scholarly journals Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke

2021 ◽  
Vol 15 ◽  
Author(s):  
Johanna L. Chang ◽  
Ashley N. Coggins ◽  
Maira Saul ◽  
Alexandra Paget-Blanc ◽  
Malgorzata Straka ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Sham Group ◽  
Triceps Brachii ◽  
Robotic Training ◽  
Clinical Trial Registration ◽  
Planning Stage

Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative to implanted VNS and may provide similar therapeutic benefit. There is much discussion about the optimal approach for combining VNS and physical therapy, as such we sought to determine whether taVNS administered during robotic training, specifically delivered during the premotor planning stage for arm extension movements, would confer additional motor improvement in patients with chronic stroke. Thirty-six patients with chronic, moderate-severe upper limb hemiparesis (>6 months; mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13–48), were randomized to receive 9 sessions (1 h in length, 3x/week for 3 weeks) of active (N = 18) or sham (N = 18) taVNS (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) delivered during robotic training. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. Compared to the sham group, the active taVNS group showed a significant reduction in spasticity of the wrist and hand at discharge (Modified Tardieu Scale; taVNS = –8.94% vs. sham = + 2.97%, p < 0.05). The EMG results also demonstrated significantly increased variance for the bicep peak sEMG amplitude during extension for the active taVNS group compared to the sham group at discharge (active = 26.29% MVC ± 3.89, sham = 10.63% MVC ± 3.10, mean absolute change admission to discharge, p < 0.01), and at 3-month follow-up, the bicep peak sEMG amplitude was significantly reduced in the active taVNS group (P < 0.05). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. taVNS administered during premotor planning of movement may play a role in improving coordinated activation of the agonist-antagonist upper arm muscle groups by mitigating spasticity and increasing motor control following stroke.Clinical Trial Registration:www.ClinicalTrials.gov, identifier (NCT03592745).

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

2020 ◽  
Vol 34 (7) ◽  
pp. 609-615
Author(s):  
Jesse Dawson ◽  
Navzer D. Engineer ◽  
Cecília N. Prudente ◽  
David Pierce ◽  
Gerard Francisco ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vagus Nerve ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Exercise Program ◽  
Home Exercise ◽  
Home Exercise Program

Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

scholarly journals Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial

The Lancet ◽  
2021 ◽  
Vol 397 (10284) ◽  
pp. 1545-1553 ◽  
Author(s):  
Jesse Dawson ◽  
Charles Y Liu ◽  
Gerard E Francisco ◽  
Steven C Cramer ◽  
Steven L Wolf ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Vagus Nerve ◽  
Motor Function ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation

scholarly journals Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy

2013 ◽  
Vol 71 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Murilo S. Meneses ◽  
Samanta F. B. Rocha ◽  
Cristiane Simão ◽  
Heraldo Nei Hardt Laroca dos Santos ◽  
Cleudi Pereira ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Palliative Treatment ◽  
Refractory Epilepsy ◽  
Therapeutic Option ◽  
Treatment Objective

INTRODUCTION: Refractory epilepsy accounts for 20 to 30% of epilepsy cases and remains a challenge for neurologists. Vagus nerve stimulation (VNS) is an option for palliative treatment. OBJECTIVE: It was to study the efficacy and tolerability of VNS in patients implanted with a stimulator at the Curitiba Institute of Neurology (INC). METHODS: A case study of six patients with refractory epilepsy submitted to a VNS procedure at the INC in the last four years was described and discussed. RESULTS: Mean age at time of implantation was 29 years. Mean follow-up was 26.6 months. Seizure frequency decreased in all patients (40-50% (n=2) and >80% (n=4)). Three patients no longer required frequent hospitalizations. Two patients previously restricted to wheelchairs started to walk, probably because of improved mood. CONCLUSION: In this population, VNS proved to be a sound therapeutic option for treating refractory epilepsy.

Long term effect of vagus nerve stimulation in pediatric intractable epilepsy: an extended follow-up

2016 ◽  
Vol 32 (4) ◽  
pp. 641-646 ◽  
Author(s):  
Ayse Serdaroglu ◽  
Ebru Arhan ◽  
Gökhan Kurt ◽  
Atilla Erdem ◽  
Tugba Hirfanoglu ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Intractable Epilepsy ◽  
Term Effect ◽  
Long Term Effect

Follow - up of neuropediatric patients treated with vagus nerve stimulation

2017 ◽  
Vol 381 ◽  
pp. 683
Author(s):  
P.M. Preto Mimura ◽  
I.B. Farias ◽  
L. Seguti Ferreira ◽  
A.L. Barbosa
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation

