1
|
Qin X, Yuan Y, Yu H, Yao Y, Li L. Acute Effect of Vagus Nerve Stimulation in Patients with Drug-Resistant Epilepsy: A Preliminary Exploration via Stereoelectroencephalogram. Neurosurg Clin N Am 2024; 35:105-118. [PMID: 38000834 DOI: 10.1016/j.nec.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
As the pathophysiological mechanisms of vagus nerve stimulation (VNS) causing individual differences in the vagal ascending network remains unclear, stereoelectroencephalography (SEEG) provides a unique platform to explore the brain networks affected by VNS and helps to understand the anti-seizure mechanism of VNS more comprehensively. This study presents a preliminary exploration of the acute effect of VNS. SEEG signals were collected to assess the acute effect of VNS on neural synchronization in patients with drug-resistant epilepsy, especially in epileptogenic networks. The results show that the better the efficacy of VNS, the wider the spread of desynchronization assessed by weighted phase lag index at a high frequency band caused by VNS. Future studies should focus on the association between the change in synchronization and the efficacy of VNS, exploring the possibility of synchronization as a biomarker for patient screening and parameter programming.
Collapse
Affiliation(s)
- Xiaoya Qin
- Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China; National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yuan Yuan
- Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China; National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Huiling Yu
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yi Yao
- Department of Functional Neurosurgery, Xiamen Humanity Hospital Affiliated to Fujian Medical University, Fujian, China; Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China; IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.
| |
Collapse
|
2
|
Furlanis GM, Favaro J, Bresolin N, Grioni D, Baro V, D’Amico A, Sartori S, Denaro L, Landi A. Role of Vagus Nerve Stimulation in Refractory and Super Refractory Status Epilepticus: A Pediatric Case Series. Brain Sci 2023; 13:1589. [PMID: 38002548 PMCID: PMC10669853 DOI: 10.3390/brainsci13111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Status epilepticus is a life-threatening condition that is defined as refractory (RSE) when the seizure activity continues despite treatment with benzodiazepine and a second appropriate treatment. Super refractory status epilepticus (SRSE) is an RSE that persists or recurs for ≥24 h. Few papers have reported the outcomes of pediatric patients affected by RSE and SRSE and treated with neuromodulation therapies. Vagus nerve stimulation (VNS) is an approved treatment for drug-resistant epilepsy. We present our findings of pediatric patients treated with VNS for RSE/SRSE. METHODS We present a case series of seven consecutive pediatric patients treated with VNS for SRSE since 2012 by a single surgeon in Monza and Padua. A rapid titration was started soon after implantation. We considered electroclinical data before and after VNS implantation and at the last follow-up. RESULTS We achieved the resolution of SRSE in five out of seven patients in a mean time of two weeks. At the last follow-up, these patients had a significant reduction of seizure burden without any relapse of SE. DISCUSSION AND CONCLUSIONS Based on our limited findings, we discuss the potential role of VNS therapy in similar but distinct clinical contexts. For patients with drug-resistant epilepsy and RSE/SRSE, prompt VNS consideration is suggested, offering rapid responses and potentially reducing pharmacological load. Meanwhile, in NORSE/FIRES, we suggest early neuromodulation during the acute phase if standard treatments prove ineffective or not tolerated. This approach may leverage VNS's potential anti-inflammatory effects and neuromodulation, enhancing patient-specific treatments. Expanding case studies and prolonged follow-ups are recommended to strengthen these clinical insights.
Collapse
Affiliation(s)
- Giulia Melinda Furlanis
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Jacopo Favaro
- Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padova, Italy; (J.F.)
| | - Nicola Bresolin
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | | | - Valentina Baro
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Alberto D’Amico
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Stefano Sartori
- Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, Padua University Hospital, 35128 Padova, Italy; (J.F.)
| | - Luca Denaro
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| | - Andrea Landi
- Pediatric and Functional Neurosurgery, Department of Neuroscience, Padua University Hospital, via Giustiniani 5, 35127 Padova, Italy; (G.M.F.); (A.L.)
| |
Collapse
|
3
|
Coa R, La Cava SM, Baldazzi G, Polizzi L, Pinna G, Conti C, Defazio G, Pani D, Puligheddu M. Estimated EEG functional connectivity and aperiodic component induced by vagal nerve stimulation in patients with drug-resistant epilepsy. Front Neurol 2022; 13:1030118. [PMID: 36504670 PMCID: PMC9728998 DOI: 10.3389/fneur.2022.1030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Vagal nerve stimulation (VNS) improves seizure frequency and quality of life in patients with drug-resistant epilepsy (DRE), although the exact mechanism is not fully understood. Previous studies have evaluated the effect of VNS on functional connectivity using the phase lag index (PLI), but none has analyzed its effect on EEG aperiodic parameters (offset and exponent), which are highly conserved and related to physiological functions. Objective This study aimed to evaluate the effect of VNS on PLI and aperiodic parameters and infer whether these changes correlate with clinical responses in subjects with DRE. Materials and methods PLI, exponent, and offset were derived for each epoch (and each frequency band for PLI), on scalp-derived 64-channel EEG traces of 10 subjects with DRE, recorded before and 1 year after VNS. PLI, exponent, and offset were compared before and after VNS for each patient on a global basis, individual scalp regions, and channels and separately in responders and non-responders. A correlation analysis was performed between global changes in PLI and aperiodic parameters and clinical response. Results PLI (global and regional) decreased after VNS for gamma and delta bands and increased for an alpha band in responders, but it was not modified in non-responders. Aperiodic parameters after VNS showed an opposite trend in responders vs. non-responders: both were reduced in responders after VNS, but they were increased in non-responders. Changes in aperiodic parameters correlated with the clinical response. Conclusion This study explored the action of VNS therapy from a new perspective and identified EEG aperiodic parameters as a new and promising method to analyze the efficacy of neuromodulation.
Collapse
Affiliation(s)
- Roberta Coa
- Neuroscience Ph.D. Program, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy,*Correspondence: Roberta Coa
| | - Simone Maurizio La Cava
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
| | - Giulia Baldazzi
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy,Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
| | - Lorenzo Polizzi
- Regional Center for the Diagnosis and Treatment of Adult Epilepsy, Neurology Unit, AOU Cagliari, Cagliari, Italy
| | - Giovanni Pinna
- SC Neurosurgery, Neuroscience and Rehabilitation Department, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Carlo Conti
- SC Neurosurgery, Neuroscience and Rehabilitation Department, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Giovanni Defazio
- Regional Center for the Diagnosis and Treatment of Adult Epilepsy, Neurology Unit, AOU Cagliari, Cagliari, Italy,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Danilo Pani
- Department of Electrical and Electronic Engineering, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Regional Center for the Diagnosis and Treatment of Adult Epilepsy, Neurology Unit, AOU Cagliari, Cagliari, Italy,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
4
|
Zhang H, Li CL, Qu Y, Yang YX, Du J, Zhao Y. Effects and neuroprotective mechanisms of vagus nerve stimulation on cognitive impairment with traumatic brain injury in animal studies: A systematic review and meta-analysis. Front Neurol 2022; 13:963334. [PMID: 36237612 PMCID: PMC9551312 DOI: 10.3389/fneur.2022.963334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/29/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction Cognitive impairment is the main clinical feature after traumatic brain injury (TBI) and is usually characterized by attention deficits, memory loss, and decreased executive function. Vagus nerve stimulation (VNS) has been reported to show potential improvement in the cognition level after traumatic brain injury in clinical and preclinical studies. However, this topic has not yet been systematically reviewed in published literature. In this study, we present a systematic review and meta-analysis of the effects of VNS on cognitive function in animal models of TBI and their underlying mechanisms. Methods We performed a literature search on PubMed, PsycINFO, Web of Science, Embase, Scopus, and Cochrane Library from inception to December 2021 to identify studies describing the effects of VNS on animal models of TBI. Results Overall, nine studies were identified in animal models (36 mice, 268 rats, and 27 rabbits). An analysis of these studies showed that VNS can improve the performance of TBI animals in behavioral tests (beam walk test: SMD: 4.95; 95% confidence interval [CI]: 3.66, 6.23; p < 0.00001) and locomotor placing tests (SMD: -2.39; 95% CI: -4.07, -0.71; p = 0.005), whereas it reduced brain edema (SMD: -1.58; 95% CI: -2.85, -0.31; p = 0. 01) and decrease TNF-α (SMD: -3.49; 95% CI: -5.78, -1.2; p = 0.003) and IL-1β (SMD: -2.84; 95% CI: -3.96, -1.71; p < 0.00001) expression level in the brain tissue. However, the checklist for SYRCLE showed a moderate risk of bias (quality score between 30% and 60%), mainly because of the lack of sample size calculation, random assignment, and blinded assessment. Conclusion The present review showed that VNS can effectively promote cognitive impairment and neuropathology in animal models of TBI. We hope that the results of this systematic review can be applied to improve the methodological quality of animal experiments on TBI, which will provide more important and conclusive evidence on the clinical value of VNS. To further confirm these results, there is a need for high-quality TBI animal studies with sufficient sample size and a more comprehensive outcome evaluation. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290797, identifier: CRD42021290797.
