Autonomic dysfunction after stroke: an overview of recent clinical evidence and perspectives on therapeutic management

Clinical Autonomic Research, Год журнала: 2025, Номер unknown

Опубликована: Март 25, 2025

Central autonomic dysfunction is common in acute stroke and associated with cardiovascular complications increased mortality. The aim of this review to present novel diagnostic therapeutic approaches the management disorder latest data on its impact clinical outcome after stroke. We performed a narrative recent literature, particular focus articles related underlying pathophysiological mechanisms cardiac dysregulation, role dysregulation activation neuroinflammatory response development cardiovascular, respiratory metabolic patients ischemic hemorrhagic assessment central by non-invasive techniques, including heart rate variability baroreflex sensitivity, has gained wide practical application years, they may have predictive for evaluating disease prognosis. emerging evidence derived from trials demonstrates that presence imbalance lead mortality an adverse effect post-stroke rehabilitation. early detection treatment system improved survival Among available approaches, neuromodulatory techniques pharmacological interventions are promising strategies which be implemented as part standard care improve patient recovery. Future studies warranted address long-term effects potential agents modulation function survivors.

Язык: Английский

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Neuromodulation: Update on current practice and future developments

Neurotherapeutics, Год журнала: 2024, Номер 21(3), С. e00371 - e00371

Опубликована: Апрель 1, 2024

During the past decades, neuromodulation has entered clinical practice exponentially with a variety of invasive and non-invasive approaches (Table 1). Most these treatments have shown not only that their adoption results in an improvement quality life (QoL) but also multidisciplinary approach is key to successful implementation. Clinical implementation aside, advanced been used gain better understanding how nervous system works normal pathological conditions. Not surprisingly, like deep brain stimulation (DBS) are now adopted almost all countries worldwide, steady growth numbers implanted patients [1Sarica C. Conner C.R. Yamamoto K. Yang A. Germann J. Lannon M. et al.Trends disparities utilization United States: Nationwide Inpatient Sample analysis from 1993 2017.Lancet Reg Health Am. 2023; 26 (PMID: 37876670; PMCID: PMC10593574)100599https://doi.org/10.1016/j.lana.2023.100599Abstract Full Text PDF PubMed Scopus (2) Google Scholar].Table 1The list techniques constantly expanding.Neuromodulatory approachesInvasiveNon-invasive•Brain-computer interface•Cochlear implant•Deep stimulation•Dorsal root ganglion stimulation•Gastric/Intestinal electrical stimulation•Motor cortex stimulation•Peripheral nerve stimulation∗•Peripheral subcutaneous field stimulation•Retinal stimulation•Responsive neurostimulation•Spinal cord stimulation•Vagus stimulation•Electroconvulsive therapy•Functional stimulation•Low-intensity focused ultrasound stimulation∗∗•Non-invasive vagus (auricular, cervical)•Peripheral stimulation∗•Transcranial alternating current stimulation•Transcranial direct stimulation•Transcutaneous stimulation•Temporal interference magnetic stimulation∗∗Possibly neuromodulatory and/or offered within same program•Intrathecal drug delivery (e.g. ITB)•Intraventricular ITB)•Lumboperitoneal shunt∗∗•Ventriculoperitoneal shunt∗∗•Intestinal pump-based infusion LICG)•Drug ketamine)•Subcutaneous CSAI)Abbreviations: ∗ includes (invasive non-invasive) nerves: trigeminal, hypoglossal, sacral, pudendal, occipital, phrenic ('diaphragm pacing') tibial (usually percutaneous)' ∗∗ non-electrical (acoustic waves, intracranial pressure modulation); CSAI: continuous apomorphine infusion; ITB: intrathecal baclofen; LCIG: levodopa-carbidopa intestinal gel. Open table new tab Abbreviations: Such resulting expansion indications less conservative patient enrollments, given high level evidence supporting early intervention translates greater sustained QoL benefit [2Schuepbach W.M. Rau Knudsen Volkmann Krack P. Timmermann L. al.Neurostimulation for Parkinson's disease motor complications.N Engl J Med. 2013; 368 23406026): 610-622https://doi.org/10.1056/NEJMoa1205158Crossref (1042) Scholar]. In this special issue Neurotherapeutics, we present compilation excellent articles provide comprehensive review both approved experimental therapies. Davidson al. [3Davidson B. Bhattacharya Sarica Darmani G. Raies N. Chen R. al.Neuromodulation – stimulation.Neurotherapeutics. 