1
|
Gerges ANH, Graetz L, Hillier S, Uy J, Hamilton T, Opie G, Vallence AM, Braithwaite FA, Chamberlain S, Hordacre B. Transcutaneous auricular vagus nerve stimulation modifies cortical excitability in middle-aged and older adults. Psychophysiology 2024:e14584. [PMID: 38602055 DOI: 10.1111/psyp.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
There is a growing interest in the clinical application of transcutaneous auricular vagus nerve stimulation (taVNS). However, its effect on cortical excitability, and whether this is modulated by stimulation duration, remains unclear. We evaluated whether taVNS can modify excitability in the primary motor cortex (M1) in middle-aged and older adults and whether the stimulation duration moderates this effect. In addition, we evaluated the blinding efficacy of a commonly reported sham method. In a double-blinded randomized cross-over sham-controlled study, 23 healthy adults (mean age 59.91 ± 6.87 years) received three conditions: active taVNS for 30 and 60 min and sham for 30 min. Single and paired-pulse transcranial magnetic stimulation was delivered over the right M1 to evaluate motor-evoked potentials. Adverse events, heart rate and blood pressure measures were evaluated. Participant blinding effectiveness was assessed via guesses about group allocation. There was an increase in short-interval intracortical inhibition (F = 7.006, p = .002) and a decrease in short-interval intracortical facilitation (F = 4.602, p = .014) after 60 min of taVNS, but not 30 min, compared to sham. taVNS was tolerable and safe. Heart rate and blood pressure were not modified by taVNS (p > .05). Overall, 96% of participants detected active stimulation and 22% detected sham stimulation. taVNS modifies cortical excitability in M1 and its effect depends on stimulation duration in middle-aged and older adults. taVNS increased GABAAergic inhibition and decreased glutamatergic activity. Sham taVNS protocol is credible but there is an imbalance in beliefs about group allocation.
Collapse
Affiliation(s)
- Ashraf N H Gerges
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Lynton Graetz
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Susan Hillier
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jeric Uy
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Taya Hamilton
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perth, Western Australia, Australia
| | - George Opie
- Discipline of Physiology, School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ann-Maree Vallence
- School of Psychology, College of Health and Education, Murdoch University, Perth, Western Australia, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Western Australia, Australia
| | - Felicity A Braithwaite
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Saran Chamberlain
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Chen L, He J, Zhang J, Wang Z, Zhang L, Gu B, Liu X, Ming D. Influence of Transcutaneous Vagus Nerve Stimulation on Motor Planning: A Resting-State and Task-State EEG Study. IEEE J Biomed Health Inform 2024; 28:1374-1385. [PMID: 37824310 DOI: 10.1109/jbhi.2023.3324085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Transcutaneous vagus nerve stimulation (tVNS) shows a potential regulatory role for motor planning. Still, existing research mainly focuses on behavioral studies, and the neural modulation mechanism needs to be clarified. Therefore, we designed a multi-condition (active or sham, pre or under, difficult or easy, left-hand or right-hand) motor planning experiment to explore the effect of online tVNS (i.e., tVNS and tasks synchronized). Twenty-eight subjects were recruited and randomly assigned to active and sham groups. Both groups performed the same tasks in the experiment and separately collected task-state EEG and 5-min eye-open resting-state EEG. The results showed that the changes in event-related potential (ERP) and movement-related cortical potential (MRCP) amplitudes were more significant for the left-hand difficult task (LD) under active-tVNS. According to the power spectrum results, active-tVNS significantly modulated the activities of the contralateral motor cortex at beta and gamma bands in the resting state. The functional connectivity based on partial directed coherence (PDC) showed significant changes in the parietal lobe after active-tVNS. These findings suggest that tVNS is a promising way to improve motor planning ability.
