Novel Use of Vagus Nerve Stimulation for Rehabilitation After Intracerebral Hemorrhage: An Initial Report

Introduction: Vagus nerve stimulation (VNS) for ischemic stroke has recently been explored as a potential avenue for ischemic stroke rehabilitation. Importantly, this technique has not yet been used in rehabilitation after intracerebral hemorrhage (ICH), although this stroke subtype is often associated with greater functional impairment. In this study, we explore the use of VNS-paired rehabilitation in a patient with a history of ICH.

Methods: Three years prior to enrollment, the patient experienced a basal ganglia ICH and, although he was treated with timely evacuation, experienced significant residual motor deficits, including upper extremity hemiparesis and spasticity. These impairments notably impacted the patient’s functional status, preventing him from performing activities of daily living, despite continued physical therapy sessions. Due to the severity of these deficits, the patient was enrolled in the enhanced VNS-based stroke recovery program. During this program, the patient would undergo 6 weeks of in-office VNS-paired rehabilitation exercises, supplemented with VNS use during daily activities.

Results: The patient successfully underwent VNS implantation surgery without any complications and was enrolled in the program. Of note, initial Fugl-Meyer Assessment-Upper Extremity (FMA-UE) testing revealed significant deficits, particularly in wrist and hand function. Following in-office program completion, there was notable improvement in upper extremity function, resulting in a net improvement of 14 points in FMA-UE scores and notable improvements in shoulder and elbow active range of motion.

Conclusion : Here, we present the first use of VNS for rehabilitation after ICH. With previous efficacy shown in rehabilitation after ischemic stroke, a VNS-based program demonstrated significant improvements in a patient with notable deficits after ICH. Although future research is required to fully understand the effects of VNS-based therapy in this cohort, this initial report provides an encouraging foundation for this treatment.