Groundbreaking Procedure Offers Improved Limb Function to Ischemic Stroke Survivors
After experiencing a stroke, nearly 60 percent of survivors continue to suffer from persistent impaired upper limb function and weakness. This impacts a person’s ability to perform routine daily activities like eating, pouring a drink, putting on clothing and, ultimately, on quality of life.
To help improve the lives of these patients, Stony Brook Medicine is the first healthcare system on Long Island to implant an FDA-approved technology for ischemic stroke survivors that improves upper limb function for those who have not regained mobility after active rehabilitation therapy, even years later.
In ischemic stroke cases, which account for nearly 90 percent of all stroke cases, blood flow to the brain is blocked. Vagus nerve stimulation (VNS) is a neurotechnology that’s used to help stroke patients get better faster. The technology has been used for epilepsy and even depression, but has recently been shown to have benefits in stroke rehabilitation.
“VNS provides small pulses of electricity to a nerve in the neck that helps your brain make changes that are beneficial,” said Charles (Chuck) Mikell, MD, associate professor and vice chair of the Department of Neurosurgery in the Renaissance School of Medicine at Stony Brook University. “For stroke patients who have trouble using his or her hand and can’t button a button or tie a tie, vagus nerve stimulation might help them regain those abilities.”
Earlier this year, Mikell and his medical team performed a 90-minute surgery at Stony Brook University Hospital and implanted a small device called the Vivistim® Paired VNS™ System in the upper left chest area of 68-year-old Long Island resident Gerald Doroski, who suffered a stroke three years ago and never regained full hand movement.
“My surgery went great,” said Doroski, who was discharged the same day as the procedure. “My mind was in a brain fog since my stroke and now my thoughts are more defined.”
Stony Brook is the first on Long Island to perform VNS for stroke, and only the second in the tri-state area to perform the procedure because of the technical expertise required.
“Our VNS program has only been possible because of our close coordination with St. Charles Rehabilitation Center,” said Mikell. “We do the surgery, they do the rehabilitation. Only a limited number of centers — and only Stony Brook on Long Island — are capable of the multidisciplinary work needed to make this technology work.”
Mikell said the technology is currently FDA-approved only for use in ischemic stroke cases, though using it on other patients with hand deficits could be a possibility, adding that many stroke patients continue to have challenges in hand function even years after the initial stroke.
“Stroke is one of the leading causes of death and disability in the United States,” he said. “And a significant fraction of those millions of patients may benefit from this technology.”
To be a candidate for vagus nerve stimulation, a patient must be initially evaluated at St. Charles Rehabilitation Center in Port Jefferson, NY, where occupational therapists will determine if the surgery is viable. Appropriate candidates are then referred to Stony Brook.
“If your hand is totally paralyzed, you wouldn’t be a candidate,” said Mikell. “But most people who have a stroke do get some hand function back, and those people in the middle who are not totally paralyzed but continue to have moderate to severe trouble with their hand are candidates.”
The underlying mechanism for why VNS works is not completely clear, Mikell noted, but it seems to drive what is called “plasticity” — when a patient gets a pulse of electrical energy from the device, it helps recruit other parts of the brain to take over the function of the hand. Although data is still being compiled, the benefits appear to be durable.
“Once you benefit from vagus nerve stimulation, you can pretty much count on those benefits being durable for the rest of your life,” said Mikell. “We don’t know that for sure because this technology has only been around about a year and a half, but it seems very likely. Everyone who gets this surgery undergoes six weeks of intensive occupational therapy to strengthen the hand, and after six weeks we’ve seen that most patients are doing a lot better.”
Mikell said that VNS has brought increasing excitement about treatment for a variety of brain disorders including depression, bipolar disorder, and even tinnitus.
“I think in the next few years, we’re going to see an expansion of the applications of vagus nerve stimulation,” he said. “This is so cutting-edge and so new that a lot of centers aren’t doing it. Right now Stony Brook is the only center on Long Island that is.”
Mikell said the goal of these surgeries is to get patients doing the routine things that they have lost the ability to do.
“We can’t guarantee that it’s going to be perfect every time,” he said, “but we’ve seen that most patients that get this surgery are doing a lot better after six weeks.”
During therapy, the occupational or physical therapist activates the medical device to pair rehabilitation exercise with VNS, strengthening nerve connections in healthy areas of the brain to create new pathways. This increases the effectiveness of the therapy to bring movement back. When used in combination with in-clinic occupational or physical therapy, the stimulation helps patients return to their normal routine. The therapy has an out-of-clinic mode so that stroke survivors can continue therapist-prescribed exercises at home on an ongoing basis.
Four months after his surgery, Gerald Dorosky has seen a clear improvement.
“I have more movement in my right arm and hand, and finer movement with everyday tasks like writing,” he said. “I have more confidence moving forward. I can’t say enough about the treatment I got from both Stony Brook and Dr. Mikell.”
“We’re very proud to be the first on Long Island to offer an option to help stroke survivors regain their independence and improve their quality of life,” said Mikell. “Even if stroke happened years ago, a person can regain function from their shoulder down to their fingertips. At Stony Brook Medicine, we’re leading the way to provide people access to the best care and most effective medical technology at all stages of stroke care and recovery.”
— Robert Emproto