Collapse
Affiliation(s)
- Han Zhang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Rehabilitation Medicine, Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, China
| | - Chun-liu Li
- Department of Rehabilitation Medicine, Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, China
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, China
| | - Yu-xuan Yang
- Department of Rehabilitation Medicine, Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Juan Du
- Department of Rehabilitation Medicine, Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yu Zhao
- Department of Rehabilitation Medicine, Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| |
Collapse
|
5
|
Gianlorenco ACL, de Melo PS, Marduy A, Kim AY, Kim CK, Choi H, Song JJ, Fregni F. Electroencephalographic Patterns in taVNS: A Systematic Review. Biomedicines 2022; 10:biomedicines10092208. [PMID: 36140309 PMCID: PMC9496216 DOI: 10.3390/biomedicines10092208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) is a newer delivery system using a non-invasive stimulation device placed at the ear. taVNS research is focused on clinical trials showing potential therapeutic benefits, however the neurophysiological effects of this stimulation on brain activity are still unclear. We propose a systematic review that aims to describe the effects of taVNS on EEG measures and identify taVNS parameters that can potentially lead to consistent EEG-mediated biomarkers for this therapy. A systematic literature review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and the Cochrane handbook for systematic reviews. Clinical trials examining EEG parameters were considered, including absolute and relative power, coherence, degree of symmetry, evoked potentials, and peak frequency of all bands. According to our criteria, 18 studies (from 122 articles) were included. Our findings show a general trend towards increased EEG power spectrum activity in lower frequencies, and changes on early components of the ERP related to inhibitory tasks. This review suggests that quantitative electroencephalography can be used to assess the effects of taVNS on brain activity, however more studies are needed to systematically establish the specific effects and metrics that would reflect the non-invasive stimulation through the auricular branch of the vagus nerve.
Collapse
Affiliation(s)
- Anna Carolyna L. Gianlorenco
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos 13565-090, Brazil
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador 40290-000, Brazil
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- União Metropolitana de Ensino e Cultura (UNIME) Salvador, Salvador 42700-000, Brazil
| | - Angela Yun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul 08308, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul 08308, Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea
- Neurive Co., Ltd., Gimhae 08308, Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul 08308, Korea
- Neurive Co., Ltd., Gimhae 08308, Korea
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Correspondence:
| |
Collapse
|
6
|
Carron R, Roncon P, Lagarde S, Dibué M, Zanello M, Bartolomei F. Latest Views on the Mechanisms of Action of Surgically Implanted Cervical Vagal Nerve Stimulation in Epilepsy. Neuromodulation 2022; 26:498-506. [PMID: 36064522 DOI: 10.1016/j.neurom.2022.08.447] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant epilepsy. Although there is a substantial amount of literature aiming at unraveling the mechanisms of action of VNS in epilepsy, it is still unclear how the cascade of events triggered by VNS leads to its antiepileptic effect. OBJECTIVE In this review, we integrated available peer-reviewed data on the effects of VNS in clinical and experimental research to identify those that are putatively responsible for its therapeutic effect. The topic of transcutaneous VNS will not be covered owing to the current lack of data supporting the differences and commonalities of its mechanisms of action in relation to invasive VNS. SUMMARY OF THE MAIN FINDINGS There is compelling evidence that the effect is obtained through the stimulation of large-diameter afferent myelinated fibers that project to the solitary tract nucleus, then to the parabrachial nucleus, which in turn alters the activity of the limbic system, thalamus, and cortex. VNS-induced catecholamine release from the locus coeruleus in the brainstem plays a pivotal role. Functional imaging studies tend to point toward a common vagal network that comes into play, made up of the amygdalo-hippocampal regions, left thalamus, and insular cortex. CONCLUSIONS Even though some crucial pieces are missing, neurochemical, molecular, cellular, and electrophysiological changes occur within the vagal afferent network at three main levels (the brainstem, the limbic system [amygdala and hippocampus], and the cortex). At this final level, VNS notably alters functional connectivity, which is known to be abnormally high within the epileptic zone and was shown to be significantly decreased by VNS in responders. The effect of crucial VNS parameters such as frequency or current amplitude on functional connectivity metrics is of utmost importance and requires further investigation.
Collapse
|
7
|
Vagal nerve stimulation cycles alter EEG connectivity in drug-resistant epileptic patients: a study with graph theory metrics. Clin Neurophysiol 2022; 142:59-67. [DOI: 10.1016/j.clinph.2022.07.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
|
8
|
Ma J, Wang Z, Cheng T, Hu Y, Qin X, Wang W, Yu G, Liu Q, Ji T, Xie H, Zha D, Wang S, Yang Z, Liu X, Cai L, Jiang Y, Hao H, Wang J, Li L, Wu Y. A prediction model integrating synchronization biomarkers and clinical features to identify responders to vagus nerve stimulation among pediatric patients with drug-resistant epilepsy. CNS Neurosci Ther 2022; 28:1838-1848. [PMID: 35894770 PMCID: PMC9532924 DOI: 10.1111/cns.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022] Open
Abstract
Aims Vagus nerve stimulation (VNS) is a neuromodulation therapy for children with drug‐resistant epilepsy (DRE). The efficacy of VNS is heterogeneous. A prediction model is needed to predict the efficacy before implantation. Methods We collected data from children with DRE who underwent VNS implantation and received regular programming for at least 1 year. Preoperative clinical information and scalp video electroencephalography (EEG) were available in 88 children. Synchronization features, including phase lag index (PLI), weighted phase lag index (wPLI), and phase‐locking value (PLV), were compared between responders and non‐responders. We further adapted a support vector machine (SVM) classifier selected from 25 clinical and 18 synchronization features to build a prediction model for efficacy in a discovery cohort (n = 70) and was tested in an independent validation cohort (n = 18). Results In the discovery cohort, the average interictal awake PLI in the high beta band was significantly higher in responders than non‐responders (p < 0.05). The SVM classifier generated from integrating both clinical and synchronization features had the best prediction efficacy, demonstrating an accuracy of 75.7%, precision of 80.8% and area under the receiver operating characteristic (AUC) of 0.766 on 10‐fold cross‐validation. In the validation cohort, the prediction model demonstrated an accuracy of 61.1%. Conclusion This study established the first prediction model integrating clinical and baseline synchronization features for preoperative VNS responder screening among children with DRE. With further optimization of the model, we hope to provide an effective and convenient method for identifying responders before VNS implantation.
Collapse
Affiliation(s)
- Jiayi Ma
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhiyan Wang
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Tungyang Cheng
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Yingbing Hu
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Xiaoya Qin
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Wen Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Guojing Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Qingzhu Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Taoyun Ji
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Han Xie
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Daqi Zha
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Shuang Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Hongwei Hao
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Jing Wang
- Beijing Key Laboratory of Epilepsy Research, Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Luming Li
- National Engineering laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China.,IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, China.,Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| |
Collapse
|
9
|
Abstract
BACKGROUND This is an updated version of the Cochrane Review published in 2015. Epilepsy is a chronic neurological disorder, characterised by recurring, unprovoked seizures. Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with drug-resistant epilepsy. VNS consists of chronic, intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator. OBJECTIVES To evaluate the efficacy and tolerability of VNS when used as add-on treatment for people with drug-resistant focal epilepsy. SEARCH METHODS For this update, we searched the Cochrane Register of Studies (CRS), and MEDLINE Ovid on 3 March 2022. We imposed no language restrictions. CRS Web includes randomised or quasi-randomised controlled trials from the Specialised Registers of Cochrane Review Groups, including Epilepsy, CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA We considered parallel or cross-over, randomised, double-blind, controlled trials of VNS as add-on treatment, which compared high- and low-level stimulation (including three different stimulation paradigms: rapid, mild, and slow duty-cycle), and VNS stimulation versus no stimulation, or a different intervention. We considered adults or children with drug-resistant focal seizures who were either not eligible for surgery, or who had failed surgery. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods, assessing the following outcomes: 1. 50% or greater reduction in seizure frequency 2. Treatment withdrawal (any reason) 3. Adverse effects 4. Quality of life (QoL) 5. Cognition 6. Mood MAIN RESULTS We did not identify any new studies for this update, therefore, the conclusions are unchanged. We included the five randomised controlled trials (RCT) from the last update, with a total of 439 participants. The baseline phase ranged from 4 to 12 weeks, and double-blind treatment phases from 12 to 20 weeks. We rated two studies at an overall low risk of bias, and three at an overall unclear risk of bias, due to lack of reported information about study design. Effective blinding of studies of VNS is difficult, due to the frequency of stimulation-related side effects, such as voice alteration. The risk ratio (RR) for 50% or greater reduction in seizure frequency was 1.73 (95% confidence interval (CI) 1.13 to 2.64; 4 RCTs, 373 participants; moderate-certainty evidence), showing that high frequency VNS was over one and a half times more effective than low frequency VNS. The RR for treatment withdrawal was 2.56 (95% CI 0.51 to 12.71; 4 RCTs, 375 participants; low-certainty evidence). Results for the top five reported adverse events were: hoarseness RR 2.17 (99% CI 1.49 to 3.17; 3 RCTs, 330 participants; moderate-certainty evidence); cough RR 1.09 (99% CI 0.74 to 1.62; 3 RCTs, 334 participants; moderate-certainty evidence); dyspnoea RR 2.45 (99% CI 1.07 to 5.60; 3 RCTs, 312 participants; low-certainty evidence); pain RR 1.01 (99% CI 0.60 to 1.68; 2 RCTs; 312 participants; moderate-certainty evidence); paraesthesia 0.78 (99% CI 0.39 to 1.53; 2 RCTs, 312 participants; moderate-certainty evidence). Results from two studies (312 participants) showed that a small number of favourable QOL effects were associated with VNS stimulation, but results were inconclusive between high- and low-level stimulation groups. One study (198 participants) found inconclusive results between high- and low-level stimulation for cognition on all measures used. One study (114 participants) found the majority of participants showed an improvement in mood on the Montgomery-Åsberg Depression Rating Scale compared to baseline, but results between high- and low-level stimulation were inconclusive. We found no important heterogeneity between studies for any of the outcomes. AUTHORS' CONCLUSIONS VNS for focal seizures appears to be an effective and well-tolerated treatment. Results of the overall efficacy analysis show that high-level stimulation reduced the frequency of seizures better than low-level stimulation. There were very few withdrawals, which suggests that VNS is well tolerated. Adverse effects associated with implantation and stimulation were primarily hoarseness, cough, dyspnoea, pain, paraesthesia, nausea, and headache, with hoarseness and dyspnoea more likely to occur with high-level stimulation than low-level stimulation. However, the evidence for these outcomes is limited, and of moderate to low certainty. Further high-quality research is needed to fully evaluate the efficacy and tolerability of VNS for drug-resistant focal seizures.
