PMID- 37416314
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230718
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 14
DP  - 2023
TI  - Application of vagus nerve stimulation on the rehabilitation of upper limb 
      dysfunction after stroke: a systematic review and meta-analysis.
PG  - 1189034
LID - 10.3389/fneur.2023.1189034 [doi]
LID - 1189034
AB  - OBJECTIVE: This study aimed to elucidate the efficacy, safety, and long-term 
      implications of vagus nerve stimulation (VNS) as a viable therapeutic option for 
      patients with upper limb dysfunction following a stroke. METHODS: Data from the 
      following libraries were searched from inception to December 2022: PubMed, 
      Wanfang, Scopus, China Science and Technology Journal Database, Embase, Web of 
      Science, China Biology Medicine Disc, Cochrane Library, and China National 
      Knowledge Infrastructure. Outcomes included indicators of upper limb motor 
      function, indicators of prognosis, and indicators of safety (incidence of adverse 
      events [AEs] and serious AEs [SAEs]). Two of the authors extracted the data 
      independently. A third researcher arbitrated when disputes occurred. The quality 
      of each eligible study was evaluated using the Cochrane Risk of Bias tool. 
      Meta-analysis and bias analysis were performed using Stata (version 16.0) and 
      RevMan (version 5.3). RESULTS: Ten trials (VNS combined with rehabilitation group 
      vs. no or sham VNS combined with rehabilitation group) with 335 patients were 
      included in the meta-analysis. Regarding upper extremity motor function, based on 
      Fugl-Meyer assessment scores, VNS combined with other treatment options had 
      immediate (mean difference [MD] = 2.82, 95% confidence interval [CI] = 1.78-3.91, 
      I(2) = 62%, p < 0.00001) and long-term (day-30 MD = 4.20, 95% CI = 2.90-5.50, p < 
      0.00001; day-90 MD = 3.27, 95% CI = 1.67-4.87, p < 0.00001) beneficial effects 
      compared with that of the control treatment. Subgroup analyses showed that 
      transcutaneous VNS (MD = 2.87, 95% CI = 1.78-3.91, I(2) = 62%, p < 0.00001) may 
      be superior to invasive VNS (MD = 3.56, 95% CI = 1.99-5.13, I(2) = 77%, p < 
      0.0001) and that VNS combined with integrated treatment (MD = 2.87, 95% CI = 
      1.78-3.91, I(2) = 62%, p < 0.00001) is superior to VNS combined with upper 
      extremity training alone (MD = 2.24, 95% CI = 0.55-3.93, I(2) = 48%, p = 0.009). 
      Moreover, lower frequency VNS (20 Hz) (MD = 3.39, 95% CI = 2.06-4.73, I(2) = 65%, 
      p < 0.00001) may be superior to higher frequency VNS (25 Hz or 30 Hz) (MD = 2.29, 
      95% CI = 0.27-4.32, I(2) = 58%, p = 0,03). Regarding prognosis, the VNS group 
      outperformed the control group in the activities of daily living (standardized MD 
      = 1.50, 95% CI = 1.10-1.90, I(2) = 0%, p < 0.00001) and depression reduction. In 
      contrast, quality of life did not improve (p = 0.51). Safety was not 
      significantly different between the experimental and control groups (AE p = 0.25; 
      SAE p = 0.26). CONCLUSION: VNS is an effective and safe treatment for upper 
      extremity motor dysfunction after a stroke. For the functional restoration of the 
      upper extremities, noninvasive integrated therapy and lower-frequency VNS may be 
      more effective. In the future, further high-quality studies with larger study 
      populations, more comprehensive indicators, and thorough data are required to 
      advance the clinical application of VNS. SYSTEMATIC REVIEW REGISTRATION: 
      https://www.crd.york.ac.uk/prospero/, identifier: CRD42023399820.
CI  - Copyright (c) 2023 Wang, Ding, Li, Li, Yin, Li, Li and Zhuang.
FAU - Wang, Xu
AU  - Wang X
AD  - School of Rehabilitation Medicine, Henan University of Chinese Medicine, 
      Zhengzhou, China.
FAU - Ding, Qixin
AU  - Ding Q
AD  - School of Rehabilitation Medicine, Henan University of Chinese Medicine, 
      Zhengzhou, China.
FAU - Li, Tianshu
AU  - Li T
AD  - School of Clinical Medicine, Henan University, Zhengzhou, China.
FAU - Li, Wanyue
AU  - Li W
AD  - Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan 
      University, Guangzhou, China.
FAU - Yin, Jialin
AU  - Yin J
AD  - Department of Rehabilitation, Henan Provincial People's Hospital, School of 
      Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
FAU - Li, Yakun
AU  - Li Y
AD  - Department of Rehabilitation, Henan Provincial People's Hospital, School of 
      Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
FAU - Li, Yuefang
AU  - Li Y
AD  - School of Clinical Medicine, Henan University, Zhengzhou, China.
FAU - Zhuang, Weisheng
AU  - Zhuang W
AD  - Department of Rehabilitation, Henan Provincial People's Hospital, School of 
      Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
LA  - eng
PT  - Systematic Review
DEP - 20230621
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC10321132
OTO - NOTNLM
OT  - meta-analysis
OT  - rehabilitation
OT  - stroke
OT  - upper limb dysfunction
OT  - vagus nerve stimulation (vns)
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/07/07 06:42
MHDA- 2023/07/07 06:43
PMCR- 2023/06/21
CRDT- 2023/07/07 04:05
PHST- 2023/03/18 00:00 [received]
PHST- 2023/05/16 00:00 [accepted]
PHST- 2023/07/07 06:43 [medline]
PHST- 2023/07/07 06:42 [pubmed]
PHST- 2023/07/07 04:05 [entrez]
PHST- 2023/06/21 00:00 [pmc-release]
AID - 10.3389/fneur.2023.1189034 [doi]
PST - epublish
SO  - Front Neurol. 2023 Jun 21;14:1189034. doi: 10.3389/fneur.2023.1189034. 
      eCollection 2023.