title: Vagus nerve stimulation in ischemic stroke: old wine in a new bottle.
abstract: Vagus nerve stimulation (VNS) is currently Food and Drug Administration-approved for treatment of both medically refractory partial-onset seizures and severe, recurrent refractory depression, which has failed to respond to medical interventions. Because of its ability to regulate mechanisms well-studied in neuroscience, such as norepinephrine and serotonin release, the vagus nerve may play an important role in regulating cerebral blood flow, edema, inflammation, glutamate excitotoxicity, and neurotrophic processes. There is strong evidence that these same processes are important in stroke pathophysiology. We reviewed the literature for the role of VNS in improving ischemic stroke outcomes by performing a systematic search for publications in Medline (1966-2014) with keywords "VNS AND stroke" in subject headings and key words with no language restrictions. Of the 73 publications retrieved, we identified 7 studies from 3 different research groups that met our final inclusion criteria of research studies addressing the role of VNS in ischemic stroke. Results from these studies suggest that VNS has promising efficacy in reducing stroke volume and attenuating neurological deficits in ischemic stroke models. Given the lack of success in Phase III trials for stroke neuroprotection, it is important to develop new therapies targeting different neuroprotective pathways. Further studies of the possible role of VNS, through normally physiologically active mechanisms, in ischemic stroke therapeutics should be conducted in both animal models and clinical studies. In addition, recent advent of a non-invasive, transcutaneous VNS could provide the potential for easier clinical translation.
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA ; Department of Anesthesiology, University of Florida , Gainesville, FL , USA.
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Cai
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Bodhit
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Roselle
authors.initials: R
authors.lastname: Derequito
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA ; Department of Anesthesiology, University of Florida , Gainesville, FL , USA ; Department of Surgery, University of Florida , Gainesville, FL , USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ansari
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Fawzi
authors.initials: F
authors.lastname: Abukhalil
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Spandana
authors.initials: S
authors.lastname: Thenkabail
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ganji
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Pradeepan
authors.initials: P
authors.lastname: Saravanapavan
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Chandana C
authors.initials: CC
authors.lastname: Shekar
authors.affiliation: Department of Radiology, University of Florida , Gainesville, FL , USA.
authors.forename: Sharatchandra
authors.initials: S
authors.lastname: Bidari
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA ; Department of Neuroscience, University of Florida , Gainesville, FL , USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Waters
authors.affiliation: Department of Neurology, University of Florida , Gainesville, FL , USA.
authors.forename: Vishnumurthy Shushrutha
authors.initials: VS
authors.lastname: Hedna
keywords: cerebral blood flow; glutamate excitotoxicity; middle cerebral artery occlusion; neuroinflammation; stroke