Collapse
Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alexandra Rigby
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
| |
Collapse
|
10
|
Broncel A, Bocian R, Konopacki J. Vagal Nerve Stimulation: The Effect on the Brain Oscillatory Field Potential. Neuroscience 2021; 483:127-138. [PMID: 34952159 DOI: 10.1016/j.neuroscience.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
More than thirty years of medical treatment with the use of vagal nerve stimulation (VNS) has shown that this therapeutic procedure works in a number of homeostatic disturbances. Although the clinical usage of VNS has a long history, our knowledge about the central mechanisms underlying this treatment is still limited. In the present paper we review the effects of VNS on brain oscillations as a possible electrophysiological bio-marker of VNS efficacy. The review was prepared mainly on the basis of data delivered from clinical observations and the outcomes of electrophysiological experiments conducted on laboratory animals that are available in PubMed. We consciously did not focus on epileptiform activity understood as a pathologic oscillatory activity, which was widely discussed in the numerous previously published reviews. The main conclusion of the present paper is that further, well-designed experiments on laboratory animals are absolutely necessary to address the electrophysiological issues. These will fill a number of gaps in our present knowledge of the central mechanisms underlying VNS therapy.
Collapse
Affiliation(s)
- Adam Broncel
- Medical Technology Centre, Natolin 15, 92-701 Lodz, Poland.
| | - Renata Bocian
- Department of Neurobiology, Faculty of Biology and Environmental Protection, The University of Lodz, Pomorska St. No. 141/143, 90-236 Lodz, Poland.
| | - Jan Konopacki
- Department of Neurobiology, Faculty of Biology and Environmental Protection, The University of Lodz, Pomorska St. No. 141/143, 90-236 Lodz, Poland.
| |
Collapse
|
11
|
Vespa S, Heyse J, Stumpp L, Liberati G, Ferrao Santos S, Rooijakkers H, Nonclercq A, Mouraux A, van Mierlo P, El Tahry R. Vagus Nerve Stimulation Elicits Sleep EEG Desynchronization and Network Changes in Responder Patients in Epilepsy. Neurotherapeutics 2021; 18:2623-2638. [PMID: 34668148 PMCID: PMC8804116 DOI: 10.1007/s13311-021-01124-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Neural desynchronization was shown as a key mechanism of vagus nerve stimulation (VNS) action in epilepsy, and EEG synchronization measures are explored as possible response biomarkers. Since brain functional organization in sleep shows different synchrony and network properties compared to wakefulness, we aimed to explore the effects of acute VNS on EEG-derived measures in the two different states of vigilance. EEG epochs were retrospectively analyzed from twenty-four VNS-treated epileptic patients (11 responders, 13 non-responders) in calm wakefulness and stage N2 sleep. Weighted Phase Lag Index (wPLI) was computed as connectivity measure of synchronization, for VNS OFF and VNS ON conditions. Global efficiency (GE) was computed as a network measure of integration. Ratios OFF/ON were obtained as desynchronization/de-integration index. Values were compared between responders and non-responders, and between EEG states. ROC curve and area-under-the-curve (AUC) analysis was performed for response classification. In responders, stronger VNS-induced theta desynchronization (p < 0.05) and decreased GE (p < 0.05) were found in sleep, but not in wakefulness. Theta sleep wPLI Ratio OFF/ON yielded an AUC of 0.825, and 79% accuracy as a response biomarker if a cut-off value is set at 1.05. Considering all patients, the VNS-induced GE decrease was significantly more important in sleep compared to awake EEG state (p < 0.01). In conclusion, stronger sleep EEG desynchronization in theta band distinguishes responders to VNS therapy from non-responders. VNS-induced reduction of network integration occurs significantly more in sleep than in wakefulness.
Collapse
Affiliation(s)
- Simone Vespa
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium.
| | - Jolan Heyse
- Medical Image and Signal Processing Group (MEDISIP), Ghent University, Ghent, Belgium
| | - Lars Stumpp
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Giulia Liberati
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Susana Ferrao Santos
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herbert Rooijakkers
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems (BEAMS), Université Libre de Bruxelles, Brussels, Belgium
| | - André Mouraux
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing Group (MEDISIP), Ghent University, Ghent, Belgium
| | - Riëm El Tahry
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium
- Centre for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
12
|
Hamdi H, Spatola G, Lagarde S, McGonigal A, Paz-Paredes A, Bizeau A, Bartolomei F, Carron R. Use of Polyvinyl Alcohol Sponge Cubes for Vagal Nerve Stimulation: A Suggestion for the Wrapping Step. Technical Note and Step-by-Step Operative Technique. Oper Neurosurg (Hagerstown) 2021; 18:487-495. [PMID: 31386756 PMCID: PMC7594176 DOI: 10.1093/ons/opz227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 05/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vagal nerve stimulation (VNS) is an approved treatment for epilepsy and depression. Wrapping the helical electrodes around the nerve can prove technically challenging. However, a quick and efficient method to slightly elevate the nerve can highly facilitate this part of the procedure. OBJECTIVE To provide useful surgical tips to facilitate the procedure. METHODS Based on experience of more than 150 adult cases for mainly epilepsy (primary lead implant), the authors share their surgical technique to provide the experienced surgeons or newcomers to the field of VNS with some useful tips. All patients signed informed consent according to the local ethics committee guidelines. RESULTS The article consists of a detailed step-by-step description of the whole procedure illustrated through high-resolution colored photographs of the surgical field. Special reference is made to the usefulness of polyvinyl alcohol (PVA) sponge cubes to elevate the nerve instead of the commonly used silicon vessel loops. CONCLUSION The use of surgical microscope and PVA sponge cubes to elevate the nerve constitute key points to make VNS an easy surgery.
Collapse
Affiliation(s)
- Hussein Hamdi
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France.,Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France.,Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Egypt
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France.,Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | - Stanislas Lagarde
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | - Armando Paz-Paredes
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
| | - Alain Bizeau
- Department of Cervico-Facial Surgery, Sainte Musse Hospital, Toulon, France
| | - Fabrice Bartolomei
- Epileptology Department, Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| | - Romain Carron
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France.,Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Marseille, France
| |
Collapse
|
13
|
Keute M, Wienke C, Ruhnau P, Zaehle T. Effects of transcutaneous vagus nerve stimulation (tVNS) on beta and gamma brain oscillations. Cortex 2021; 140:222-231. [PMID: 34015727 DOI: 10.1016/j.cortex.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Physiological and behavioral effects induced through transcutaneous vagus nerve stimulation (tVNS) are under scrutiny in a growing number of studies, yet its mechanisms of action remain poorly understood. One candidate mechanism is a modulation of γ-aminobutyric acid (GABA) transmission through tVNS. Two recent behavioral studies suggest that such a GABAergic effect might occur in a lateralized fashion, i.e., the GABA modulation might be stronger in the left than in the right brain hemisphere after tVNS applied to the left ear. Using magnetoencephalography (MEG), we tested for GABA-associated modulations in resting and event-related brain oscillations and for a lateralization of those effects in a sample of 41 healthy young adults. Our data provide substantial evidence against all hypotheses, i.e., we neither find effects of tVNS on oscillatory power nor a lateralization of effects.
