Paired vagus nerve stimulation for treatment of upper extremity impairment after stroke

The use of a paired vagus nerve stimulation (VNS) system for the treatment of moderate-to-severe upper extremity motor deficits associated with chronic ischemic stroke has recently been approved by the US Food and Drug Administration. This treatment aims to increase the task-specific neuroplasticity through the activation of cholinergic and noradrenergic networks during rehabilitation therapy. A recent pivotal Phase III trial showed that VNS paired with rehabilitation led to improvements in upper extremity impairment and function in people with moderate-to-severe arm weakness for an average of 3 years after ischemic stroke. The between-group difference following 6 weeks of in-clinic therapy and 90 days of home exercise therapy was three points on the upper extremity Fugl-Meyer score. A clinically meaningful response defined as a greater than or equal to six-point improvement was seen in approximately half of the people treated with VNS compared to approximately a quarter of people treated with rehabilitation alone. Further post-marketing research should aim to establish whether the treatment is also of use for people with intracerebral hemorrhage, in people with more severe arm weakness, and for other post-stroke impairments. In addition, high-quality randomized studies of non-invasive VNS are required.

Automated summary

The use of paired vagus nerve stimulation (VNS) for the treatment of upper extremity motor deficits associated with chronic ischemic stroke has been approved by the US FDA. This treatment aims to enhance neuroplasticity during rehabilitation therapy and has shown significant improvements in upper extremity impairment and function in patients with moderate-to-severe arm weakness for up to 3 years after stroke. Further research is needed to explore the effectiveness of this treatment for other post-stroke impairments and to evaluate the use of non-invasive VNS.