Collapse
|
3
|
Roth J, Bergman L, Weil AG, Brunette-Clement T, Weiner HL, Treiber JM, Shofty B, Cukiert A, Cukiert CM, Tripathi M, Sarat Chandra P, Bollo RJ, Machado HR, Santos MV, Gaillard WD, Oluigbo CO, Ibrahim GM, Jallo GI, Shimony N, O'Neill BR, Budke M, Pérez-Jiménez MÁ, Mangano FT, Iwasaki M, Iijima K, Gonzalez-Martinez J, Kawai K, Ishishita Y, Elbabaa SK, Bello-Espinosa L, Fallah A, Maniquis CAB, Ben-Zvi I, Tisdall M, Panigrahi M, Jayalakshmi S, Blount JP, Dorfmüller G, Bulteau C, Stone SS, Bolton J, Singhal A, Connolly M, Alsowat D, Alotaibi F, Ragheb J, Uliel-Sibony S. Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox-Gastaut syndrome: A multicenter, multinational study. Epilepsia 2023; 64:3205-3212. [PMID: 37823366 DOI: 10.1111/epi.17796] [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] [Received: 08/04/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Lennox-Gastaut syndrome (LGS) is a severe form of epileptic encephalopathy, presenting during the first years of life, and is very resistant to treatment. Once medical therapy has failed, palliative surgeries such as vagus nerve stimulation (VNS) or corpus callosotomy (CC) are considered. Although CC is more effective than VNS as the primary neurosurgical treatment for LGS-associated drop attacks, there are limited data regarding the added value of CC following VNS. This study aimed to assess the effectiveness of CC preceded by VNS. METHODS This multinational, multicenter retrospective study focuses on LGS children who underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a 50% reduction in drop attacks. RESULTS A total of 127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months (interquartile range [IQR] = 3.12-22.75). The median age at VNS surgery was 7 years (IQR = 4-10), and CC was performed at a median age of 11 years (IQR = 8.76-15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. Eighty-six patients underwent a single-stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures in 83% and 60%, respectively. Permanent morbidity occurred in 1.5%, with no mortality. SIGNIFICANCE CC is vital in seizure control in children with LGS in whom VNS has failed. Surgical risks are low. A complete CC has a tendency toward better effectiveness than anterior CC for some seizure types.
Collapse
Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Lottem Bergman
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Alexander G Weil
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Tristan Brunette-Clement
- Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre and University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey M Treiber
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Arthur Cukiert
- Department of Neurosurgery, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Cristine Mella Cukiert
- Department of Neurology and Neurophysiology, Epilepsy Surgery Program, Clinica Cukiert, Sao Paulo, Brazil
| | - Manjari Tripathi
- Center of Excellence for Epilepsy and MEG, AIIMS, New Delhi, India
| | | | - Robert J Bollo
- Division of Pediatric Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Hélio Rubens Machado
- Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - Marcelo Volpon Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, Brazil
| | - William D Gaillard
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - George M Ibrahim
- Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George I Jallo
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent R O'Neill
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Marcelo Budke
- Department of Neurosurgery, Niño Jesus University Children's Hospital, Madrid, Spain
| | | | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jorge Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Yohei Ishishita
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
| | - Samer K Elbabaa
- Pediatric Neurosurgery, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Luis Bello-Espinosa
- Pediatric Neurology and Epilepsy, Leon Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Cassia A B Maniquis
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ido Ben-Zvi
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, Paris, France
| | | | - Scellig S Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashutosh Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Connolly
- Comprehensive Epilepsy Program, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Daad Alsowat
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faisal Alotaibi
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - John Ragheb
- Department of Surgery, Nicklaus Children's Hospital, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Wang MX, Wumiti A, Zhang YW, Gao XS, Huang Z, Zhang MF, Peng ZY, Oku Y, Tang ZM. Transcutaneous cervical vagus nerve stimulation improved motor cortex excitability in healthy adults: a randomized, single-blind, self-crossover design study. Front Neurosci 2023; 17:1234033. [PMID: 37854293 PMCID: PMC10579560 DOI: 10.3389/fnins.2023.1234033] [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: 06/20/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose To investigate the effect of transcutaneous cervical vagus nerve stimulation (tcVNS) on motor cortex excitability in healthy adults. Method Twenty eight healthy subjects were assigned to receive real and sham tcVNS for 30 min. The interval between the real and sham conditions was more than 24 h, and the sequence was random. The central and peripheral motor-evoked potential (MEP) of the right first dorsal interosseous (FDI) muscle was measured by transcranial magnetic stimulation (TMS) before and after stimulation. MEP latency, MEP amplitude and rest motor threshold (rMT) were analyzed before and after stimulation. Results MEP amplitude, MEP latency and rMT had significant interaction effect between time points and conditions (p < 0.05). After real stimulation, the MEP amplitude was significantly increased (p < 0.001). MEP latency (p < 0.001) and rMT (p = 0.006) was decreased than that of baseline. The MEP amplitude on real condition was higher than that of sham stimulation after stimulation (p = 0.027). The latency after the real stimulation was significantly shorter than that after sham stimulation (p = 0.005). No significantly difference was found in rMT after stimulation between real and sham conditions (p > 0.05). Conclusion tcVNS could improve motor cortex excitability in healthy adults.