2024; 3: xxxGoogle Scholar] broad overview technologies, encompassing methods transcranial (TMS), (tDCS), (TUS), surgical such as (DBS), spinal (SCS), (VNS), which significantly treatment neurological disorders by enabling precise modulation neural activity. Techniques TMS tDCS applied diagnostic therapeutic purposes, leveraging ability induce transient or lasting changes excitability address psychiatric disorders. The authors emphasize that, expands, ongoing research trials vital optimizing technologies personalized medicine, enhancing efficacy mechanisms various Durham [4Durham P.G. Butnariu Alghorazi Pinton Krishna V. Dayton P.A. Current investigations blood-brain barrier disruption: review.Neurotherapeutics. (FUS) technology, highlighting its potential brain, could improve underscores efforts optimize technique need further test across emerging applications, Alzheimer's disease, (PD), tumors; prospect holds great promise improving outcomes. Gouveia [5Gouveia F.V. Warsi N.M. Suresh H. Matin Ibrahim G.M. Neurostimulatory epilepsy: stimulation, responsive neurostimulation discuss drug-resistant epilepsy, specifically focusing on VNS, DBS, (RNS). These treatments, include open-loop closed-loop systems, offer options who do respond traditional candidates resection. While VNS most accessible FDA-approved children, DBS RNS show reducing seizure frequency cases, develop biomarkers predicting response. Neudorfer [6Neudorfer Kultas-Ilinsky Ilinsky I. Paschen S. Helmers A.-K. Cosgrove G.R. al.The role thalamus essential tremor.Neurotherapeutics. evolution state targeting tremor (ET), controversies surrounding optimal targets thalamic ventral intermediate nucleus (Vim) posterior subthalamic area (PSA). They historical anatomical basis selecting targets, emphasizing cerebellothalamic tract (CTT) integration modern imaging electrophysiological accuracy. This suggests while Vim focus ET treatment, technological advances indicate PSA, particularly areas adjacent involving CTT, may superior outcomes suppression, refined strategies enhance efficacy. Further developing theme, Silva [7Silva N.A. Barrios-Martinez Yeh F.-C. Hodaie Roque D. Boerwinkle V.L. al.Diffusion functional MRI neuromodulation.Neurotherapeutics. neuromodulation, mainly ablation means high-intensity FUS well optimization through diffusion (dMRI) (fMRI). highlight shift toward conceptualizing nodes specific networks, rather than merely structures, paradigm facilitated dMRI fMRI, improved precision programming Their modalities personalizing conditions, calling fully realize capabilities practice. Martinez-Nunez therapies PD, application, mechanisms, [8Martinez-Nunez A.E. Justich M.-B. Okun M.S. Fasano Emerging disease.Neurotherapeutics. details methods, including TMS, tDCS, electroconvulsive therapy (ECT), alongside Temporal Interference Stimulation FUS. importance consider patient's symptoms, progression, genetic background, aiming more tailored manage PD complex symptomatology. [9Davidson Luka Milosevic Kondrataviciute Kalia L.V. S.K. Neuroscience fundamentals relevant neuromodulation: neurobiology in-depth neurobiological underpinning discussing effects at local, circuit, neurobiochemical levels, (STN) prime target. elaborate influences neuronal activity axons, neurotransmitter release, impacting microenvironment. It affects broader circuits alters oscillatory activities basal ganglia. addresses debate whether exerts disease-modifying robust large-scale prospective determine long-term impact progression conclusively. Noor [10Noor Steina A.K. McIntyre C.M. Dissecting evoked ganglia.Neurotherapeutics. underlying DBS-evoked ganglia, STN globus pallidus internus treatment. recent discovery large amplitude (EP) oscillations opportunities understand human ganglia network highlights DBS-induced antidromic activation externus (GPe) critical driver oscillations, suggesting significant previously underappreciated GPe outlines EPs clinically useful confirming target engagement. Wang [11Bath J.E. Unraveling threads stability: neurophysiology postural control challenges complexities treating instability biomechanical circuitry deficits contribute condition. describe therapies, feedback-based wearable devices, managing instability. implantable devices chronic data collection mechanisms. future interventions where personalized, circuit-based symptom control. Sammartino colleagues [12Sammartino F. MacDonnell North R.B. Vibhor Poree Disease applications stimulation: nonmalignant pain.Neurotherapeutics. SCS established cost-effective neuropathic