Sonographic vagus nerve atrophy in Parkinson's disease: Myth or fact? A systematic review and meta-analysis of recent evidence answers

Abdelnaby, Ramy; Moawad, Mostafa Hossam El Din; Shabib, Ahmed Samy; Mohamed, Khaled Ashraf; Ebrahim, Mohamed Ayman; Aboutaleb, Aya Moustafa; Gaber, Dina Elsayed; Serour, Aya Sayed; Shamim, Muhammad Aaqib; Elberry, Mostafa H.; Bedewi, Mohamed Abdelmohsen; Elsayed, Mohamed; Walter, Uwe

doi:10.1016/j.parkreldis.2023.105451

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Over the last decade, HRUS enabled the reliable examination of small nerves like the VN ( 10 ). A reduced VN-CSA was repeatedly measured in neurodegenerative disorders like PD or amyotrophic lateral sclerosis ( 1 , 2 , 12 ), while enlarged VN-CSA was described in inflammatory ( 13 , 16 , 17 ), but also in hereditary neuropathies ( 18 ). The enlarged left VN-CSA in patients with MDD and especially in the subgroup of patients with RDD might be due to a subtle inflammatory edema of the left VN.…”

Section: Discussionmentioning

confidence: 99%

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Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder

Schreiber,

Wozniak,

Scheller

et al. 2023

Front. Psychiatry

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PurposeAutonomic dysfunction and a chronic low-grade inflammation are supposed to play a role in the etiology of major depressive disorder (MDD). The vagus nerves (VN) form a major part of the parasympathetic nervous system and of the gut-brain axis. They are supposed to exert anti-inflammatory and epithelial barrier protective effects in the gut. A reduced vagal activity was described in patients with MDD. We aimed to examine the VN in patients with MDD with high-resolution ultrasound (HRUS) and hypothesized that the cross-sectional area (CSA) and the echogenicity of the VNs were altered in comparison to healthy controls.Materials and methodsThe echogenicity (gray scale mean) and the CSA of the cervical VNs at the level of the thyroid gland and both median nerves were examined with HRUS in 50 patients with MDD and 50 matched healthy controls.ResultsThe left VN-CSA was significantly larger in the MDD group compared to the control group (1.7 ± 0.4 mm2 versus 1.5 ± 0.4 mm2; p = 0.045). The CSA of the right VN and both median nerves (MN) were similar between groups. In MDD subgroup analyses, recurrent depressive disorders were the main contributing factor for the left VN-CSA enlargement. Echogenicity was not altered in the VN and MN between groups.ConclusionThe enlargement of the left VN-CSA in patients with MDD, and especially in these patients with recurrent depressive disorders, might turn out as a promising imaging biomarker. Longitudinal studies are warranted to examine whether the VNs-CSA change in the course of MDD.

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Section: Discussionmentioning

confidence: 99%

“…Morphological alterations of the cervical VNs were described in different neurological disorders. An atrophy was found in patients with Parkinson’s Disease (PD) [e.g., ( 1 , 12 )], while an enlargement of the VN-CSA was associated with autonomic dysfunction in patients with Guillain-Barré-Strohl syndrome ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder

Schreiber,

Wozniak,

Scheller

et al. 2023

Front. Psychiatry

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Diagnostic accuracy and confounders of vagus nerve ultrasound in amyotrophic lateral sclerosis—a single-center case series and pooled individual patient data meta-analysis

Müller,

Schmidbauer,

Schönecker

et al. 2024

J Neurol

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Background Several single-center studies proposed utility of vagus nerve (VN) ultrasound for detecting disease severity, autonomic dysfunction, and bulbar phenotype in amyotrophic lateral sclerosis (ALS). However, the resulting body of literature shows opposing results, leaving considerable uncertainty on the clinical benefits of VN ultrasound in ALS. Methods Relevant studies were identified up to 04/2024 and individual patient data (IPD) obtained from the respective authors were pooled with a so far unpublished cohort (from Munich). An IPD meta-analysis of 109 patients with probable or definite ALS (El Escorial criteria) and available VN cross-sectional area (CSA) was performed, with age, sex, ALS Functional Rating Scale-revised (ALSFRS-R), disease duration, and bulbar phenotype as independent variables. Results Mean age was 65 years (± 12) and 47% of patients (± 12) had bulbar ALS. Mean ALSFRS-R was 38 (± 7), and mean duration was 18 months (± 18). VN atrophy was highly prevalent [left: 67% (± 5), mean CSA 1.6mm2 (± 0.6); right: 78% (± 21), mean CSA 1.8 mm2 (± 0.7)]. VN CSA correlated with disease duration (mean slope: left − 0.01; right − 0.01), but not with ALSFRS-R (mean slope: left 0.004; mean slope: right − 0.002). Test accuracy for phenotyping bulbar vs. non-bulbar ALS was poor (summary receiver operating characteristic area under the curve: left 0.496; right 0.572). Conclusion VN atrophy in ALS is highly prevalent and correlates with disease duration, but not with ALSFRS-R. VN CSA is insufficient to differentiate bulbar from non-bulbar ALS phenotypes. Further studies are warranted to analyze the link between VN atrophy, autonomic impairment, and survival in ALS.

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Vagus nerve size determined via ultrasonography is associated with white matter lesions in patients with vascular risk factors

Nezu,

Eto,

Hironaka

et al. 2024

J Ultrasound

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Purpose The cross-sectional area (CSA) of the cervical vagus nerve (VN), as assessed through ultrasonography, might be linked to autonomic nervous system dysfunction. Hypertension is the primary factor associated with cerebral white matter lesions (WMLs), but there is also evidence of a connection with autonomic nervous system dysfunction. However, the associations between WMLs and VN size are unclear. Our objective was to investigate the associations between WMLs and VN size in patients with vascular risk factors. Methods The CSA of the VN was evaluated using carotid ultrasonography in patients with a history of stroke (acute or chronic) and comorbidities (n = 196, 70.2 ± 12.7 years). Common carotid artery (CCA) intima-media thickness and interadventitial diameter (IAD) were also measured. The severity of the WMLs was assessed by the Fazekas classification and Scheltens’ scale. Results The CSA of the right VN (2.08 ± 0.65 mm2) was significantly greater than that of the CSA of the left VN (1.56 ± 0.44 mm2) (P < 0.001). Multiple linear regression analyses revealed that older age, hypertension, increased right CCA IAD, and decreased CSA of the right VN (standardized partial regression coefficient [β] − 0.226; P < 0.001) were independently associated with the severity of WMLs (Scheltens’ scale). A decreased CSA of the left VN was also associated with the severity of WMLs (β = − 0.239; P < 0.001). Conclusion VN size determined via ultrasonography was associated with the severity of WMLs. While these findings do not establish a causal relationship, they suggest that autonomic nervous system dysfunction is involved in the progression of WMLs.

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Sonographic vagus nerve atrophy in Parkinson's disease: Myth or fact? A systematic review and meta-analysis of recent evidence answers

Cited by 5 publications

References 29 publications

Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder

Enlarged cross-sectional area of the left vagus nerve in patients with major depressive disorder

Diagnostic accuracy and confounders of vagus nerve ultrasound in amyotrophic lateral sclerosis—a single-center case series and pooled individual patient data meta-analysis

Vagus nerve size determined via ultrasonography is associated with white matter lesions in patients with vascular risk factors

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