Collapse
Affiliation(s)
- Marius Keute
- Department of Neurology, Otto-von Guericke-University, Magdeburg, Germany; Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany.
| | - Christian Wienke
- Department of Neurology, Otto-von Guericke-University, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg
| | - Philipp Ruhnau
- Department of Neurology, Otto-von Guericke-University, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg
| | - Tino Zaehle
- Department of Neurology, Otto-von Guericke-University, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg
| |
Collapse
|
14
|
Machetanz K, Berelidze L, Guggenberger R, Gharabaghi A. Brain-Heart Interaction During Transcutaneous Auricular Vagus Nerve Stimulation. Front Neurosci 2021; 15:632697. [PMID: 33790736 PMCID: PMC8005577 DOI: 10.3389/fnins.2021.632697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/17/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Transcutaneous auricular vagus nerve stimulation (taVNS) modulates brain activity and heart function. The induced parasympathetic predominance leads to an increase of heart rate variability (HRV). Knowledge on the corresponding cortical activation pattern is, however, scarce. We hypothesized taVNS-induced HRV increases to be related to modulation of cortical activity that regulates the autonomic outflow to the heart. MATERIALS AND METHODS In thirteen healthy subjects, we simultaneously recorded 64-channel electroencephalography and electrocardiography during taVNS. Two taVNS stimulation targets were investigated, i.e., the cymba conchae and inner tragus, and compared to active control stimulation in the anatomical vicinity, i.e., at the crus helicis and outer tragus. We used intermitted stimulation bursts of 25 Hz applied at a periodicity of 1 Hz. HRV was estimated with different time-domain methodologies: standard deviation of RR (SDNN), the root mean squares of successive differences (RMSSD), the percentage of RR-intervals with at least 50 ms deviation from the preceding RR-interval (pNN50), and the difference of consecutive RR intervals weighted by their mean (rrHRV). RESULTS The stimulation-induced HRV increases corresponded to frequency-specific oscillatory modulation of different cortical areas. All stimulation targets induced power modulations that were proportional to the HRV elevation. The most prominent changes that corresponded to HRV increases across all parameters and stimulation locations were frontal elevations in the theta-band. In the delta-band, there were frontal increases (RMSSD, pNN50, rrHRV, SDNN) and decreases (SDNN) across stimulation sites. In higher frequencies, there was a more divers activity pattern: Outer tragus/crus helicis stimulation increased oscillatory activity with the most prominent changes for the SDNN in frontal (alpha-band, beta-band) and fronto-parietal (gamma-band) areas. During inner tragus/cymba conchae stimulation the predominant pattern was a distributed power decrease, particularly in the fronto-parietal gamma-band. CONCLUSION Neuro-cardiac interactions can be modulated by electrical stimulation at different auricular locations. Increased HRV during stimulation is correlated with frequency-specific increases and decreases of oscillatory activity in different brain areas. When applying specific HRV measures, cortical patterns related to parasympathetic (RMSSD, pNN50, rrHRV) and sympathetic (SDNN) modulation can be identified. Thus, cortical oscillations may be used to define stimulation locations and parameters for research and therapeutic purposes.
Collapse
Affiliation(s)
- Kathrin Machetanz
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | | | | | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
15
|
Spindler P, Vajkoczy P, Schneider UC. Closed-loop vagus nerve stimulation. Patient-tailored therapy or undirected treatment? INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
16
|
Sangare A, Marchi A, Pruvost-Robieux E, Soufflet C, Crepon B, Ramdani C, Chassoux F, Turak B, Landre E, Gavaret M. The Effectiveness of Vagus Nerve Stimulation in Drug-Resistant Epilepsy Correlates with Vagus Nerve Stimulation-Induced Electroencephalography Desynchronization. Brain Connect 2020; 10:566-577. [PMID: 33073582 PMCID: PMC7757623 DOI: 10.1089/brain.2020.0798] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: VNS is an adjunctive neuromodulation therapy for patients with drug-refractory epilepsy. The antiseizure effect of VNS is thought to be related to a diffuse modulation of functional connectivity but remains to be confirmed. Aim: To investigate electroencephalographic (EEG) metrics of functional connectivity in patients with drug-refractory epilepsy treated by vagus nerve stimulation (VNS), between VNS-stimulated “ON” and nonstimulated “OFF” periods and between responder (R) and nonresponder (NR) patients. Methods: Scalp-EEG was performed for 35 patients treated by VNS, using 21 channels and 2 additional electrodes on the neck to detect the VNS stimulation. Patients were defined as VNS responders if a reduction of seizure frequency of ∼50% was documented. We analyzed the synchronization in EEG time series during “ON” and “OFF” periods of stimulation, using average phase lag index (PLI) in signal space and phase-locking value (PLV) between 10 sources. Based on graph theory, we computed brain network models and analyzed minimum spanning tree (MST) for responder and nonresponder patients. Results: Among 35 patients treated by VNS for a median time of 7 years (range 4 months to 22 years), 20 were R and 15 were NR. For responder patients, PLI during ON periods was significantly lower than that during OFF periods in delta (p = 0.009), theta (p = 0.02), and beta (p = 0.04) frequency bands. For nonresponder patients, there were no significant differences between ON and OFF periods. Moreover, variations of seizure frequency with VNS correlated with the PLI OFF/ON ratio in delta (p = 0.02), theta (p = 0.04), and beta (p = 0.03) frequency bands. Our results were confirmed using PLV in theta band (p < 0.05). No significant differences in MST were observed between R and NR patients. Conclusion: The correlation between VNS-induced interictal EEG time-series desynchronization and decrease in seizure frequency suggested that VNS therapeutic impact might be related to changes in interictal functional connectivity.
Collapse
Affiliation(s)
- Aude Sangare
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Angela Marchi
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Estelle Pruvost-Robieux
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France.,Université de Paris, Paris, France
| | - Christine Soufflet
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Benoit Crepon
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Céline Ramdani
- Institut de Recherche Biomédicale des Armées (IRBA), Paris, France
| | - Francine Chassoux
- Neurosurgery and Epileptology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Baris Turak
- Neurosurgery and Epileptology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Elisabeth Landre
- Neurosurgery and Epileptology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martine Gavaret
- Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1266, IPNP, Paris, France
| |
Collapse
|
17
|
Plesinger F, Halamek J, Chladek J, Jurak P, Dolezalova I, Chrastina J, Brazdil M. Response to Vagal Stimulation by Heart-rate Features in Drug-resistant Epileptic Patients .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:46-49. [PMID: 33017927 DOI: 10.1109/embc44109.2020.9176326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vagal Nerve Stimulation (VNS) is an option in the treatment of drug-resistant epilepsy. However, approximately a quarter of VNS subjects does not respond to the therapy. In this retrospective study, we introduce heart-rate features to distinguish VNS responders and non-responders. Standard pre-implantation measurements of 66 patients were segmented in relation to specific stimuli (open/close eyes, photic stimulation, hyperventilation, and rests between). Median interbeat intervals were found for each segment and normalized (NMRR). Five NMRRs were significant; the strongest feature achieved significance with p=0.013 and AUC=0.66. Low mutual correlation and independence on EEG signals mean that presented features could be considered as an addition for models predicting VNS response using EEG.
Collapse
|
18
|
Yokoyama R, Akiyama Y, Enatsu R, Suzuki H, Suzuki Y, Kanno A, Ochi S, Mikuni N. The Immediate Effects of Vagus Nerve Stimulation in Intractable Epilepsy: An Intra-operative Electrocorticographic Analysis. Neurol Med Chir (Tokyo) 2020; 60:244-251. [PMID: 32295979 PMCID: PMC7246227 DOI: 10.2176/nmc.oa.2019-0221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to investigate whether and how vagus nerve stimulation (VNS) reduces the epileptogenic activity in the bilateral cerebral cortex in patients with intractable epilepsy. We analyzed the electrocorticograms (ECoGs) of five patients who underwent callosotomy due to intractable epilepsy even after VNS implantation. We recorded ECoGs and analyzed power spectrum in both VNS OFF and ON phases. We counted the number of spikes and electrodes with epileptic spikes, distinguishing unilaterally and bilaterally hemispherically spread spikes as synchronousness of the epileptic spikes in both VNS OFF and ON phases. There were 24.80 ± 35.55 and 7.20 ± 9.93 unilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.157), and 35.8 ± 29.21 and 10.6 ± 13.50 bilaterally spread spikes in the VNS OFF and ON phases, respectively (P = 0.027). The number of electrodes with unilaterally and bilaterally spread spikes in the VNS OFF and ON phases was 3.84 ± 2.13 and 3.59 ± 1.82 (P = 0.415), and 8.20 ± 3.56 and 6.89 ± 2.89 (P = 0.026), respectively. The ECoG background power spectra recordings in the VNS OFF and ON phases were also analyzed. The spectral power tended to be greater in the high-frequency band at VNS ON phase than OFF phase. This study showed the reduction of epileptogenic spikes and spread areas of the spikes by VNS as immediate effects, electrophysiologically.
Collapse
Affiliation(s)
| | | | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University
| | - Yuto Suzuki
- Department of Neurosurgery, Sapporo Medical University
| | - Aya Kanno
- Department of Neurosurgery, Sapporo Medical University
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University
| | | |
Collapse
|
19
|
Colzato L, Beste C. A literature review on the neurophysiological underpinnings and cognitive effects of transcutaneous vagus nerve stimulation: challenges and future directions. J Neurophysiol 2020; 123:1739-1755. [PMID: 32208895 DOI: 10.1152/jn.00057.2020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Brain stimulation approaches are important to gain causal mechanistic insights into the relevance of functional brain regions and/or neurophysiological systems for human cognitive functions. In recent years, transcutaneous vagus nerve stimulation (tVNS) has attracted considerable popularity. It is a noninvasive brain stimulation technique based on the stimulation of the vagus nerve. The stimulation of this nerve activates subcortical nuclei, such as the locus coeruleus and the nucleus of the solitary tract, and from there, the activation propagates to the cortex. Since tVNS is a novel stimulation technique, this literature review outlines a brief historical background of tVNS, before detailing underlying neurophysiological mechanisms of action, stimulation parameters, cognitive effects of tVNS on healthy humans, and, lastly, current challenges and future directions of tVNS research in cognitive functions. Although more research is needed, we conclude that tVNS, by increasing norepineprine (NE) and gamma-aminobutyric acid (GABA) levels, affects NE- and GABA-related cognitive performance. The review provides detailed background information how to use tVNS as a neuromodulatory tool in cognitive neuroscience and outlines important future leads of research on tVNS.
