中国神经再生研究(英文版) ›› 2024, Vol. 19 ›› Issue (8): 1707-1717.doi: 10.4103/1673-5374.389365

• 综述:脑损伤修复保护与再生 • 上一篇    下一篇

迷走神经刺激治疗脑卒中:生物学机制、治疗模式、临床应用和未来方向

  

  • 出版日期:2024-08-15 发布日期:2024-01-03

Vagus nerve stimulation in cerebral stroke: biological mechanisms, therapeutic modalities, clinical applications, and future directions

Li Du1, Xuan He1, Xiaoxing Xiong2, Xu Zhang2, Zhihong Jian2, Zhenxing Yang2, *   

  1. 1Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China; 2Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
  • Online:2024-08-15 Published:2024-01-03
  • Contact: Zhenxing Yang, PhD, MD, neuroyzx@whu.edu.cn.
  • Supported by:
    This work was supported by the Natural Science Foundation of Hubei Province, No. 2022CBF680 and Independent Scientific Research Project of Wuhan University, No. 2042022kf1119 (both to LD).

摘要:

脑卒中患者所遗留的长期神经功能障碍,对个人的生活质量及社会经济产生严重影响,卒中后的中枢神经功能恢复也是脑卒中治疗的难题。迷走神经刺激疗法已获得美国食品和药物管理局批准,用于自闭症、难治性抑郁症、癫痫和阿尔茨海默病的探索性治疗。由于迷走神经刺激与改变神经递质和中枢神经元的可塑性等多种机制有关,有望成为治疗脑卒中的新型治疗技术,在全球多中心开展临床试验,目前也成为神经康复研究的热点之一。文章对近年来迷走神经刺激促进神经功能恢复的相关研究结果进行总结及更新,发现在急性缺血性脑卒中的动物模型中,迷走神经刺激疗法通过减少炎症反应、调节血脑屏障通透性、促进血管生成和神经轴突再生,缩小脑梗死面积、减轻脑卒中后的神经损伤,并改善脑卒中大鼠的学习和记忆能力。同时重点讨论了迷走神经刺激在临床试验中促进患者肢体感觉及运动功能恢复所取得的研究成果及进展,并展望迷走神经刺激疗法在未来脑卒中疾病中的运用前景及目前所面临的缺陷及不足。迷走神经刺激疗法在临床可与各种急、慢性期脑缺血疗法和常规康复疗法相结合,以更好地改善脑损伤后的神经功能。但在临床运用中仍有许多关于迷走神经刺激最佳选择和个性化参数设置的问题需要解决。

https://orcid.org/0000-0001-5572-6798 (Zhenxing Yang)

Abstract: Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life. Many stroke victims are left with long-term neurological dysfunction, which adversely affects the well-being of the individual and the broader socioeconomic impact. Currently, post-stroke brain dysfunction is a major and difficult area of treatment. Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autism, refractory depression, epilepsy, and Alzheimer’s disease. It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as altering neurotransmitters and the plasticity of central neurons. In animal models of acute ischemic stroke, vagus nerve stimulation has been shown to reduce infarct size, reduce post-stroke neurological damage, and improve learning and memory capacity in rats with stroke by reducing the inflammatory response, regulating blood-brain barrier permeability, and promoting angiogenesis and neurogenesis. At present, vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation. Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in improving upper limb motor and cognitive abilities in stroke patients. Further clinical studies have shown that non-invasive vagus nerve stimulation, including ear/cervical vagus nerve stimulation, can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect. In this paper, we first describe the multiple effects of vagus nerve stimulation in stroke, and then discuss in depth its neuroprotective mechanisms in ischemic stroke. We go on to outline the results of the current major clinical applications of invasive and non-invasive vagus nerve stimulation. Finally, we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends. We believe that vagus nerve stimulation, as an effective treatment for stroke, will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.

Key words: cerebral stroke, neuroplasticity, non-invasive vagus nerve stimulation, rehabilitation, vagus nerve stimulation