Abstract TP79: Vagal Nerve Stimulation for Enhanced Stroke Recovery: Real-World Application in a Multidisciplinary Program

Abstract

Introduction: Randomized-controlled trial (RCT) evidence has demonstrated the efficacy of vagal nerve stimulation (VNS) with paired rehabilitation for upper limb functional recovery after ischemic stroke. There remains a need to assess the generalizability of these findings to a broader population of stroke patients with chronic functional deficits. Hypothesis: VNS for upper limb recovery after stroke may be safely and effectively applied to diverse populations of patients in a multidisciplinary program. Methods: Patients at one center not included in the original RCT of VNS for stroke recovery were implanted with left-sided VNS, paired with six weeks of in-clinic therapy, as implemented in the original RCT. At the conclusion of in-clinic therapy, clinical benefit was assessed by improvement from baseline in the validated Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score for stroke recovery (maximum score of 66 equating to normal function). Results: All four patients included had chronic, stable functional deficits >1.5 years after stroke when implanted with VNS at ages of 43, 61, 70, and 71. Three patients with ischemic stroke were included with FMA-UE improvements of 13 (baseline 45, left-sided deficits), 15 (baseline 36, right-sided deficits), and 6 (baseline 21, left-sided deficits). One patient was implanted 3.0 years after intracerebral hemorrhagic stroke, with an FMA-UE improvement of 14 (baseline 16, right-sided deficits). No procedural complications were seen. Conclusions: Vagal nerve stimulation paired with in-clinic therapy can have a profound impact on upper limb function in patients after stroke. All patients in this series achieved greater FMA-UE improvement than the mean improvement in the largest RCT of VNS for stroke recovery (5.0 ± 4.4 points). This pilot series of real world application of paired VNS for upper limb functional recovery after stroke demonstrates early feasibility, safety, and efficacy of this treatment.