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Breakthroughs in Brain Health: Nerve Stimulation for Stroke Recovery and More
Electrical pulses help boost the therapy effectiveness. Plus improvements in Parkinson's, mental health and Alzheimer's testing
After nerve stimulation therapy following a stroke in 2020, Kathy Reynolds is regaining use of her right hand.
Elias Williams
A 2020 stroke caused by a blocked artery on the left side of her brain left Kathy Reynolds, 69, unable to use her right hand. Despite extensive rehab, she couldn’t knit or even cut her own food. “I learned to do things with my left hand and tried holding one knitting needle under my armpit,” says this retired teacher from Succasunna, New Jersey. “But there were things I just couldn’t do.”
In February of this year, Reynolds had a new type of device implanted just below her collarbone, with a wire under the skin leading to her vagus nerve. During occupational therapy sessions and at home, she or her therapist can turn on the Vivistim System, sending mild electrical pulses to the vagus nerve and on to the brain. Stimulating the vagus nerve changes electrical activity and levels of neurotransmitters in brain cells, nudging the brain’s efforts to build new pathways as Reynolds works to recover the use of her right arm and hand.
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Long used to quiet seizures for people with epilepsy and for stubborn depression, vagus nerve stimulation (VNS) — paired with extensive rehab — helped people recover more use of their arms and hands in a recent study of 108 stroke survivors published in The Lancet. Up to 60 percent of stroke survivors have lingering problems with use of their hands and arms. “The conventional wisdom up until now is that by a year after a stroke, there really isn’t much that helps,” says study coauthor Charles Liu, M.D., director of the University of Southern California Neurorestoration Center and neurosurgeon with Keck Medicine of USC. But with VNS, “it is possible to achieve meaningful improvements many years after stroke,” the study’s authors conclude.
Vagus nerve stimulation - Mild electrical pulses help boost the effectiveness of stroke-recovery therapy.
Illustration by Glenn Harvey
Double the improvement in rehab
It takes hard work. People in the study completed an intensive rehab program of three 90-minute in-clinic sessions per week for six weeks, plus additional sessions at home, repeating the hand and arm movements needed for everyday tasks — such as grabbing, eating and opening containers — hundreds of times. Those who did just the rehab program recovered some additional use of their arms and hands, but adding VNS doubled the amount of improvement. “The vagus nerve connects many parts of the body to many parts of the brain,” Liu notes. “It’s a natural antenna.” The system helped about half of users. “In general, people have been happy with their improved level of function,” Liu says. “It’s important to understand that VNS is not a panacea; not all your stroke symptoms will be gone.”
In 2021, the FDA approved Micro-Transponder’s Vivistim System, which pairs VNS with hand and arm rehab in people who’ve had an ischemic stroke (the most common type, caused by a blood vessel blockage). Vagus nerve stimulation is the topic of continued medical research. In the future, VNS and other types of nerve stimulation may be used to jump-start recovery of mobility in legs and feet, too, Liu notes. VNS lab studies have also looked at VNS’s effects on thinking and memory after a stroke.
Reynolds recently succeeded in writing with a regular pen, rather than one with a large foam grip, with her right hand. And she’s using both hands to knit — including a practice piece with a checkerboard pattern. After a short walk with her best friend, the two women sit together like old times.
“We visit, we chitchat, we knit,” she says. “There are pathways in my brain that haven’t been working since my stroke. This is making them wake up again.”
Cerebrospinal Fluid Tests for Alzheimer’s Disease
Fujirebio
More Brain Health Breakthroughs
Cerebrospinal fluid tests for Alzheimer’s disease
New tests that measure beta-amyloid and tau proteins in cerebrospinal fluid — which surrounds the brain and spinal cord — could help doctors diagnose early Alzheimer’s so people with the disease can take new and emerging medications that may slow progression. One test, cleared by the FDA in 2022, compares levels of two beta-amyloids that build up in the brain with Alzheimer’s. Other tests for Alzheimer’s biomarkers have also received FDA clearance in the past two years. In studies, results of the tests were comparable to PET brain scans used to detect Alzheimer’s brain changes.
Magnetic brain stimulation for mental health disorders
Transcranial magnetic stimulation (TMS), first cleared by the FDA for treatment-resistant depression in 2008, shows promise for a wide variety of mental health conditions, including anxiety, post-traumatic stress disorder and addiction. It uses magnets to stimulate brain cells. Conventional TMS requires six weeks or more of daily sessions, but the SAINT system, a new version of accelerated TMS, received FDA clearance in 2022. One study of people with treatment-resistant depression showed a remission rate of 79 percent after just five days of using SAINT.
On the Horizon
Smartwatches that catch early Parkinson’s
Researchers analyzed data from 103,712 people who wore a smartwatch-like movement-tracking device for a week. Those who went on to develop Parkinson’s disease after wearing the watch showed signs of a unique slowness of movement up to seven years before diagnosis. Researchers say the finding could help detect this neurological disorder earlier and possibly aid in prevention studies.
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