Collapse
Affiliation(s)
- Lorenza Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| |
Collapse
|
20
|
Qin X, Lin S, Yuan Y, Wen J, Chen Q, Lu X, Sun Y, Wang F, Tian X, Jiang N, Liao J, Li L. Vagus nerve stimulation for pediatric patients with drug-resistant epilepsy caused by genetic mutations: Two cases. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Vagus nerve stimulation (VNS) is a neuromodulation therapy increasingly used for treating drug-resistant epilepsy. However, it remains to be determined which patients are best suited for the treatment, and it is difficult to predict the therapeutic effect before the implantation. Mutations in some genes could lead to epilepsy. Here we report two cases of pediatric patients with drug-resistant epilepsy treated by VNS therapy: Patient 1 with ARX mutation achieved good outcomes; Patient 2 with the CDKL5 mutation did not show improvement. Additionally, the therapeutic impact of VNS on brain networks was investigated, hoping to provide some empirical evidence for a better understanding of the mechanism of VNS treatment.
Collapse
|
21
|
Effect of short-term transcutaneous trigeminal nerve stimulation on EEG activity in drug-resistant epilepsy. J Neurol Sci 2019; 400:90-96. [PMID: 30904691 DOI: 10.1016/j.jns.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/08/2019] [Accepted: 03/09/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transcutaneous trigeminal nerve stimulation (TNS) has antiepileptic effects in patients with drug-resistant epilepsy (DRE). However, whether and how TNS is able to modulate the electroencephalogram (EEG) background activity in patients with DRE is still unknown. OBJECTIVES To investigate the effect of short-term TNS on EEG background activity in DRE by qualitative and quantitative analyses. METHODS Twenty-nine DRE patients participated in the study. Twenty-two were randomly divided into a "sham-TNS" or "real-TNS" group; seven patients underwent stimulation of the median nerve (MNS) at the wrist. Real-TNS was delivered bilaterally to the infraorbital nerve (trains of 1-20 mA, 120 Hz, cyclic modality for 20 min). The sham-TNS protocol mimicked the real-TNS one but at a zero intensity. For MNS, the same parameters as real-TNS were used. EEG was continuously acquired for 40 min: 10' pre, 20' during and 10' post stimulation. EEG was visually inspected for interictal epileptiform discharge (IEDs) changes and processed by spectral analysis for changes in mean frequency and absolute power of each frequency band. RESULTS A significant increase of EEG absolute alpha power was observed during real-TNS compared with the sham-TNS (F34,680 = 1.748; p = 0.006). Conversely, no significant effects were noticed either for quantitative analysis of other frequency bands or for IEDs detection. MNS proved unable to modulate EEG activity. CONCLUSIONS Short-term TNS induces an acute and specific effect on background EEG of DRE by increasing the absolute alpha band power. EEG alpha rhythm enhancement may index a cortical functional inhibition and act as a seizure-preventing mechanism.
Collapse
|
22
|
Brázdil M, Doležalová I, Koritáková E, Chládek J, Roman R, Pail M, Jurák P, Shaw DJ, Chrastina J. EEG Reactivity Predicts Individual Efficacy of Vagal Nerve Stimulation in Intractable Epileptics. Front Neurol 2019; 10:392. [PMID: 31118916 PMCID: PMC6507513 DOI: 10.3389/fneur.2019.00392] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Chronic vagal nerve stimulation (VNS) is a well-established non-pharmacological treatment option for drug-resistant epilepsy. This study sought to develop a statistical model for prediction of VNS efficacy. We hypothesized that reactivity of the electroencephalogram (EEG) to external stimuli measured during routine preoperative evaluation differs between VNS responders and non-responders. Materials and Methods: Power spectral analyses were computed retrospectively on pre-operative EEG recordings from 60 epileptic patients with VNS. Thirty five responders and 25 non-responders were compared on the relative power values in four standard frequency bands and eight conditions of clinical assessment-eyes opening/closing, photic stimulation, and hyperventilation. Using logistic regression, groups of electrodes within anatomical areas identified as maximally discriminative by n leave-one-out iterations were used to classify patients. The reliability of the predictive model was verified with an independent data-set from 22 additional patients. Results: Power spectral analyses revealed significant differences in EEG reactivity between responders and non-responders; specifically, the dynamics of alpha and gamma activity strongly reflected VNS efficacy. Using individual EEG reactivity to develop and validate a predictive model, we discriminated between responders and non-responders with 86% accuracy, 83% sensitivity, and 90% specificity. Conclusion: We present a new statistical model with which EEG reactivity to external stimuli during routine presurgical evaluation can be seen as a promising avenue for the identification of patients with favorable VNS outcome. This novel method for the prediction of VNS efficacy might represent a breakthrough in the management of drug-resistant epilepsy, with wide-reaching medical and economic implications.
Collapse
Affiliation(s)
- Milan Brázdil
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Irena Doležalová
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Eva Koritáková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia.,Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Robert Roman
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Martin Pail
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Jurák
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Daniel J Shaw
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Jan Chrastina
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| |
Collapse
|
23
|
Vecchio E, Bassez I, Ricci K, Tassorelli C, Liebler E, de Tommaso M. Effect of Non-invasive Vagus Nerve Stimulation on Resting-State Electroencephalography and Laser-Evoked Potentials in Migraine Patients: Mechanistic Insights. Front Hum Neurosci 2018; 12:366. [PMID: 30271335 PMCID: PMC6146235 DOI: 10.3389/fnhum.2018.00366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/28/2018] [Indexed: 12/24/2022] Open
Abstract
A recent multicenter trial provided Class I evidence that for patients with an episodic migraine, non-invasive vagus nerve stimulation (nVNS) significantly increases the probability of having mild pain or being pain-free 2 h post-stimulation. Here we aimed to investigate the potential effect of nVNS in the modulation of spontaneous and pain related bioelectrical activity in a subgroup of migraine patients enrolled in the PRESTO trial by using resting-state electroencephalography and trigeminal laser-evoked potentials (LEPs). LEPs were recorded for 27 migraine patients who received active or sham nVNS over the cervical vagus nerve. We measured power values for frequencies between 1–100 Hz in a resting-state condition and the latency and amplitude of N1, N2, and P2 components of LEPs in a basal condition during and after active or sham vagus nerve stimulation (T0, T1, T2). The P2 evoked by the right and the left trigeminal branch was smaller during active nVNS. The sham device also attenuated the P2 amplitude evoked by the left trigeminal branch at T1 and T2, but this attenuation did not reach significance. No changes were observed for N1 amplitude, N1, N2, P2 latency, or pain rating. nVNS induced an increase of EEG power in both slow and fast rhythms, but this effect was not significant as compared to the sham device. These findings suggest that nVNS acts on the cortical areas that are responsible for trigeminal pain control and pave the ground for future studies aimed at confirming the possible correlations with clinical outcomes, including the effect on symptoms that are directly correlated with trigeminal pain processing and modulation.
Collapse
Affiliation(s)
- Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Iege Bassez
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eric Liebler
- electroCore LLC, Basking Ridge, NJ, United States
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| |
Collapse
|
24
|
Kibleur A, Pellissier S, Sinniger V, Robert J, Gronlier E, Clarençon D, Vercueil L, Hoffmann D, Bonaz B, David O. Electroencephalographic correlates of low-frequency vagus nerve stimulation therapy for Crohn’s disease. Clin Neurophysiol 2018; 129:1041-1046. [DOI: 10.1016/j.clinph.2018.02.127] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/22/2017] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
|
25
|
Ibrahim GM, Wong S, Morgan BR, Lipsman N, Fallah A, Weil AG, Krishna V, Wennberg RA, Lozano AA. Phase-amplitude coupling within the anterior thalamic nuclei during seizures. J Neurophysiol 2018; 119:1497-1505. [DOI: 10.1152/jn.00832.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cross-frequency phase-amplitude coupling (cfPAC) subserves an integral role in the hierarchical organization of interregional neuronal communication and is also expressed by epileptogenic cortex during seizures. Here, we sought to characterize patterns of cfPAC expression in the anterior thalamic nuclei during seizures by studying extra-operative recordings in patients implanted with deep brain stimulation electrodes for intractable epilepsy. Nine seizures from two patients were analyzed in the peri-ictal period. CfPAC was calculated using the modulation index and interregional functional connectivity was indexed using the phase-locking value. Statistical analysis was performed within subjects on the basis of nonparametric permutation and corrected with Gaussian field theory. Five of the nine analyzed seizures demonstrated significant cfPAC. Significant cfPAC occurred during the pre-ictal and ictal periods in three seizures, as well as the postictal windows in four seizures. The preferred phase at which cfPAC occurred differed 1) in space, between the thalami of the epileptogenic and nonepileptogenic hemispheres; and 2) in time, at seizure termination. The anterior thalamic nucleus of the epileptogenic hemisphere also exhibited altered interregional phase-locking synchrony concurrent with the expression of cfPAC. By analyzing extraoperative recordings from the anterior thalamic nuclei, we show that cfPAC associated with altered interregional phase synchrony is lateralized to the thalamus of the epileptogenic hemisphere during seizures. Electrophysiological differences in cfPAC, including preferred phase of oscillatory interactions may be further investigated as putative targets for individualized neuromodulation paradigms in patients with drug-resistant epilepsy. NEW & NOTEWORTHY The association between fast brain activity and slower oscillations is an integral mechanism for hierarchical neuronal communication, which is also manifested in epileptogenic cortex. Our data suggest that the same phenomenon occurs in the anterior thalamic nuclei during seizures. Further, the preferred phase of modulation shows differences in space, between the epileptogenic and nonepileptogenic hemispheres and time, as seizures terminate. Our data encourage the study of cross-frequency coupling for targeted, individualized closed-loop stimulation paradigms.