Collapse
Affiliation(s)
- Meng-Xin Wang
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Aihaiti Wumiti
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao-Wen Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-Sheng Gao
- Rehabilitation Medicine Department, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Zi Huang
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
| | - Meng-Fei Zhang
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
| | - Zhi-Yong Peng
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
| | - Yoshitaka Oku
- Department of Physiology, Hyogo Medical University, Hyogo, Japan
| | - Zhi-Ming Tang
- Department of Rehabilitation Medicine, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Xue T, Chen S, Bai Y, Han C, Yang A, Zhang J. Neuromodulation in drug-resistant epilepsy: A review of current knowledge. Acta Neurol Scand 2022; 146:786-797. [PMID: 36063433 DOI: 10.1111/ane.13696] [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: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
Nearly 1% of the global population suffers from epilepsy. Drug-resistant epilepsy (DRE) affects one-third of epileptic patients who are unable to treat their condition with existing drugs. For the treatment of DRE, neuromodulation offers a lot of potential. The background, mechanism, indication, application, efficacy, and safety of each technique are briefly described in this narrative review, with an emphasis on three approved neuromodulation therapies: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS), and closed-loop responsive neurostimulation (RNS). Neuromodulatory approaches involving direct or induced electrical currents have been developed to lessen seizure frequency and duration in patients with DRE since the notion of electrical stimulation as a therapy for neurologic diseases originated in the early nineteenth century. Although few people have attained total seizure independence for more than 12 months using these treatments, more than half have benefitted from a 50% drop in seizure frequency over time. Although promising outcomes in adults and children with DRE have been achieved, challenges such as heterogeneity among epilepsy types and etiologies, optimization of stimulation parameters, a lack of biomarkers to predict response to neuromodulation therapies, high-level evidence to aid decision-making, and direct comparisons between neuromodulatory approaches remain. To solve these existing gaps, authorize new kinds of neuromodulation, and develop personalized closed-loop treatments, further research is needed. Finally, both invasive and non-invasive neuromodulation seems to be safe. Implantation-related adverse events for invasive stimulation primarily include infection and pain at the implant site. Intracranial hemorrhage is a frequent adverse event for DBS and RNS. Other stimulation-specific side-effects are mild with non-invasive stimulation.
Collapse
Affiliation(s)
- Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shujun Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunlei Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Lim MJR, Fong KY, Zheng Y, Chua CYK, Miny S, Lin JB, Nga VDW, Ong HT, Rathakrishnan R, Yeo TT. Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2361-2373. [PMID: 35217961 DOI: 10.1007/s10143-022-01757-9] [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: 12/04/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/28/2022]
Abstract
To analyze the efficacy and safety of high-frequency VNS versus control (low-frequency VNS or no VNS) in patients with DRE using data from randomized controlled trials (RCTs). An electronic literature search was conducted on PubMed, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL); 12 RCTs reporting seizure frequency or treatment response in studies containing a high-frequency VNS treatment arm (conventional VNS or transcutaneous VNS [tVNS]) compared to control (low-frequency VNS or no VNS) were included. Seizure frequency, treatment response (number of patients with ≥ 50% reduction in seizure frequency), quality of life (QOL), and adverse effects were analyzed. Seizure frequency was reported in 9 studies (718 patients). Meta-analysis with random-effects models favored high-frequency VNS over control (standardized mean difference = 0.82, 95%-CI = 0.39-1.24, p < .001). This remained significant for subgroup analyses of low-frequency VNS as the control, VNS modality, and after removing studies with moderate-to-high risk of bias. Treatment response was reported in 8 studies (758 patients). Random-effects models favored high-frequency VNS over control (risk ratio = 1.57, 95%-CI = 1.19-2.07, p < .001). QOL outcomes were reported descriptively in 4 studies (363 patients), and adverse events were reported in 11 studies (875 patients). Major side effects and death were not observed to be more common in high-frequency VNS compared to control. High-frequency VNS results in reduced seizure frequency and improved treatment response compared to control (low-frequency VNS or no VNS) in patients with drug-resistant epilepsy. Greater consideration for VNS in patients with DRE may be warranted to decrease seizure frequency in the management of these patients.
