Facial nerve stimulation as a future treatment for ischemic stroke

Borsody, Mark K.; Sacristán, E.

doi:10.4103/2394-8108.195281

Cited by 18 publications

(25 citation statements)

References 81 publications

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“…In rat models of traumatic brain injury, trigeminal nerve stimulation was reported to increase CBF and reduce the development of secondary injury symptoms, such as oedema, blood–brain barrier disruption and lesion volumes (Chiluwal et al., 2017). In humans, therapeutic use of trigeminal nerve stimulation using external electrical stimulation has been examined in neurological, cardiovascular and psychiatric conditions such as epilepsy, depression, attention deficit hyperactivity disorder and post‐traumatic stress disorder (Borsody & Sacristan, 2016; Cook, Abrams, & Leuchter, 2016; Cook, Kealey, & DeGiorgio, 2015; Grahame & Hann, 1978). This approach resulted in reduced CBF in regions attributed to initiation and propagation of seizures, whereas CBF was enhanced in other cortex regions where metabolism is low because of depression (Cook et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

Human cerebrovascular responses to diving are not related to facial cooling

Alsalahi

Bráz

Ahmed

et al. 2020

Experimental Physiology

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Diving evokes a pattern of physiological responses purported to preserve oxygenated blood delivery to vital organs such as the brain. We sought to uncouple the effects of trigeminal nerve stimulation on cerebral blood flow (CBF) from other modifiers associated with the diving response, such as apnoea and changes in arterial carbon dioxide tension. Thirty-seven young healthy individuals participated in separate trials of facial cooling (FC, 3 min) and cold pressor test (CPT, 3 min) under poikilocapnic (Protocol 1) and isocapnic conditions (Protocol 2), facial cooling while either performing a breath-hold (FC +BH) or breathing spontaneously for a matched duration (FC −BH) (Protocol 3), and BH during facial cooling (BH +FC) or without facial cooling (BH −FC) (Protocol 4). Under poikilocapnic conditions neither facial cooling nor CPT evoked a change in middle cerebral artery blood flow velocity (MCA v mean ; transcranial Doppler) (P > 0.05 vs. baseline). Under isocapnic conditions, facial cooling did not change MCA v mean (P > 0.05), whereas CPT increased MCA v mean by 13% (P < 0.05). Facial cooling with a concurrent BH markedly increased MCA v mean (Δ23%) and internal carotid artery blood flow (ICA Q ; duplex Doppler ultrasound) (Δ26%) (P < 0.001), but no change in MCA v mean and ICA Q was observed when facial cooling was accompanied by spontaneous breathing (P > 0.05). Finally, MCA v mean and ICA Q were similarly increased by BH either with or without facial cooling. These findings suggest that physiological factors associated with BH, and not facial cooling (i.e. trigeminal nerve stimulation) per se, make the predominant contribution to increases in CBF during diving in humans. K E Y W O R D S blood flow, brain, diving response 1 wileyonlinelibrary.com/journal/eph Experimental Physiology. 2020;105:940-949.

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Section: Discussionmentioning

confidence: 99%

Human cerebrovascular responses to diving are not related to facial cooling

Alsalahi

Bráz

Ahmed

et al. 2020

Experimental Physiology

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“…Similarly, while we targeted the vagus nerve due to its widespread and growing list of clinical indications it should be noted that other cranial nerve targets have recently come to attention as potential targets for neuromodulation. If the primary mechanism driving CSF entrance into the brain parenchyma is proven to be cerebral arterial pulsation, then the facial nerve (CN VII) becomes a tempting target as it has been well-documented to regulate cerebral arterial dilation and blood flow (55). Interestingly, transection of the facial nerve blocked the ability of VNS to induce cerebral bloodflow indicating the effects of VNS may be due to crosstalk of the vagus and facial nerves since the facial nerve directly parasympathetically innervates the cerebral arteries (4,35).…”

Section: Discussionmentioning

confidence: 99%

Is Vagus Nerve Stimulation Brain Washing?