Collapse
Affiliation(s)
- George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Simeon Wong
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Benjamin R. Morgan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aria Fallah
- Department of Neurosurgery, Mattel Children’s Hospital, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Alexander G. Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Vibhor Krishna
- The Ohio State University, Center for Neuromodulation, Department of Neurosurgery, Columbus, Ohio
- The Ohio State University, Department of Neuroscience, Columbus, Ohio
| | - Richard A. Wennberg
- Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andres A. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
|
27
|
Presurgical thalamocortical connectivity is associated with response to vagus nerve stimulation in children with intractable epilepsy. NEUROIMAGE-CLINICAL 2017; 16:634-642. [PMID: 28971013 PMCID: PMC5619991 DOI: 10.1016/j.nicl.2017.09.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/16/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
Although chronic vagus nerve stimulation (VNS) is an established treatment for medically-intractable childhood epilepsy, there is considerable heterogeneity in seizure response and little data are available to pre-operatively identify patients who may benefit from treatment. Since the therapeutic effect of VNS may be mediated by afferent projections to the thalamus, we tested the hypothesis that intrinsic thalamocortical connectivity is associated with seizure response following chronic VNS in children with epilepsy. Twenty-one children (ages 5-21 years) with medically-intractable epilepsy underwent resting-state fMRI prior to implantation of VNS. Ten received sedation, while 11 did not. Whole brain connectivity to thalamic regions of interest was performed. Multivariate generalized linear models were used to correlate resting-state data with seizure outcomes, while adjusting for age and sedation status. A supervised support vector machine (SVM) algorithm was used to classify response to chronic VNS on the basis of intrinsic connectivity. Of the 21 subjects, 11 (52%) had 50% or greater improvement in seizure control after VNS. Enhanced connectivity of the thalami to the anterior cingulate cortex (ACC) and left insula was associated with greater VNS efficacy. Within our test cohort, SVM correctly classified response to chronic VNS with 86% accuracy. In an external cohort of 8 children, the predictive model correctly classified the seizure response with 88% accuracy. We find that enhanced intrinsic connectivity within thalamocortical circuitry is associated with seizure response following VNS. These results encourage the study of intrinsic connectivity to inform neural network-based, personalized treatment decisions for children with intractable epilepsy.
Collapse
|
28
|
Ravan M. Investigating the correlation between short-term effectiveness of VNS Therapy in reducing the severity of seizures and long-term responsiveness. Epilepsy Res 2017; 133:46-53. [DOI: 10.1016/j.eplepsyres.2017.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/08/2017] [Accepted: 04/08/2017] [Indexed: 12/18/2022]
|
29
|
Ravan M, Sabesan S, D'Cruz O. On Quantitative Biomarkers of VNS Therapy Using EEG and ECG Signals. IEEE Trans Biomed Eng 2017; 64:419-428. [DOI: 10.1109/tbme.2016.2554559] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
30
|
Martínez-Vargas D, Valdés-Cruz A, Magdaleno-Madrigal V, Fernández-Mas R, Almazán-Alvarado S. Effect of Electrical Stimulation of the Nucleus of the Solitary Tract on Electroencephalographic Spectral Power and the Sleep–Wake Cycle in Freely Moving Cats. Brain Stimul 2017; 10:116-125. [DOI: 10.1016/j.brs.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 07/15/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022] Open
|
31
|
Burgess AP, Fouquet NC, Seri S, Hawken MB, Heard A, Neasham D, Little MP, Elliott P. Acute Exposure to Terrestrial Trunked Radio (TETRA) has effects on the electroencephalogram and electrocardiogram, consistent with vagal nerve stimulation. ENVIRONMENTAL RESEARCH 2016; 150:461-469. [PMID: 27419367 PMCID: PMC5010210 DOI: 10.1016/j.envres.2016.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Terrestrial Trunked Radio (TETRA) is a telecommunications system widely used by police and emergency services around the world. The Stewart Report on mobile telephony and health raised questions about possible health effects associated with TETRA signals. This study investigates possible effects of TETRA signals on the electroencephalogram and electrocardiogram in human volunteers. METHODS Blinded randomized provocation study with a standardized TETRA signal or sham exposure. In the first of two experiments, police officers had a TETRA set placed first against the left temple and then the upper-left quadrant of the chest and the electroencephalogram was recorded during rest and active cognitive processing. In the second experiment, volunteers were subject to chest exposure of TETRA whilst their electroencephalogram and heart rate variability derived from the electrocardiogram were recorded. RESULTS In the first experiment, we found that exposure to TETRA had consistent neurophysiological effects on the electroencephalogram, but only during chest exposure, in a pattern suggestive of vagal nerve stimulation. In the second experiment, we observed changes in heart rate variability during exposure to TETRA but the electroencephalogram effects were not replicated. CONCLUSIONS Observed effects of exposure to TETRA signals on the electroencephalogram (first experiment) and electrocardiogram are consistent with vagal nerve stimulation in the chest by TETRA. However given the small effect on heart rate variability and the lack of consistency on the electroencephalogram, it seems unlikely that this will have a significant impact on health. Long-term monitoring of the health of the police force in relation to TETRA use is on-going.
Collapse
Affiliation(s)
- Adrian P Burgess
- Aston Brain Centre, School of Life & Health Sciences, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK.
| | - Nathalie C Fouquet
- Aston Brain Centre, School of Life & Health Sciences, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK
| | - Stefano Seri
- Aston Brain Centre, School of Life & Health Sciences, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK
| | - Malcolm B Hawken
- Research Institute for Sport & Exercise Sciences. Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK
| | - Andrew Heard
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK
| | - David Neasham
- Creativ-Ceutical Ltd, The Bank Chambers, 10 Borough High Street, London SE1 9QQ, UK
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St Mary's Campus, London W2 1PG, UK.
| |
Collapse
|
32
|
Bartolomei F, Bonini F, Vidal E, Trébuchon A, Lagarde S, Lambert I, McGonigal A, Scavarda D, Carron R, Benar CG. How does vagal nerve stimulation (VNS) change EEG brain functional connectivity? Epilepsy Res 2016; 126:141-6. [PMID: 27497814 DOI: 10.1016/j.eplepsyres.2016.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
An effect of vagal nerve stimulation (VNS) on cortical synchronization has been postulated but remains to be verified. In this study we investigated the impact of VNS on functional connectivity (Fc) using direct intracerebral recordings (stereotactic EEG, SEEG). Five patients with epilepsy who underwent SEEG recordings during ongoing VNS therapy were investigated. Interdependencies between twenty-six selected bipolar SEEG channels were estimated by nonlinear regression analysis during ON and OF periods of stimulation. In comparison with OFF periods, the ON periods disclosed higher values for four patients (P1, P3, P4, P5) and lower values for one patient (P2). From thresholded graphs, we observed increased connections between several brain regions in P1 and P5 and decreased connections in P2. Finally, the only decreased Fc occurring during VNS corresponded to the responder patient, suggesting that therapeutic impact might be related to this mechanism.
Collapse
Affiliation(s)
- Fabrice Bartolomei
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, France.