pain, application conditions post-laminectomy syndrome, peripheral neuropathy, regional pain syndrome. case studies followed demonstrates exhausted conventional treatments. emphasizes therapy, loss over time, explores other syndromes, underscoring evolving landscape management. Saway [13Saway B.F. Palmer Hughes Triano R.E. Gilmore stroke: neuroplasticity brain-computer interfaces.Neurotherapeutics. exciting development facilitate stroke recovery, rooted interfaces (BCIs). BCIs, augment rehabilitation efforts. explore directions field, integrating artificial intelligence personalization effectiveness recovery patients. Finally, Ranjan [14Ranjan Mahoney J.J. Rezai A.R. Neurosurgical indications.Neurotherapeutics. disorders, obsessive-compulsive disorder (OCD), depression, addiction. OCD, uses remain investigational. techniques, testing safety, efficacy, hopes expanding future. With very few exceptions, centers offering nowadays organized classic framework hospitals' operations, whereby different departments (neurology, neurosurgery, psychiatry, etc.) collaborate maintaining distinct space personnel allocation. existence multiple center centralize decision making process related selection right candidate procedure (e.g., ketamine rTMS before ECT depressed patient). Therefore, any tertiary should be able alternative less-invasive options. Furthermore, existing rate complications reduces time individual [15Sorar Hanalioglu Kocer Eser M.T. Comoglu S.S. Kertmen Experience hardware-related surgery: single-center study 181 operated six years.Parkinsons Dis. 2018; 30140425; PMC6081564)056018https://doi.org/10.1155/2018/3056018Crossref (33) academic tend overall outcome [16Deng Yue J.K. D.D. Trends safety cost movement 2002-2014.Br Neurosurg. 2021; 35 (Epub 2020 Jun 1. PMID: 32476485): 57-64https://doi.org/10.1080/02688697.2020.1759776Crossref (9) fast pace requires dedicated expertise, ready change similar well-established neurosurgeon there specialist expertise management treated treatments; e.g., 'functional' neurologist. Establishing subspecialty, educational training curricula students, residents, postgraduate fellowships necessary accreditation certain programs, highlighted priority many experts field. was indeed goal Brain Subspecialty Summit, took place September 14–15, 2023, hosted Brigham & Women's Hospital Harvard Faculty Club, Boston, Massachusetts. meeting attended 54 physicians scientists representing psychology, neurology, partners neuroscience, industry, professional societies, bodies. A unified agnostic advantages. From point view, some can treat post-traumatic Tourettism seizures whom centromedian chosen, problems [17Picillo Rohani Lozano A.M. Two indications, one target: concomitant epilepsy Centromedian/parafascicular stimulation.Brain Stimul. 2017; 10 2017 Jan 12. 28117177): 711-713https://doi.org/10.1016/j.brs.2017.01.577Abstract (4) standpoint, inspire novel paradigms. (an management) freezing gait [18Rohani Kalsi-Ryan Spinal primary progressive gait.Mov Disord. 32 Jul 6. 28681922): 1336-1337https://doi.org/10.1002/mds.27103Crossref (11) Another example classically recently pipeline PD-related Interestingly migraine potentially predict newer indications. Lastly, clearly interdisciplinarity success it contemporary medicine (Fig. Beyond neurologists, psychiatrists neurosurgeons, Table 2 offers partial contributors practitioners whose adds value neuromodulation.Table 2Beyond professionals program.ExpertiseRoleBiomedical engineers, computational scientistDiscovery commercialization stimulating algorithmsEthicistDesign dilemmasGeneticistPrognosis surgery, i.e. 'surgicogenomics' (visanji al., 2022)KinesiologistObjective evaluation gait, balance disturbances.NeuropathologistAnalysis biopsies taken during surgeryNeurophysiologistNeuronal recordings surgery externalized wires LFP recording.NeuroradiologistAnatomical DTI-based targeting, aggregated individualized VTA heatmaps assist neuroimaging-based DBS).PsychologistAssessment around psychosocial introduced life-changing interventions, e.g. disordersRehabilitation physiotherapistsMaximizing benefits gained mobility.Abbreviations: DBS: DTI: tensor (tractography), LFP: local potential, VTA: volume tissue activated. summary, Neurotherapeutics ranging range reviews collectively pivotal several advancing paradigms modulation, hope deemed intractable. All included response, applications. Moreover, promises exploration into neuromodulation's capabilities, especially revolutionize care. aims serve cornerstone space, inspiring collaborations will push boundaries what possible neurotherapeutics.

