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Review
. 2023 Dec;23(12):947-962.
doi: 10.1007/s11910-023-01323-w. Epub 2023 Nov 27.

Vagus Nerve Stimulation in Ischemic Stroke

Sasan Andalib  1   2 , Afshin A Divani  3 , Cenk Ayata  4 , Sheharyar Baig  5 , Ethem Murat Arsava  6 , Mehmet Akif Topcuoglu  6 , Eder Leonardo Cáceres  7 , Vinay Parikh  8 , Masoom J Desai  9 , Arshad Majid  5 , Sara Girolami  10 , Mario Di Napoli  10
Affiliations
Review

Vagus Nerve Stimulation in Ischemic Stroke

Sasan Andalib et al. Curr Neurol Neurosci Rep. 2023 Dec.

Abstract

Purpose of review: Vagus nerve stimulation (VNS) has emerged as a potential therapeutic approach for neurological and psychiatric disorders. In recent years, there has been increasing interest in VNS for treating ischemic stroke. This review discusses the evidence supporting VNS as a treatment option for ischemic stroke and elucidates its underlying mechanisms.

Recent findings: Preclinical studies investigating VNS in stroke models have shown reduced infarct volumes and improved neurological deficits. Additionally, VNS has been found to reduce reperfusion injury. VNS may promote neuroprotection by reducing inflammation, enhancing cerebral blood flow, and modulating the release of neurotransmitters. Additionally, VNS may stimulate neuroplasticity, thereby facilitating post-stroke recovery. The Food and Drug Administration has approved invasive VNS (iVNS) combined with rehabilitation for ischemic stroke patients with moderate to severe upper limb deficits. However, iVNS is not feasible in acute stroke due to its time-sensitive nature. Non-invasive VNS (nVNS) may be an alternative approach for treating ischemic stroke. While the evidence from preclinical studies and clinical trials of nVNS is promising, the mechanisms through which VNS exerts its beneficial effects on ischemic stroke are still being elucidated. Therefore, further research is needed to better understand the efficacy and underlying mechanisms of nVNS in ischemic stroke. Moreover, large-scale randomized clinical trials are necessary to determine the optimal nVNS protocols, assess its long-term effects on stroke recovery and outcomes, and identify the potential benefits of combining nVNS with other rehabilitation strategies.

Keywords: Anti-inflammatory; Blood–brain barrier; Cortical spreading depolarization; Ischemic stroke; Locus coeruleus; Neuroplasticity; Non-invasive vagus nerve stimulation; Nucleus tractus solitarius; Stroke recovery; Traumatic brain injury.

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Conflict of interest statement

Conflict of Interest Sasan Andalib, Cenk Ayata, Ethem Murat Arsava, Mehmet Akif Topcuoglu, Eder Leonardo Cáceres, Vinay Parikh, Masoom J Desai, Sara Girolami, and Mario Di Napoli each declare no potential conflicts of interest.

Afshin A. Divani is supported by the National Institute of Neurological Disorders and Stroke (NINDS) grant # 1R21NS130423–01.

Sheharyar Baig is supported by the Association of British Neurologists Clinical Research Training Fellowship (co-funded by the Stroke Association and Berkeley Foundation). Sheharyar Baig and Arshad Majid are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre, Sheffield, England. The expressed views are those of the authors and not necessarily those of the NINDS, the National Health Service (NHS), the NIHR, or the Department of Health and Social Care (DHSC).

Figures

Fig. 1
Fig. 1
Vagus nerve stimulation methods used in clinical settings (created with BioRender.com)
Fig. 2
Fig. 2
Mechanism of action of vagus nerve stimulation (VNS) (created with BioRender.com). Abbreviations: ACh, acetyl cholin; DMN, dorsal motor nucleus; NTS, nucleus tractus solitarius; α7nAChR, α7 nicotinic acetylcholine receptor subunit
See this image and copyright information in PMC

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