| | - Francesca Bonini
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, France
| | - Elsa Vidal
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France
| | - Agnes Trébuchon
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, France
| | - Stanislas Lagarde
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, France
| | - Isabelle Lambert
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France
| | - Aileen McGonigal
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France; AP-HM, Hôpital de la Timone, Service de Neurophysiologie Clinique, Marseille, F-13005, France
| | - Didier Scavarda
- AP-HM, Hôpital de la Timone, Service de Neurochirurgie Pédiatrique, Marseille, F-13005, France
| | - Romain Carron
- AP-HM, Hôpital de la Timone, Service de Neurochirurgie Fonctionnelle, Marseille, F-13005, France
| | - Christian G Benar
- Aix Marseille Université, Institut de Neurosciences des Systèmes, Marseille, F-13005, France
| |
Collapse
|
33
|
Desbeaumes Jodoin V, Lespérance P, Nguyen DK, Fournier-Gosselin MP, Richer F. Effects of vagus nerve stimulation on pupillary function. Int J Psychophysiol 2015; 98:455-9. [DOI: 10.1016/j.ijpsycho.2015.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 01/28/2023]
|
34
|
Bodin C, Aubert S, Daquin G, Carron R, Scavarda D, McGonigal A, Bartolomei F. Responders to vagus nerve stimulation (VNS) in refractory epilepsy have reduced interictal cortical synchronicity on scalp EEG. Epilepsy Res 2015; 113:98-103. [DOI: 10.1016/j.eplepsyres.2015.03.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/18/2015] [Accepted: 03/28/2015] [Indexed: 11/27/2022]
|
35
|
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with medically refractory epilepsy. VNS consists of chronic intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator. The majority of people given a diagnosis of epilepsy have a good prognosis, and their seizures will be controlled by treatment with a single antiepileptic drug (AED), but up to 20%-30% of patients will develop drug-resistant epilepsy, often requiring treatment with combinations of AEDs. The aim of this systematic review was to overview the current evidence for the efficacy and tolerability of vagus nerve stimulation when used as an adjunctive treatment for people with drug-resistant partial epilepsy. This is an updated version of a Cochrane review published in Issue 7, 2010. OBJECTIVES To determine:(1) The effects on seizures of VNS compared to controls e.g. high-level stimulation compared to low-level stimulation (presumed sub-therapeutic dose); and(2) The adverse effect profile of VNS compared to controls e.g. high-level stimulation compared to low-level stimulation. SEARCH METHODS We searched the Cochrane Epilepsy Group's Specialised Register (23 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 23 February 2015), MEDLINE (1946 to 23 February 2015), SCOPUS (1823 to 23 February 2015), ClinicalTrials.gov (23 February 2015) and ICTRP (23 February 2015). No language restrictions were imposed. SELECTION CRITERIA The following study designs were eligible for inclusion: randomised, double-blind, parallel or crossover studies, controlled trials of VNS as add-on treatment comparing high and low stimulation paradigms (including three different stimulation paradigms - duty cycle: rapid, mid and slow) and VNS stimulation versus no stimulation or a different intervention. Eligible participants were adults or children with drug-resistant partial seizures not eligible for surgery or who failed surgery. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and extracted data. The following outcomes were assessed: (a) 50% or greater reduction in total seizure frequency; (b) treatment withdrawal (any reason); (c) adverse effects; (d) quality of life; (e) cognition; (f) mood. Primary analyses were intention-to-treat. Sensitivity best and worst case analyses were also undertaken to account for missing outcome data. Pooled Risk Ratios (RR) with 95% confidence intervals (95% Cl) were estimated for the primary outcomes of seizure frequency and treatment withdrawal. For adverse effects, pooled RRs and 99% CI's were calculated. MAIN RESULTS Five trials recruited a total of 439 participants and between them compared different types of VNS stimulation therapy. Baseline phase ranged from 4 to 12 weeks and double-blind treatment phases from 12 to 20 weeks in the five trials. Overall, two studies were rated as having a low risk of bias and three had an unclear risk of bias due to lack of reported information around study design. Effective blinding of studies of VNS is difficult due to the frequency of stimulation-related side effects such as voice alteration; this may limit the validity of the observed treatment effects. Four trials compared high frequency stimulation to low frequency stimulation and were included in quantitative syntheses (meta-analyses).The overall risk ratio (95% CI) for 50% or greater reduction in seizure frequency across all studies was 1.73 (1.13 to 2.64) showing that high frequency VNS was over one and a half times more effective than low frequency VNS. For this outcome, we rated the evidence as being moderate in quality due to incomplete outcome data in one included study; however results did not vary substantially and remained statistically significant for both the best and worst case scenarios. The risk ratio (RR) for treatment withdrawal was 2.56 (0.51 to 12.71), however evidence for this outcome was rated as low quality due to imprecision of the result and incomplete outcome data in one included study. The RR of adverse effects were as follows: (a) voice alteration and hoarseness 2.17 (99% CI 1.49 to 3.17); (b) cough 1.09 (99% CI 0.74 to 1.62); (c) dyspnea 2.45 (99% CI 1.07 to 5.60); (d) pain 1.01 (99% CI 0.60 to 1.68); (e) paresthesia 0.78 (99% CI 0.39 to 1.53); (f) nausea 0.89 (99% CI 0.42 to 1.90); (g) headache 0.90 (99% CI 0.48 to 1.69); evidence of adverse effects was rated as moderate to low quality due to imprecision of the result and/or incomplete outcome data in one included study. No important heterogeneity between studies was found for any of the outcomes. AUTHORS' CONCLUSIONS VNS for partial seizures appears to be an effective and well tolerated treatment in 439 included participants from five trials. Results of the overall efficacy analysis show that VNS stimulation using the high stimulation paradigm was significantly better than low stimulation in reducing frequency of seizures. Results for the outcome "withdrawal of allocated treatment" suggest that VNS is well tolerated as withdrawals were rare. No significant difference was found in withdrawal rates between the high and low stimulation groups, however limited information was available from the evidence included in this review so important differences between high and low stimulation cannot be excluded . Adverse effects associated with implantation and stimulation were primarily hoarseness, cough, dyspnea, pain, paresthesia, nausea and headache, with hoarseness and dyspnea more likely to occur on high stimulation than low stimulation. However, the evidence on these outcomes is limited and of moderate to low quality. Further high quality research is needed to fully evaluate the efficacy and tolerability of VNS for drug resistant partial seizures.
Collapse
Affiliation(s)
- Mariangela Panebianco
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | - Alexandra Rigby
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | - Jennifer Weston
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | - Anthony G Marson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneLiverpoolUKL9 7LJ
| | | |
Collapse
|
36
|
Affiliation(s)
- Margaret Gross
- School of Medicine Case Western Reserve University Cleveland, Ohio
| | - Monisha Goyal
- Division of Pediatric Neurology Rainbow Babies and Children's Hospital University Hospitals Case Medical Center Case Western Reserve University Cleveland, Ohio
| |
Collapse
|
37
|
Fan PC, Peng SSF, Yen RF, Shieh JY, Kuo MF. Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy. J Formos Med Assoc 2014; 113:258-63. [DOI: 10.1016/j.jfma.2013.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 01/30/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
|
38
|
Jaseja H, Gupta A, Jain R, Gupta P. Intractable epilepsy: deep brain stimulation (DBS)-based electrophysiological biomarker. Epilepsy Behav 2014; 31:13-4. [PMID: 24291523 DOI: 10.1016/j.yebeh.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 02/05/2023]
Affiliation(s)
| | - Alok Gupta
- Artemis Health Institute, Gurgaon, India
| | - Rahul Jain
- Artemis Health Institute, Gurgaon, India
| | | |
Collapse
|
39
|
Effect of vagus nerve stimulation on electrical kindling in different stages of seizure severity in freely moving cats. Epilepsy Res 2014; 108:81-9. [DOI: 10.1016/j.eplepsyres.2013.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/19/2013] [Accepted: 10/18/2013] [Indexed: 11/21/2022]
|
40
|
Ibrahim GM, Anderson R, Akiyama T, Ochi A, Otsubo H, Singh-Cadieux G, Donner E, Rutka JT, Snead OC, Doesburg SM. Neocortical pathological high-frequency oscillations are associated with frequency-dependent alterations in functional network topology. J Neurophysiol 2013; 110:2475-83. [DOI: 10.1152/jn.00034.2013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Synchronization of neural oscillations is thought to integrate distributed neural populations into functional cell assemblies. Epilepsy is widely regarded as a disorder of neural synchrony. Knowledge is scant, however, regarding whether ictal changes in synchrony involving epileptogenic cortex are expressed similarly across various frequency ranges. Cortical regions involved in epileptic networks also exhibit pathological high-frequency oscillations (pHFOs, >80 Hz), which are increasingly utilized as biomarkers of epileptogenic tissue. It is uncertain how pHFO amplitudes are related to epileptic network connectivity. By calculating phase-locking values among intracranial electrodes implanted in children with intractable epilepsy, we constructed ictal connectivity networks and performed graph theoretical analysis to characterize their network properties at distinct frequency bands. Ictal data from 17 children were analyzed with a hierarchical mixed-effects model adjusting for patient-level covariates. Epileptogenic cortex was defined in two ways: 1) a hypothesis-driven method using the visually defined seizure-onset zone and 2) a data-agnostic method using the high-frequency amplitude of each electrode. Epileptogenic cortex exhibited a logarithmic decrease in interregional functional connectivity at high frequencies (>30 Hz) during seizure initiation and propagation but not at termination. At slower frequencies, conversely, epileptogenic cortex expressed a relative increase in functional connectivity. Our findings suggest that pHFOs reflect epileptogenic network interactions, yielding theoretical support for their utility in the presurgical evaluation of intractable epilepsy. The view that abnormal network synchronization plays a critical role in ictogenesis and seizure dynamics is supported by the observation that functional isolation of epileptogenic cortex at high frequencies is absent at seizure termination.
Collapse
Affiliation(s)
- George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Anderson
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomoyuki Akiyama
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Gabrielle Singh-Cadieux
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - James T. Rutka
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - O. Carter Snead
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Sam M. Doesburg
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Predicting success of vagus nerve stimulation (VNS) from interictal EEG. Seizure 2011; 20:541-5. [DOI: 10.1016/j.seizure.2011.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/03/2011] [Accepted: 04/01/2011] [Indexed: 11/18/2022] Open
|
42
|
Reyt S, Picq C, Sinniger V, Clarençon D, Bonaz B, David O. Dynamic Causal Modelling and physiological confounds: A functional MRI study of vagus nerve stimulation. Neuroimage 2010; 52:1456-64. [DOI: 10.1016/j.neuroimage.2010.05.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/23/2010] [Accepted: 05/07/2010] [Indexed: 12/27/2022] Open
|
43
|
Jaseja H. EEG-desynchronization as the major mechanism of anti-epileptic action of vagal nerve stimulation in patients with intractable seizures: clinical neurophysiological evidence. Med Hypotheses 2010; 74:855-6. [PMID: 20005054 DOI: 10.1016/j.mehy.2009.11.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 11/22/2009] [Indexed: 02/08/2023]
Abstract
Vagal nerve stimulation (VNS) has emerged as an effective and acceptable alternative therapy for patients with intractable seizures. Despite its reported efficacy in several studies, the precise mechanism of its anti-epileptic action remains elusive and requires to be established. Based on neurophysiological alterations induced by VNS, it has been proposed earlier that a major mechanism of its anti-epileptic action could be EEG-desynchronization, which is known to be associated with increased resistance to seizures. This brief paper attempts to support the proposed mechanism with clinical neurophysiological evidence that has emerged in recent times.
