迷走神经刺激在神经康复中的应用：一项系统综述。
Neurorehabilitation with vagus nerve stimulation: a systematic review.
作者信息
Korupolu Radha, Miller Alyssa, Park Andrew, Yozbatiran Nuray
机构信息
University of Texas Health Science Center at Houston, Houston, TX, United States.
TIRR Memorial Hermann Hospital, Houston, TX, United States.
出版信息
Front Neurol. 2024 May 30;15:1390217. doi: 10.3389/fneur.2024.1390217. eCollection 2024.
OBJECTIVE
To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI).
METHODS
Data sources: PubMed, EMBASE, SCOPUS, and Cochrane.
STUDY SELECTION
Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery.
DATA EXTRACTION
Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically.
DATA SYNTHESIS
Twenty-nine studies were included; 11 were animal models of stroke, TBI, and SCI, and eight involved humans with stroke. While there was heterogeneity in methods of delivering VNS with respect to rehabilitation therapy in animal studies and human non-invasive studies, a similar methodology was used in all human-invasive VNS studies. In animal studies, pairing VNS with rehabilitation therapy consistently improved motor outcomes compared to controls. Except for one study, all human invasive and non-invasive studies with controls demonstrated a trend toward improvement in motor outcomes compared to sham controls post-intervention. However, compared to non-invasive, invasive VNS, studies reported severe adverse events such as vocal cord palsy, dysphagia, surgical site infection, and hoarseness of voice, which were found to be related to surgery.
CONCLUSION
Our review suggests that VNS (non-invasive or invasive) paired with rehabilitation can improve motor outcomes after stroke in humans. Hence, VNS human studies are needed in people with TBI and SCI. There are risks related to device implantation to deliver invasive VNS compared to non-invasive VNS. Future human comparison studies are required to study and quantify the efficacy vs. risks of paired VNS delivered via different methods with rehabilitation, which would allow patients to make an informed decision.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330653.
目的
系统回顾迷走神经刺激（VNS）研究，以呈现关于中风、创伤性脑损伤（TBI）和脊髓损伤（SCI）后运动恢复的安全性和有效性的数据。
方法
数据来源：PubMed、EMBASE、SCOPUS和Cochrane。
研究选择
纳入VNS在动物模型以及TBI和SCI患者中的临床试验，以评估VNS与康复治疗相结合对运动恢复的影响。
数据提取
两名评审员根据评估标准独立评估文章，并以电子方式提取相关数据。
数据综合
共纳入29项研究；11项为中风、TBI和SCI的动物模型研究，8项涉及中风患者。虽然在动物研究和人类非侵入性研究中，VNS与康复治疗相结合的给药方法存在异质性，但所有人类侵入性VNS研究均采用了类似的方法。在动物研究中，与对照组相比，VNS与康复治疗相结合始终能改善运动结果。除一项研究外，所有有对照组的人类侵入性和非侵入性研究均表明，与假手术对照组相比，干预后运动结果有改善趋势。然而，与非侵入性VNS相比，侵入性VNS研究报告了严重不良事件，如声带麻痹、吞咽困难、手术部位感染和声音嘶哑，这些不良事件被发现与手术有关。
结论
我们的综述表明，VNS（非侵入性或侵入性）与康复相结合可改善人类中风后的运动结果。因此，需要对TBI和SCI患者进行VNS人体研究。与非侵入性VNS相比，设备植入以提供侵入性VNS存在风险。未来需要进行人体比较研究，以研究和量化通过不同方法与康复相结合的VNS的疗效与风险，这将使患者能够做出明智的决定。
系统综述注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330653 。
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