Collapse
Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yilong Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christopher Yuan Kit Chua
- Division of Neurology, University Medical Centre, National University Hospital, Singapore, Singapore
| | - Samuel Miny
- Systematic Review Unit, National University Hospital, Singapore, Singapore
| | - Jeremy Bingyuan Lin
- Division of Pediatric Neurology, Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Hian Tat Ong
- Division of Pediatric Neurology, Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Rahul Rathakrishnan
- Division of Neurology, University Medical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| |
Collapse
|
7
|
Motolese F, Capone F, Di Lazzaro V. New tools for shaping plasticity to enhance recovery after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:299-315. [PMID: 35034743 DOI: 10.1016/b978-0-12-819410-2.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stroke is the second most common cause of death worldwide and its prevalence is projected to increase in the coming years in parallel with the increase of life expectancy. Despite the great improvements in the management of the acute phase of stroke, some residual disability persists in most patients thus requiring rehabilitation. One third of patients do not reach the maximal recovery potential and different approaches have been explored with the aim to boost up recovery. In this regard, noninvasive brain stimulation techniques have been widely used to induce neuroplasticity phenomena. Different protocols of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES) can induce short- and long-term changes of synaptic excitability and are promising tools for enhancing recovery in stroke patients. New options for neuromodulation are currently under investigation. They include: vagal nerve stimulation (VNS) that can be delivered invasively, with implanted stimulators and noninvasively with transcutaneous VNS (tVNS); and extremely low-frequency (1-300Hz) magnetic fields. This chapter will provide an overview on the new techniques that are used for neuroprotection and for enhancing recovery after stroke.
Collapse
Affiliation(s)
- Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| |
Collapse
|
8
|
Chen L, Zhang J, Wang Z, Zhang X, Zhang L, Xu M, Liu S, Ming D. Effects of Transcutaneous Vagus Nerve Stimulation (tVNS) on Action Planning: A Behavioural and EEG study. IEEE Trans Neural Syst Rehabil Eng 2021; 30:1675-1683. [PMID: 34847035 DOI: 10.1109/tnsre.2021.3131497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Action planning is an important decision-making process, which can be specially affected by environment. Response selection during action planning has been demonstrated to be modulated by tVNS. Therefore, tVNS shows a great potential for modulating the action planning process. We aimed to explore the tVNS-induced effect on action planning in behavioural and electrophysiology. Twenty-eight participants were randomly divided into two groups (active group and sham group). A single-blind, sham-controlled between-subject design was applied to explore the effect of online-tVNS (i.e., tVNS overlapping with the task) on action planning paradigm. We measured and compared reaction time (RT) and movement-related cortical potentials (MRCPs) before and after tVNS between active and sham groups. As compared to sham group, for the ipsilateral hand/contralateral hemisphere relative to the stimulated side, active tVNS significantly reduced the reaction time and decreased the MRCP amplitude mainly in the challenging tasks. Our results indicate that tVNS can produce a lateralization effect on action planning, especially plays an important role in the more challenging tasks as reflected both in the behavioural and electrophysiological results.
