Long Chen, Huixin Gao, Zhongpeng Wang, Bin Gu, Wanqi Zhou, Meijun Pang, Kuo Zhang, Xiuyun Liu, Dong Ming
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引用次数: 0
摘要
缺血性脑卒中(IS)的特点是死亡率高、致残率高、复发风险高。运动功能障碍,如肢体偏瘫、吞咽困难、听觉障碍和语言障碍,通常在脑卒中后持续存在,给社会和医疗系统带来沉重负担。传统的康复疗法可能无法有效促进脑卒中后的功能恢复,因此迫切需要替代策略。美国食品和药物管理局(FDA)已经批准了侵入性迷走神经刺激疗法(iVNS),用于改善慢性缺血性中风后的难治性癫痫、耐药抑郁症、肥胖症和中重度上肢运动障碍。此外,美国食品及药物管理局已批准经皮迷走神经刺激(tVNS)用于改善丛集性头痛和急性偏头痛。最近的研究表明,迷走神经刺激(VNS)对短暂性和永久性脑缺血动物模型均有神经保护作用,可显著改善上肢运动障碍、听觉障碍和吞咽困难。本文首先回顾了IS后两种潜在的神经元死亡途径,包括自噬和炎症反应。然后,深入探讨使用 VNS 进行 IS 后功能恢复的临床前和临床研究现状,以及介导其神经保护作用的潜在机制。最后,总结了应用 VNS 的最佳参数和时机,并讨论了 VNS 治疗 IS 的未来挑战和方向。VNS 在中风康复研究中的应用已进入关键阶段,如何安全有效地将这项技术转化为临床实践至关重要。需要进一步开展临床前和临床研究,以阐明 VNS 的治疗机制。
Vagus nerve electrical stimulation in the recovery of upper limb motor functional impairment after ischemic stroke
Ischemic stroke (IS) is characterized by high mortality, disability rates, and a high risk of recurrence. Motor dysfunction, such as limb hemiparesis, dysphagia, auditory disorders, and speech disorders, usually persists after stroke, which imposes a heavy burden on society and the health care system. Traditional rehabilitation therapies may be ineffective in promoting functional recovery after stroke, and alternative strategies are urgently needed. The Food and Drug Administration (FDA) has approved invasive vagus nerve stimulation (iVNS) for the improvement of refractory epilepsy, treatment-resistant depression, obesity, and moderate to severe upper limb motor impairment following chronic ischemic stroke. Additionally, the FDA has approved transcutaneous vagus nerve stimulation (tVNS) for the improvement of cluster headaches and acute migraines. Recent studies have demonstrated that vagus nerve stimulation (VNS) has neuroprotective effects in both transient and permanent cerebral ischemia animal models, significantly improving upper limb motor impairments, auditory deficits, and swallowing difficulties. Firstly, this article reviews two potential neuronal death pathways following IS, including autophagy and inflammatory responses. Then delves into the current status of preclinical and clinical research on the functional recovery following IS with VNS, as well as the potential mechanisms mediating its neuroprotective effects. Finally, the optimal parameters and timing of VNS application are summarized, and the future challenges and directions of VNS in the treatment of IS are discussed. The application of VNS in stroke rehabilitation research has reached a critical stage, and determining how to safely and effectively translate this technology into clinical practice is of utmost importance. Further preclinical and clinical studies are needed to elucidate the therapeutic mechanisms of VNS.
期刊介绍:
Cognitive Neurodynamics provides a unique forum of communication and cooperation for scientists and engineers working in the field of cognitive neurodynamics, intelligent science and applications, bridging the gap between theory and application, without any preference for pure theoretical, experimental or computational models.
The emphasis is to publish original models of cognitive neurodynamics, novel computational theories and experimental results. In particular, intelligent science inspired by cognitive neuroscience and neurodynamics is also very welcome.
The scope of Cognitive Neurodynamics covers cognitive neuroscience, neural computation based on dynamics, computer science, intelligent science as well as their interdisciplinary applications in the natural and engineering sciences. Papers that are appropriate for non-specialist readers are encouraged.
1. There is no page limit for manuscripts submitted to Cognitive Neurodynamics. Research papers should clearly represent an important advance of especially broad interest to researchers and technologists in neuroscience, biophysics, BCI, neural computer and intelligent robotics.
2. Cognitive Neurodynamics also welcomes brief communications: short papers reporting results that are of genuinely broad interest but that for one reason and another do not make a sufficiently complete story to justify a full article publication. Brief Communications should consist of approximately four manuscript pages.
3. Cognitive Neurodynamics publishes review articles in which a specific field is reviewed through an exhaustive literature survey. There are no restrictions on the number of pages. Review articles are usually invited, but submitted reviews will also be considered.