Язык: Английский

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Effect and optimal exercise prescription of robot-assisted gait training on lower extremity motor function in stroke patients: a network meta-analysis

Neurological Sciences, Год журнала: 2024, Номер unknown

Опубликована: Сен. 23, 2024

Язык: Английский

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Advancing Post‐Stroke Rehabilitation: Emerging and Current Neuromodulation Approaches and Integration of Artificial Intelligence‐Driven Closed‐Loop Systems

Опубликована: Апрель 1, 2025

ABSTRACT Chronic stroke represents a significant global health burden, requiring innovative rehabilitation strategies that extend beyond conventional therapies. Neuromodulation, including transcutaneous vagus nerve stimulation, deep brain and brain–computer interfaces, has emerged as transformative approach, leveraging neuroplasticity to enhance motor cognitive recovery. Integrating artificial intelligence (AI) within these modalities enables adaptive, patient‐specific interventions through real‐time feedback, predictive modeling, advanced signal processing. This perspective article provides comparative analysis of neuromodulation techniques, examines clinical evidence, while also identifying AI‐centric research priorities address current challenges.

Язык: Английский

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Two decades of vagus nerve stimulation for stroke: a bibliometric analysis

Frontiers in Neurology, Год журнала: 2025, Номер 16

Опубликована: Апрель 4, 2025

Background Stroke is a major global health concern, imposing significant medical and social burdens. Vagus nerve stimulation (VNS), an emerging neuromodulation technology, has shown potential in the treatment of stroke. This bibliometric analysis aims to explore knowledge structure research trends field VNS for stroke from 2004 2024. Methods Publications were retrieved Web Science Core Collection. CiteSpace VOSviewer used conduct analyses, including author productivity, institutional contributions, themes etc. Results A total 191 eligible publications analysed. Kilgard, M. P., Hays, S. A. most prolific authors, each contributing 26 publications. The USA (96 publications), China (69 Scotland (17 publications) countries. University Texas at Dallas (33 was institution, followed by Chongqing Medical (19 Glasgow (15 publications). Future expected focus on: (1) neurophysiological mechanisms recovery; (2) synergistic effects with other rehabilitation therapies; (3) comparative efficacy non-invasive transauricular versus invasive VNS; (4) safety effectiveness post-stroke functional impairments beyond motor rehabilitation; (5) optimisation parameters treatment. Conclusion experienced steady growth over past two decades. provides valuable insights guide future research, clinical applications, policy developments.

Язык: Английский

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Age-defying swallowing

Frontiers in Aging, Год журнала: 2025, Номер 6

Опубликована: Апрель 7, 2025

Swallowing disorders, which are generally underdiagnosed, affect the elderly, leading to a decreased quality of life and complications, including aspiration pneumonia death. Understanding neurophysiology swallowing causes its dysfunction is fundamental tool for prevention, early diagnosis, treatment dysphagia. New technologies open wide range possibilities implementation new care protocols this disorder.