Cheng

Brodnick

Blanz

et al. 2019

Preprint

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Authors contributed equally to this work One Sentence Summary: Cervical vagus nerve stimulation using clinically derived parameters enhances movement of cerebrospinal fluid into the brain parenchyma presenting a previously unreported effect of vagus nerve stimulation with potential clinical utility.Abstract: Vagal nerve stimulation (VNS) is an FDA approved treatment method for intractable epilepsy, treatment resistant depression, cluster headaches and migraine with over 100,000 patients having received vagal nerve implants to date. Moreover, evidence in the literature has led to a growing list of possible clinical indications, with several small clinical trials applying VNS to treat conditions ranging from neurodegenerative diseases to arthritis, anxiety disorders, and obesity. Despite the growing list of therapeutic applications, the fundamental mechanisms by which VNS achieves its beneficial effects are poorly understood and an area of active research. In parallel, the glymphatic and meningeal lymphatic systems have recently been proposed and experimentally validated to explain how the brain maintains a healthy homeostasis without a traditionally defined lymphatic system. In particular, the glymphatic system relates to the interchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) whose net effect is to wash through the brain parenchyma removing metabolic waste products and misfolded proteins from the interstitium. Of note, clearance is sensitive to adrenergic signaling, and a primary driver of CSF influx into the parenchyma appears to be cerebral arterial pulsations and respiration. As VNS has well-documented effects on cardiovascular and respiratory physiology as well as brain adrenergic signaling, we hypothesized that VNS delivered at clinically derived parameters would increase CSF influx in the brain. To test this hypothesis, we injected a low molecular weight (3 kD) lysine-fixable fluorescent tracer (TxRed) into the CSF system of mice with a cervical vagus nerve cuff implant and measured the amount of CSF penetrance following VNS. We found that the clinical VNS group showed a significant increase in CSF dye penetrance as compared to the naïve control and sham groups. This study demonstrates that VNS therapeutic strategies already being applied in the clinic today may induce intended effects and/or unwanted side effects by altering CSF/ISF exchange in the brain. This may have broad ranging implications in the treatment of various CNS pathologies.

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“…). Recently, clinical interest has increased in the SPG, not only for the possibility of neuromodulation to treat cluster headaches, but also for nervus facialis stimulation as a future treatment for cerebral stroke (Borsody & Sacristan, ).…”

Section: Discussionmentioning

confidence: 99%

“…The PPF contains the SPG, which has been implicated in cranial autonomic symptoms associated with cluster headaches, which result from the activation of the trigeminal autonomic reflex (L ainez et al 2014). Recently, clinical interest has increased in the SPG, not only for the possibility of neuromodulation to treat cluster headaches, but also for nervus facialis stimulation as a future treatment for cerebral stroke (Borsody & Sacristan, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Many important anatomical structures are crammed together inside the PPF, which is why the PPF has been called 'the Piccadilly Circus of the face' (Wentges, 1975). Among them, the ganglion pterygopalatinum (sphenopalatine ganglion, SPG), also referred to as the pterygopalatine ganglion, stands out for its clinical and surgical interest (Piagkou et al 2011;L ainez et al 2014;Assaf et al 2016;Borsody & Sacristan, 2016;Frautschi et al 2016).…”

Section: Introductionmentioning

confidence: 99%

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Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum

et al. 2017

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The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo-caudal third (Measure C). Intra-subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter-subject measures in which fissures were compared according to patients' age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra-subject differences were not significant for gender or age. No statistically significant differences were found for the inter-subject measures between the measures of fissures according to patients' age. However, our data revealed that males' fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2-mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and II fissure values (with a higher prevalence) were equal to or were greater than 2 mm in all three measures, or in two measures. Type III fissure values were only greater than or equal to 2 mm in Measure A, whereas all the Type IV fissure values were below 2 mm. Future studies are necessary to correlate the fissure types successfully proposed in the surgical ganglion pterygopalatinum approach.

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Facial nerve stimulation as a future treatment for ischemic stroke

Cited by 18 publications

References 81 publications

Human cerebrovascular responses to diving are not related to facial cooling

Human cerebrovascular responses to diving are not related to facial cooling

Is Vagus Nerve Stimulation Brain Washing?

Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum

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