Vagus nerve stimulation for upper limb motor impairment after ischemic stroke A meta-analysis

Background: Upper limb motor impairment is a common complication following stroke. Although few treatments are used to enhance motor function, still approximately 60% of survivors are left with upper limb motor impairment. Several studies have investigated vagus nerve stimulation (VNS) as a potential technique for upper limb function. However, the efficacy and safety of VNS on upper limb motor function after ischemic stroke have not been systematically evaluated. Therefore, a meta-analysis based on randomized controlled trial will be conducted to determine the efficacy and safety of VNS on upper limb motor function after ischemic stroke. Method: We searched PUBMED, MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Library (CNKI), and Wan Fang Database until April 1, 2021. Results: Six studies consisting of 234 patients were included in the analysis. Compared with control group, VNS improved upper limb function via Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.26, 95% confidence interval [CI] [2.79, 3.74], P < .00001) and Functional Independence Measurement (mean difference = 6.59, 95%CI [5.77, 7.41], P < .00001), but showed no significant change on Wolf motor function test (standardized mean difference = 0.31, 95%CI [-0.15, 0.77], P = .19). The number of adverse events were not significantly different between the studied groups (risk ratio = 1.05, 95%CI [0.85, 1.31], P = .64). Conclusion: VNS resulted in improvement of motor function in patients after ischemic stroke, especially in the sub-chronic stage. Moreover, compared with implanted VNS, transcutaneous VNS exhibited greater efficacy in poststroke patients. Based on this meta-analysis, VNS could be a feasible and safe therapy for upper limb motor impairment.