Collapse
|
9
|
Rembado I, Song W, Su DK, Levari A, Shupe LE, Perlmutter S, Fetz E, Zanos S. Cortical Responses to Vagus Nerve Stimulation Are Modulated by Brain State in Nonhuman Primates. Cereb Cortex 2021; 31:5289-5307. [PMID: 34151377 PMCID: PMC8567998 DOI: 10.1093/cercor/bhab158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) has been tested as therapy for several brain disorders and as a means to modulate cortical excitability and brain plasticity. Cortical effects of VNS, manifesting as vagal-evoked potentials (VEPs), are thought to arise from activation of ascending cholinergic and noradrenergic systems. However, it is unknown whether those effects are modulated by brain state at the time of stimulation. In 2 freely behaving macaque monkeys, we delivered short trains of 5 pulses to the left cervical vagus nerve at different frequencies (5-300 Hz) while recording local field potentials (LFPs) from sites in contralateral prefrontal, sensorimotor and parietal cortical areas. Brain states were inferred from spectral components of LFPs and the presence of overt movement: active awake, resting awake, REM sleep and NREM sleep. VNS elicited VEPs in all sampled cortical areas. VEPs comprised early (<70 ms), intermediate (70-250 ms) and late (>250 ms) components. The magnitude of the intermediate and late components was largest during NREM sleep and smallest during wakefulness, whereas that of the early component was not modulated by brain state. VEPs during NREM were larger for stimuli delivered at the depolarized phase of ongoing delta oscillations. Higher pulsing frequencies generated larger VEPs. These short VNS trains did not affect brain state transitions during wakefulness or sleep. Our findings suggest that ongoing brain state modulates the evoked effects of VNS on cortical activity. This has implications for the role of ongoing cortical activity and brain state in shaping cortical responses to peripheral stimuli, for the modulation of vagal interoceptive signaling by cortical activity, and for the dose calibration of VNS therapies.
Collapse
Affiliation(s)
- Irene Rembado
- MindScope Program, Allen Institute, 615 Westlake Ave N., Seattle, WA 98103, USA
| | - Weiguo Song
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
| | - David K Su
- Providence Regional Medical Center Cranial Joint and Spine Clinic, Everett, WA 98201, USA
| | - Ariel Levari
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Larry E Shupe
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Steve Perlmutter
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Eberhard Fetz
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
| |
Collapse
|
10
|
Keute M, Gharabaghi A. Brain plasticity and vagus nerve stimulation. Auton Neurosci 2021; 236:102876. [PMID: 34537681 DOI: 10.1016/j.autneu.2021.102876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 08/29/2021] [Indexed: 01/01/2023]
Abstract
After damage to the central nervous system, caused by traumatic injury or ischemia, plasticity becomes critically important for functional recovery. When this inherent capacity to adapt is limited despite training, external stimulation may support this process. Vagus nerve stimulation (VNS) is an effective method to enhance the effect of motor rehabilitation training on functional recovery. However, the mechanisms by which VNS exerts beneficial effects on cortical plasticity are not completely understood. Experimental work suggests that VNS fosters a neurochemical milieu that facilitates synaptic plasticity and supports reinforcement mechanisms. Animal studies, furthermore, suggest that VNS delivery is time-critical and that optima in the parameter space need to be titrated for effect maximization. Human studies suggest that VNS modifies corticospinal excitability. First studies in stroke patients show positive results for invasive, and also promising findings for non-invasive VNS.
Collapse
Affiliation(s)
- Marius Keute
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University of Tuebingen, Tuebingen, Germany.
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
11
|
Mertens A, Carrette S, Klooster D, Lescrauwaet E, Delbeke J, Wadman WJ, Carrette E, Raedt R, Boon P, Vonck K. Investigating the Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Cortical Excitability in Healthy Males. Neuromodulation 2021; 25:395-406. [PMID: 35396071 DOI: 10.1111/ner.13488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES As a potential treatment for epilepsy, transcutaneous auricular vagus nerve stimulation (taVNS) has yielded inconsistent results. Combining transcranial magnetic stimulation with electromyography (TMS-EMG) and electroencephalography (TMS-EEG) can be used to investigate the effect of interventions on cortical excitability by evaluating changes in motor evoked potentials (MEPs) and TMS-evoked potentials (TEPs). The goal of this study is to objectively evaluate the effect of taVNS on cortical excitability with TMS-EMG and TMS-EEG. These findings are expected to provide insight in the mechanism of action and help identify more optimal stimulation paradigms. MATERIALS AND METHODS In this prospective single-blind cross-over study, 15 healthy male subjects underwent active and sham taVNS for 60 min, using a maximum tolerated stimulation current. Single and paired pulse TMS was delivered over the right-sided motor hotspot to evaluate MEPs and TEPs before and after the intervention. MEP statistical analysis was conducted with a two-way repeated measures ANOVA. TEPs were analyzed with a cluster-based permutation analysis. Linear regression analysis was implemented to investigate an association with stimulation current. RESULTS MEP and TEP measurements were not affected by taVNS in this study. An association was found between taVNS stimulation current and MEP outcome measures indicating a decrease in cortical excitability in participants who tolerated higher taVNS currents. A subanalysis of participants (n = 8) who tolerated a taVNS current ≥2.5 mA showed a significant increase in the resting motor threshold, decrease in MEP amplitude and modulation of the P60 and P180 TEP components. CONCLUSIONS taVNS did not affect cortical excitability measurements in the overall population in this study. However, taVNS has the potential to modulate specific markers of cortical excitability in participants who tolerate higher stimulation levels. These findings indicate the need for adequate stimulation protocols based on the recording of objective outcome parameters.
