AUTHOR=Korupolu Radha , Miller Alyssa , Park Andrew , Yozbatiran Nuray 

TITLE=Neurorehabilitation with vagus nerve stimulation: a systematic review

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1390217

DOI=10.3389/fneur.2024.1390217

ISSN=1664-2295

ABSTRACT=Objective: To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI).Methods: Data Sources: PubMed, EMBASE, SCOPUS, and Cochrane Study Selection: Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery.Data Extraction: Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically.Data Synthesis: Twenty-nine studies were included; eleven were animal models of stroke, TBI, and SCI, and eight involved humans with stroke. While there was heterogeneity in methods of delivering VNS with respect to rehabilitation therapy in animal studies and human non-invasive studies, a similar methodology was used in all human-invasive VNS studies. In animal studies, pairing VNS with rehabilitation therapy consistently improved motor outcomes compared to controls. Except for one study, all human invasive and non-invasive studies with controls demonstrated a trend toward improvement in motor outcomes compared to sham controls post-intervention. However, compared to non-invasive, invasive VNS, studies reported severe adverse events such as vocal cord palsy, dysphagia, surgical site infection, and hoarseness of voice, which were found to be related to surgery.Our review suggests that VNS (non-invasive or invasive) paired with rehabilitation can improve motor outcomes after stroke in humans. Data from animal studies suggest a similar potential of enhanced recovery with paired VNS after SCI and TBI. Hence, VNS human studies are needed in this population. There are risks related to device implantation to deliver invasive VNS compared to noninvasive VNS. Future human comparison studies are required to study and quantify the efficacy versus risks of paired VNS delivered via different methods with rehabilitation, which would allow patients to make an informed decision.