Hays Seth A, Rennaker Robert L, Kilgard Michael P
Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, USA.
Texas Biomedical Device Center, The University of Texas at Dallas, Richardson, TX, USA; School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
Brain Stimul. 2023 Sep-Oct;16(5):1252-1258. doi: 10.1016/j.brs.2023.08.009. Epub 2023 Aug 17.
Vagus nerve stimulation (VNS) has gained enormous traction as a promising bioelectronic therapy. In particular, the delivery of VNS paired with training to promote neural changes has demonstrated clinical success for stroke recovery and found far-reaching application in other domains, from autism to psychiatric disorders to normal learning. The success of paired VNS has been extensively documented. Here, we consider a more unusual question: why does VNS have such broad utility, and perhaps more importantly, when does VNS not work? We present a discussion of the concepts that underlie VNS therapy and an anthology of studies that describe conditions in which these concepts are violated and VNS fails. We focus specifically on the mechanisms engaged by implanted VNS, and how the parameters of stimulation, stimulation method, pharmacological manipulations, accompanying comorbidities, and specifics of concurrent training interact with these mechanisms to impact the efficacy of VNS therapy. As paired VNS therapy is increasing translated to clinical implementation, a clear understanding of the conditions in which it does, and critically, does not work is fundamental to the success of this approach.
迷走神经刺激（VNS）作为一种有前景的生物电子疗法已获得巨大关注。特别是，将VNS与训练相结合以促进神经变化，已在中风康复方面取得临床成功，并在从自闭症到精神疾病再到正常学习等其他领域得到广泛应用。配对VNS的成功已有大量文献记载。在此，我们考虑一个更不寻常的问题：为什么VNS具有如此广泛的效用，或许更重要的是，VNS何时不起作用？我们对VNS疗法背后的概念进行了讨论，并汇编了一系列研究，这些研究描述了这些概念被违背且VNS失败的情况。我们特别关注植入式VNS所涉及的机制，以及刺激参数、刺激方法、药物操作、伴随的合并症和同步训练的细节如何与这些机制相互作用，从而影响VNS疗法的疗效。随着配对VNS疗法越来越多地转化为临床应用，清楚了解其起作用以及至关重要的不起作用的条件，是这种方法取得成功的根本。
