Dopaminergic Pathways in Neuroplasticity After Stroke and Vagus Nerve Stimulation

Stroke remains a significant cause of disability worldwide. In addition to multidisciplinary rehabilitation approaches, various forms of technology, including vagus nerve stimulation, have emerged to facilitate neuroplasticity and, thereby, improve functional status after stroke. Vagus nerve stimulation was recently approved by the Food and Drug Administration, but questions remain regarding its mechanism of action. Here, a potential role for dopaminergic signaling is considered. This review first examines evidence that dopamine is important to neuroplasticity after stroke. Next, 2 different dopaminergic pathways are considered as potential mechanisms underlying vagus nerve stimulation–related benefits after stroke: direct modulation of brain dopaminergic pathways, and engagement of systemic dopaminergic pathways such as those found in the gut-brain axis. A contribution of dopamine signaling to vagus nerve stimulation efficacy could have therapeutic implications that extend to a precision medicine approach to stroke rehabilitation.