Older Age and Longer Epilepsy Duration Do Not Predict Worse Seizure Reduction Outcome after Vagus Nerve Stimulation

2017 ◽  
Vol 79 (02) ◽  
pp. 152-158 ◽  
Author(s):  
Jitka Kocvarova ◽  
Zdenek Novak ◽  
Irena Dolezalova ◽  
Michal Svoboda ◽  
Milan Brazdil ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Older Patients ◽  
Age Groups ◽  
Seizure Reduction ◽  
Follow Up Care ◽  
Patients With Epilepsy

Introduction We analyzed the results of vagus nerve stimulation (VNS) on older patients and patients with long-lasting epilepsy and included severely intellectually disabled patients. Patients and Methods A total of 103 adults with VNS implanted from 2005 to 2014 were studied. The responder rates, that is, the percentage of VNS patients who responded to VNS, classified as seizure reduction ≥ 50% (50R) and seizure reduction ≥ 90% (90R), were compared in defined age groups (< 40 and ≥ 40 years, and < 50 and ≥ 50 years) and epilepsy duration groups (< 20 and ≥ 20 years, < 30 and ≥ 30 years, and < 40 and ≥ 40 years) at the 1-year follow-up visit and the last follow-up visit (at least 2 years after surgery). The age distributions and responder rates were also studied in patients with an intellectual disability. Results The analysis did not confirm a significantly lower 50R or 90R rate in patients ≥ 40, ≥ 50, or ≥ 60 years when compared with their younger counterparts, but the 50R rate increase during follow-up care was the lowest in patients ≥ 50 and ≥ 60 years. The highest percentage of patients with an intellectual disability in the group < 40 years of age did not adversely affect the 50R rate. Longer epilepsy duration was not confirmed as a negative predictor of VNS outcome. There was a significantly higher 50R rate in patients with epilepsy duration ≥ 20 years (at the last follow-up visit) and a higher 90R rate in patients with epilepsy duration ≥ 30 years (at the 1-year follow-up visit). The increase in the 50R rate during follow-up care was lower in patients with epilepsy durations ≥ 30 and ≥ 40 years. Conclusions The study did not find worse VNS outcomes, as defined by the 50R or 90R rate, in older adult patients or in patients with a longer epilepsy duration. The increasing stimulation effect over time is less marked in older patients and in patients with longer epilepsy duration.

Vagus Nerve Stimulation for Intractable Seizures: One Year Follow-Up

1993 ◽  
Vol 25 (6) ◽  
pp. 362-366 ◽  
Author(s):  
Janice E. Michael ◽  
Karen Wegener ◽  
Donald W. Barnes
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Intractable Seizures ◽  
One Year

FC34.2 Vagus nerve stimulation: Results after 6 years follow-up

2006 ◽  
Vol 117 ◽  
pp. 1-2
Author(s):  
J.J. Ardesch ◽  
L.J.J.C. Wagener-Schimmel ◽  
G. Hageman ◽  
H.E. van der Aa ◽  
H.P.J. Buschman
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation

scholarly journals A.6 Vagus Nerve Stimulation in patients with therapy resistant generalized epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S15-S15
Author(s):  
AS Suller Marti ◽  
SM Mirsattari ◽  
KW MacDougall ◽  
D Steven ◽  
A Parrent ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Hospital Admissions ◽  
Focal Epilepsy ◽  
Limited Information ◽  
Best Response ◽  
History Of ◽  
Generalized Epilepsy

Background: For patients with generalized epilepsy who do not respond to anti-seizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox Gastaut Syndrome(LGS) and genetic generalized epilepsy(GGE). Methods: We identified patients with a diagnosis of Lennox-Gastaut Syndrome or Genetic Generalized Epilepsy, who underwent VNS implantation, between1997 and July 2018. Results: A total of 46 patients were included in this study with a history of therapy resistant generalized epilepsy. The mean age at implantation was 24 years(IQR= 17.8-31 years) and 50%(n=23) were female. The most common etiologies were GGE in 37%(n=17) and LGS in 63%(n=29). Median follow-up since VNS implantation was 63 months(IQR:31-112.8months). 41.7%(n=12) of the LGS group became responders, and 64.7%(n=11) in the GGE group. The best response in seizure reduction was seen in generalized tonic-clonic seizures. There was a reduction of seizure-related hospital admissions from 89.7%(N=26) pre-implantation, to 41.4%(N=12) post-implantation (p<0.0001). The frequency of side effects due to the stimulation was similar in both groups(62.1% in LGS and 61.1% in GGE). Conclusions: VNS is an effective treatment in patients with therapy resistant generalized epilepsy, especially GGE.

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