Язык: Английский

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The Hybrid Mind in Precision Neurorehabilitation: Integrating AI-Driven Neurotechnologies and Ethical Governance

World Journal of Neuroscience, Год журнала: 2025, Номер 15(02), С. 105 - 125

Опубликована: Янв. 1, 2025

Язык: Английский

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Efficacy observation of combined transcutaneous vagus nerve stimulation and transcranial direct current stimulation on gait in 169 subacute stroke patients

Journal of Rehabilitation Medicine, Год журнала: 2024, Номер 56, С. jrm40348 - jrm40348

Опубликована: Ноя. 7, 2024

To investigate the combined effect of transcranial magnetic stimulation (TMS) and direct current on improving lower limb function in stroke patients. Randomized controlled trial. Subacute 169 post-stroke hemiplegia patients were randomly divided into 4 groups (control, stimulation, transcutaneous auricular vagus nerve with stimulation) evaluated using Fugl-Meyer Assessment-Lower Extremity (FMA-LL), Timed Up-and-Go (TUG) test, Modified Barthel Index (MBI), Berg Balance Scale (BBS), gait parameters, surface electromyography (sEMG). Significant improvements FMA-LL, MBI, BBS, TUG, sEMG noted intervention compared control, group showing most pronounced improvements. Differences some outcomes also notable between groups. The combination effectively enhances gait, balance, daily living activities subacute These benefits are likely due to activating solitary trigeminal nuclei stimulating motor cortex. Wearable analysis systems valuable clinical assessment for these

Язык: Английский

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tDCS combined with kinesthetic motor imagery-based brain computer interface training promotes upper limb function in subacute stroke: A randomized controlled study

Research Square (Research Square), Год журнала: 2024, Номер unknown

Опубликована: Май 17, 2024

Background Most stroke survivors have upper extremity dysfunction. According to neuroplasticity theory, transcranial direct current stimulation (tDCS) and kinesthetic motor imagery-based brain computer interface (KI-BCI) the potential improve function of participants with subacute stroke. However, efficacy tDCS combined KI-BCI in is unknown. Objective To investigate whether effect on limb more effective than effects or alone. Methods We randomized 48 into a group (n = 16), tDCS-BCI 16). Participants received 30 min anode over M1. The performed training. 15 KI-BCI. All conventional intervention. treatment cycle consisted 1 session each day, 5 days per week for 4 weeks. Fugl–Meyer Assessment Upper Extremity (FMA-UE) subscale, Motor Status Scale (MSS), Action Research Arm Test (ARAT), Modified Barthel Index (MBI) were used assess function, activities daily living (ADL) before after 4-week period. In addition, electroencephalography (EEG) was explore clinical mechanisms. Results After four weeks intervention, superior terms MSS. FMA-UE, MSS, MBI scores those group. There no difference number quantitative EEGs among three groups, while greater before. Conclusion TDCS KI-CI training can function. alone ADL simultaneously. could alter electrical excitatory levels cerebral hemispheres. Trial registry number: ChiCTR2000034730

Язык: Английский

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The Role of Neurosurgical Techniques in Management of Acute and Chronic Stroke: A Comprehensive Literature Review

Cureus, Год журнала: 2024, Номер unknown

Опубликована: Июль 29, 2024

Stroke is a medical condition that results from decreased or completely diminished supply of blood to the brain, and it considered one major causes morbidity mortality globally. categorized as ischemic hemorrhagic stroke, both which demand prompt particular timely intervention. This extensive review done investigate precise management acute chronic manifestations stroke in relation neurosurgical interventions, ultimately providing thorough analysis regarding indications, procedures, outcomes, complications are associated with it. In this regard, pervasive literature was carried out, primarily sourced databases such PubMed. paper particularly outlines sound relative anticipating competence each technique use. Endovascular clot retrieval (ECR) has been highlighted, its effectiveness profoundly observed when selected treatment option within time period 6-24 hours following an stroke. less than frame 48 hours, decompressive hemicraniectomy (DH) usually most suitable for cases intracranial hypertension resulting middle cerebral artery (MCA) infarction. Hemorrhages occur due ruptured aneurysms commonly dealt clipping neuroendovascular techniques. Additionally, considering revascularization surgery time-sensitive, can vary. Competent have linked stereotactic surgery, includes deep brain stimulation (DBS) focused ultrasound ablation (FUSA), also famous being minimally invasive nature. However, broader application these techniques hindered by absence established protocols. highlights importance advanced equipment, protocols optimize outcomes.

Язык: Английский

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