In a video case presentation of VNS paired with intense rehabilitation, Christopher P. Kellner, MD, and Fedor (Ted) Panov, MD, showcase the remarkable success achieved with VNS in conjunction with upper limb rehabilitation in one 60-year-old former stroke patient, JN, nine years following a stroke.
“While JN, over time, had been able to regain some strength, and he could walk and drive, he had had significant limitations in his left upper extremity and his left lower extremity that limited his ability to walk and use his left arm and hand, and he was left unable to move his fingers independently,” says Dr. Kellner, Associate Professor of Neurosurgery at the Icahn School of Medicine at Mount Sinai, and Director of the Mount Sinai Health System’s Intracerebral Hemorrhage Program.
Yet, even with this long-standing, plateaued condition, significant improvements were observed.
“Six weeks postoperatively, which included intense in-clinic rehabilitation, JN had quite a significant improvement in his upper extremity motor function, and he was able to individually move his fingers,” says Dr. Kellner. “These are improvements many years after his stroke and many years after he plateaued in his recovery. Rehabilitation, combined with stimulation, is really the secret sauce to this strategy working to enhance recovery after stroke.” Helping patients to achieve these new milestones, says Dr. Kellner, is the coordinated and specialized neurorehabilitation care they receive at Mount Sinai's Abilities Research Center in the Department of Rehabilitation Medicine and Human Performance.
Dr. Panov, who is Associate Professor of Neurosurgery at Icahn Mount Sinai, and Director of the Adult Epilepsy Surgery Program for the Mount Sinai Health System, says: “As we look for the enhanced stroke recovery mechanism of action, we believe that VNS is causing an increase in neuroplasticity. What we are finding is that rehabilitation itself does not cause much of a change in stroke, but VNS, together with acute, intense rehabilitation, does. Paired VNS seems to increase global corticospinal tract connectivity, and we are seeing a three- to sixfold greater recruitment of neurons in the motor cortex of both hemispheres compared to intense rehabilitation alone.”
Watch this video for the latest insights from Dr. Kellner and Dr. Panov on VNS therapy—from the implantation of the device to its seamless integration into daily rehabilitation routines and its mechanisms of action—as they demonstrate the remarkable outcome in this patient and continue to study its efficacy.
Cerebrovascular neurosurgeon Christopher Kellner, MD, and neuromodulation neurosurgeon Fedor (Ted) Panov, MD, show how VNS in conjunction with physical therapy can enhance upper limb function and quality of life post-stroke, empowering stroke survivors to regain independence and functionality, even years after the initial event.