Collapse
Affiliation(s)
- Ann Mertens
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Sofie Carrette
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Debby Klooster
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Emma Lescrauwaet
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Jean Delbeke
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Wytse Jan Wadman
- Swammerdam Institute of Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Carrette
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Robrecht Raedt
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kristl Vonck
- Department of Neurology, 4BRAIN Research Group, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
12
|
Non-Pharmacological and Non-Surgical Treatment of Refractory Childhood Epilepsy. Indian J Pediatr 2020; 87:1062-1069. [PMID: 32048226 DOI: 10.1007/s12098-019-03164-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023]
Abstract
Nearly 20-40% of patients with epilepsy are likely to have drug resistant epilepsy (DRE). Add-on antiseizure drugs do not produce optimal seizure control in these patients. Among the non-pharmacological options, only resective surgery is curative. However, a large majority of patients are not candidates for resective epilepsy surgery. For these children with DRE, non-pharmacological non-surgery "palliative" options should be considered early than late. These include dietary therapies and neuromodulation. While there are numerous clinical trials supporting the efficacy of dietary therapies (viz ketogenic diet, modified Atkins diet and low glycemic index therapy), the evidence for neuromodulation is still evolving. Neuromodulation techniques include vagal nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation. Each of the options, whether diet or neuromodulation, has its own advantages, disadvantages and adverse events profile. These have to be considered and discussed with the family before deciding the modality being chosen.
Collapse
|
13
|
Transcutaneous Vagus Nerve Stimulation Modulates EEG Microstates and Delta Activity in Healthy Subjects. Brain Sci 2020; 10:brainsci10100668. [PMID: 32992726 PMCID: PMC7599782 DOI: 10.3390/brainsci10100668] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Transcutaneous vagus nerve stimulation (tVNS) is an alternative non-invasive method for the electrical stimulation of the vagus nerve with the goal of treating several neuropsychiatric disorders. The objective of this study is to assess the effects of tVNS on cerebral cortex activity in healthy volunteers using resting-state microstates and power spectrum electroencephalography (EEG) analysis. Eight male subjects aged 25–45 years were recruited in this randomized sham-controlled double-blind study with cross-over design. Real tVNS was administered at the left external acoustic meatus, while sham stimulation was performed at the left ear lobe, both of them for 60 min. The EEG recording lasted 5 min and was performed before and 60 min following the tVNS experimental session. We observed that real tVNS induced an increase in the metrics of microstate A mean duration (p = 0.039) and an increase in EEG power spectrum activity in the delta frequency band (p < 0.01). This study confirms that tVNS is an effective way to stimulate the vagus nerve, and the mechanisms of action of this activation can be successfully studied using scalp EEG quantitative metrics. Future studies are warranted to explore the clinical implications of these findings and to focus the research of the prognostic biomarkers of tVNS therapy for neuropsychiatric diseases.
