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Meta-Analysis
. 2021 Nov 19;100(46):e27871.
doi: 10.1097/MD.0000000000027871.

Vagus nerve stimulation for upper limb motor impairment after ischemic stroke: A meta-analysis

Yu-Lei Xie  1 , Shan Wang, Qing Wu, Xin Chen
Affiliations
Meta-Analysis

Vagus nerve stimulation for upper limb motor impairment after ischemic stroke: A meta-analysis

Yu-Lei Xie et al. Medicine (Baltimore). .

Abstract

Background: Upper limb motor impairment is a common complication following stroke. Although few treatments are used to enhance motor function, still approximately 60% of survivors are left with upper limb motor impairment. Several studies have investigated vagus nerve stimulation (VNS) as a potential technique for upper limb function. However, the efficacy and safety of VNS on upper limb motor function after ischemic stroke have not been systematically evaluated. Therefore, a meta-analysis based on randomized controlled trial will be conducted to determine the efficacy and safety of VNS on upper limb motor function after ischemic stroke.

Method: We searched PUBMED, MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Library (CNKI), and Wan Fang Database until April 1, 2021.

Results: Six studies consisting of 234 patients were included in the analysis. Compared with control group, VNS improved upper limb function via Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.26, 95% confidence interval [CI] [2.79, 3.74], P < .00001) and Functional Independence Measurement (mean difference = 6.59, 95%CI [5.77, 7.41], P < .00001), but showed no significant change on Wolf motor function test (standardized mean difference = 0.31, 95%CI [-0.15, 0.77], P = .19). The number of adverse events were not significantly different between the studied groups (risk ratio = 1.05, 95%CI [0.85, 1.31], P = .64).

Conclusion: VNS resulted in improvement of motor function in patients after ischemic stroke, especially in the sub-chronic stage. Moreover, compared with implanted VNS, transcutaneous VNS exhibited greater efficacy in poststroke patients. Based on this meta-analysis, VNS could be a feasible and safe therapy for upper limb motor impairment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The PRISMA flow chart of the study selection process.
Figure 2
Figure 2
Risk of bias summary of included studies in this meta-analysis.
Figure 3
Figure 3
Forest plot of efficacy of VNS on motor function with FMA-UE. FMA-UE = Fugl-Meyer Assessment-Upper Extremity, VNS = vagus nerve stimulation.
Figure 4
Figure 4
Forest plot for meta-analysis of safety of VNS on motor function. VNS = vagus nerve stimulation.
Figure 5
Figure 5
Forest plot for meta-analysis of efficacy of VNS on motor function with WMFT. VNS = vagus nerve stimulation, WMFT = Wolf motor function test.
Figure 6
Figure 6
Forest plot for sensitivity analysis of efficacy of VNS on motor function with WMFT. VNS = vagus nerve stimulation, WMFT = Wolf motor function test.
Figure 7
Figure 7
Forest plot for meta-analysis of efficacy of VNS on motor function with FIM. FIM = Functional Independence Measurement, VNS = vagus nerve stimulation.
Figure 8
Figure 8
Forest plot for within intervention subgroup analysis of efficacy of VNS on motor function. VNS = vagus nerve stimulation.
Figure 9
Figure 9
Forest plot for within stroke duration subgroup analysis of efficacy of VNS on motor function. VNS = vagus nerve stimulation.
See this image and copyright information in PMC

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