Collapse
Affiliation(s)
- Harinder Jaseja
- Physiology Department, G.R. Medical College, Gwalior, MP, India.
| |
Collapse
|
44
|
Magdaleno-Madrigal VM, Martínez-Vargas D, Valdés-Cruz A, Almazán-Alvarado S, Fernández-Mas R. Preemptive effect of nucleus of the solitary tract stimulation on amygdaloid kindling in freely moving cats. Epilepsia 2010; 51:438-44. [DOI: 10.1111/j.1528-1167.2009.02337.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Wang H, Chen X, Lin Z, Shao Z, Sun B, Shen H, Liu L. Long-term effect of vagus nerve stimulation on interictal epileptiform discharges in refractory epilepsy. J Neurol Sci 2009; 284:96-102. [PMID: 19427651 DOI: 10.1016/j.jns.2009.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/19/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) therapy has been widely recognized as an effective alternative for the treatment of refractory epilepsy. However, the precise mechanism of VNS is poorly understood. The purpose of this study was to observe the long-term interictal EEG changes induced by VNS, and to investigate the probable mechanism of action of VNS in achieving seizure control. METHODS Eight patients with VNS were selected from two epilepsy centers in China (Harbin and Shanghai) between 2001 and 2004. We studied the clinical efficacy by long-term follow-up, ranging from 37 to 81 months (mean 55.8 months). Moreover, serial EEGs were performed at the different time (preoperative baseline, 3, 6, 12, and 24 months after VNS initiation) and the different states of VNS stimulator ("activation", "deactivation" and "reactivation"). RESULTS A > or = 50% seizure reduction was achieved in 12.5%, 62.5%, 75%, 62.5% and 75% of the total patients (n=8) at 6, 12, 18, 24 and 36 months of post-VNS, respectively. The results revealed a statistically significant progressive decrease in the number of IEDs (interictal epileptiform discharges) on EEG with time (P<0.01). Significant correlation had been highlighted after 6 months of VNS stimulation, between the reduction of seizure frequency and the decreasing of IEDs (P<0.01). Furthermore, statistically significant difference of IEDs was seen when comparing the state of "deactivation" with the states of "activation" and "reactivation", respectively (P<0.01). However, there was no significant difference in IEDs between "activation" and "reactivation" (P>0.05). CONCLUSIONS VNS is an efficient, well-tolerated therapy for refractory epilepsy. It can induce progressive electrophysiological effect on epileptiform activity over time. This may reflect the mechanism of chronic action of VNS with desynchronization of EEG in achieving seizure control.
Collapse
Affiliation(s)
- Haiyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | | | | | | | | | | | | |
Collapse
|
46
|
Jaseja H. Vagal nerve stimulation: exploring its efficacy and success for an improved prognosis and quality of life in cerebral palsy patients. Clin Neurol Neurosurg 2008; 110:755-62. [PMID: 18572305 DOI: 10.1016/j.clineuro.2008.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 04/29/2008] [Accepted: 05/09/2008] [Indexed: 02/08/2023]
Abstract
Cerebral palsy (CP) continues to pose a cause for major socioeconomic concern and medical challenge worldwide. It is associated with a multi-faceted symptomatology warranting a multi-dimensional management-approach. Recent recognition of neurocognitive impairment and its hopefully possible treatment has opened up a new dimension in its management to the neurologists. Vagal nerve stimulation (VNS) technique is presently emerging as an effective alternative anti-epileptic therapeutic measure in intractable epilepsy. VNS has recently been shown to possess a suppressive effect also on interictal epileptiform discharges (IEDs) that are now being widely accepted as established associates of neurocognitive impairment. In this paper, the author proposes VNS technique implantation in CP patients on account of its dual therapeutic effectiveness, i.e. anti-epileptic and IED-suppression. These two effects are likely to control seizures that are quite often drug-resistant and also improve neurocognition in CP patients, thus hoping for a better overall prognostic outcome and an improved quality of life of the CP patients by VNS.
Collapse
Affiliation(s)
- Harinder Jaseja
- Physiology Department, G.R. Medical College, Gwalior 474001, MP, India.
| |
Collapse
|
47
|
Zhang JL, Zhang SP, Zhang HQ. Antiepileptic effects of electroacupuncture vs vagus nerve stimulation on cortical epileptiform activities. J Neurol Sci 2008; 270:114-21. [DOI: 10.1016/j.jns.2008.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 02/20/2008] [Accepted: 02/20/2008] [Indexed: 11/30/2022]
|
48
|
Scientific basis behind traditional practice of application of "shoe-smell" in controlling epileptic seizures in the eastern countries. Clin Neurol Neurosurg 2008; 110:535-8. [PMID: 18353533 DOI: 10.1016/j.clineuro.2008.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 12/28/2007] [Accepted: 02/06/2008] [Indexed: 02/05/2023]
Abstract
Epilepsy has been known for thousands of years and has been subjected to various forms of conventional and non-conventional therapies including a non-pharmacological conservative treatment known as aromatherapy, ever since. One commonly practiced form of aromatherapy that persists as an immediate first-aid measure even today in some parts of developing countries in the East is the application of "shoe-smell" during an epileptic attack. The questionable remedial role has intrigued neuro-scientists at least in these parts of the world. This brief paper attempts to provide an insight to the basis of persistence of this practice and to explore a possible scientific logic behind its unscientifically reported remedial effectiveness. The neurophysiology of olfactory stimulation from "shoe-smell" reveals a sound and scientific reasoning for its remedial efficacy in epilepsy; olfactory stimuli in this study have been found to possess significantly effective anti-epileptic influence which could have formed the basis for the use of application of "shoe-smell" in earlier times and also for its persistence even today in those parts of developing regions.
Collapse
|
49
|
Abstract
Although often overshadowed by factors influencing seizure initiation, seizure termination is a critical step in the return to the interictal state. Understanding the mechanisms contributing to seizure termination could potentially identify novel targets for anticonvulsant drug development and may also highlight the pathophysiological processes contributing to seizure initiation. In this article, we review known physiological mechanisms contributing to seizure termination and discuss additional mechanisms that are likely to be relevant even though specific data are not yet available. This review is organized according to successively increasing "size scales"-from membranes to synapses to networks to circuits. We first discuss mechanisms of seizure termination acting at the shortest distances and affecting the excitable membranes of neurons in the seizure onset zone. Next we consider the contributions of ensembles of neurons and glia interacting at intermediate distances within the region of the seizure onset zone. Lastly, we consider the contribution of brain nuclei, such as the substantia nigra pars reticulata (SNR), that are capable of modulating seizures and exert their influence over the seizure onset zone (and neighboring areas) from a relatively great-in neuroanatomical terms-distance. It is our hope that the attention to the mechanisms contributing to seizure termination will stimulate novel avenues of epilepsy research and will contribute to improved patient care.
Collapse
Affiliation(s)
- Fred A Lado
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, NY 10461, USA.
| | | |
Collapse
|
50
|
Li YL, Chen ZY, Ma J, Chen YH. Simulation study of stimulation parameters in desynchronisation based on the Hodgkin-Huxley small-world neural networks and its possible implications for vagus nerve stimulation. Acta Neuropsychiatr 2008; 20:25-32. [PMID: 25385387 DOI: 10.1111/j.1601-5215.2007.00254.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adopting small-world neural networks of the Hodgkin-Huxley (HH) model, the stimulation parameters in desynchronisation and its possible implications for vagus nerve stimulation (VNS) are numerically investigated. With the synchronisation status of networks to represent epilepsy, then, adding pulse to stimulations to 10% of neurons to simulate the VNS, we obtain the desynchronisation status of networks (representing antiepileptic effects). The simulations show that synchronisation evolves into desynchronisation in the HH neural networks when a part (10%) of neurons are stimulated with a pulse current signal. The network desynchronisation appears to be sensitive to the stimulation parameters. For the case of the same stimulation intensity, weakly coupled networks reach desynchronisation more easily than strongly coupled networks. The network desynchronisation reduced by short-stimulation interval is more distinct than that of induced by long stimulation interval. We find that there exist the optimal stimulation interval and optimal stimulation intensity when the other stimulation parameters remain certain.
Collapse
Affiliation(s)
- Yan-Long Li
- 1Institute of Theoretical Physics, Lanzhou University of Technology, Lanzhou, China
| | - Zhao-Yang Chen
- 2Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Jun Ma
- 1Institute of Theoretical Physics, Lanzhou University of Technology, Lanzhou, China
| | - Yu-Hong Chen
- 1Institute of Theoretical Physics, Lanzhou University of Technology, Lanzhou, China
| |
Collapse
|