vagus nerve stimulation (VNS) combined with rehabilitation
therapies in restoring upper extremity (UE) function following stroke. Data Sources
A search was implemented in key databases along with hand searches of relevant papers
and performed on 31 July 2021.
Materials and Methods
Only randomized controlled trials (RCTs) assessing the effect of VNS focusing on UE
dysfunction in patients post-stroke were identified in this systematic review. Data
were extracted independently by two authors. The study was conducted by the Preferred
Reporting Items for Meta-Analyses (PRISMA) guidelines. Meta-analyses were performed
when deemed feasible.
Results
Five RCTs involving 178 patients (VNS/C 87/91) were included. The primary outcome
was the function assessment by upper UE Fugl-Meyer assessment (FMA-U). As secondary
outcomes, strength was assessed with the Wolf motor function test (WMFT), the Stroke
Impact Scale (SIS) and the Motor Activity Log (MAL). Meta-analysis showed a significant
immediate favoring VNS-based rehabilitation (five studies) for improving upper extremity
function after stroke (mean difference [MD] 3.31; 95% confidence interval [CI], 2.33–4.29;
p < 0.0001,fixed-effects model), along the lines of the long-term effect (three studies)
(MD = 3.13; 95% CI, 1.47––4.79; p < 0.0001,fixed-effects model). No effect was observed when compared with control
groups in adverse outcomes (Risk Ratio [RR] 1.61; 95% CI, 0.65–3.99; P = 0.30).
Conclusions
VNS combined with rehabilitation training may be considered as a promising intervention
in UE recovery in stroke patients.
Key Words
Abbreviations:
CI (Confidence interval), DVNS (Direct vagus nerve stimulation), FMA-U (Fugl-Meyer assessment), MAL (Motor Activity Log), MD (Mean difference), No-RCT (non-randomized controlled trial), RCT (Randomized controlled trial), RR (Risk ratio), SD (Standard deviation), SIS (Stroke Impact Scale), Ta-VNS (Transcutaneous auricular vagus nerve stimulation), UE (Upper extremity), VN (Vagus nerve), VNS (Vagus nerve stimulation), WMFT (Wolf Motor Function Test)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 22, 2022
Accepted:
January 31,
2022
Received in revised form:
January 28,
2022
Received:
December 15,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106390
Copyright
© 2022 Elsevier Inc. All rights reserved.