Collapse
|
14
|
|
15
|
Tsuboyama M, Lee Kaye H, Rotenberg A. Biomarkers Obtained by Transcranial Magnetic Stimulation of the Motor Cortex in Epilepsy. Front Integr Neurosci 2019; 13:57. [PMID: 31736722 PMCID: PMC6837164 DOI: 10.3389/fnint.2019.00057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is associated with numerous neurodevelopmental disorders. Transcranial magnetic stimulation (TMS) of the motor cortex coupled with electromyography (EMG) enables biomarkers that provide measures of cortical excitation and inhibition that are particularly relevant to epilepsy and related disorders. The motor threshold (MT), cortical silent period (CSP), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval intracortical inhibition (LICI) are among TMS-derived metrics that are modulated by antiepileptic drugs. TMS may have a practical role in optimization of antiepileptic medication regimens, as studies demonstrate dose-dependent relationships between TMS metrics and acute medication administration. A close association between seizure freedom and normalization of cortical excitability with long-term antiepileptic drug use highlights a plausible utility of TMS in measures of anti-epileptic drug efficacy. Finally, TMS-derived biomarkers distinguish patients with various epilepsies from healthy controls and thus may enable development of disorder-specific biomarkers and therapies both within and outside of the epilepsy realm.
Collapse
Affiliation(s)
- Melissa Tsuboyama
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Harper Lee Kaye
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
| |
Collapse
|
16
|
Couturier NH, Durand DM. Corpus callosum low-frequency stimulation suppresses seizures in an acute rat model of focal cortical seizures. Epilepsia 2018; 59:2219-2230. [PMID: 30426470 PMCID: PMC6279515 DOI: 10.1111/epi.14595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Low-frequency fiber-tract stimulation has been shown to be effective in treating mesial temporal lobe epilepsies through activation of the hippocampal commissure in rodents and human patients. The corpus callosum is a major pathway connecting the two hemispheres of the brain; however, few experiments have documented corpus callosum stimulation. The objective is to determine the efficacy of corpus callosum stimulation at low frequencies to suppress cortical seizures. METHODS 4-Aminopyridine was injected in the primary motor cortex of 24 rats under anesthesia. Recording electrodes were placed in the contralateral motor cortex and hippocampus. Three pairs of stimulating electrodes were inserted into the corpus callosum along its longitudinal axis. Local field potentials were recorded 1 hour before, during, and after stimulation to determine the effect of stimulation on seizure duration. Stimulation was delivered from each pair of electrodes independently in separate experiments. Furthermore, electrical stimulation was applied to the region of the corpus callosum with the highest degree of innervation of the seizure focus to compare the efficacy of different stimulation frequencies (1-30 Hz) on seizure suppression. RESULTS Corpus callosum stimulation was effective at suppressing seizures at 10 Hz by 76% (P < 0.05, n = 5) and at 20 Hz by 95% (P < 0.0001, n = 14). Stimulation at frequencies of 1 and 30 Hz did not have a significant effect on reducing the total time spent seizing (P > 0.9999, n = 5). Furthermore, stimulation was only effective at suppressing seizures when the pair of electrodes was placed within the section of corpus callosum containing fibers innervating the seizure focus. Secondarily generalized seizures in the hippocampus were eliminated when seizures in the cortical focus were suppressed. SIGNIFICANCE Low-frequency fiber-tract stimulation of the corpus callosum suppresses both cortical and cortically induced hippocampal seizures in an acute model of focal cortical seizures. The stimulation paradigm is selective, as it is only effective when targeted to specific regions of the corpus callosum that project maximally to cortical regions generating the seizure activity. Selective placement of stimulation electrodes along the corpus callosum could be used as a patient-specific treatment for cortical epilepsies.
Collapse
Affiliation(s)
- Nicholas H. Couturier
- Department of Biomedical Engineering, Neural Engineering Center, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Dominique M. Durand
- Department of Biomedical Engineering, Neural Engineering Center, Case Western Reserve University, Cleveland, OH, U.S.A
| |
Collapse
|
17
|
Keute M, Ruhnau P, Heinze HJ, Zaehle T. Behavioral and electrophysiological evidence for GABAergic modulation through transcutaneous vagus nerve stimulation. Clin Neurophysiol 2018; 129:1789-1795. [DOI: 10.1016/j.clinph.2018.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 01/19/2023]
|
18
|
Hameed MQ, Dhamne SC, Gersner R, Kaye HL, Oberman LM, Pascual-Leone A, Rotenberg A. Transcranial Magnetic and Direct Current Stimulation in Children. Curr Neurol Neurosci Rep 2017; 17:11. [PMID: 28229395 DOI: 10.1007/s11910-017-0719-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Promising results in adult neurologic and psychiatric disorders are driving active research into transcranial brain stimulation techniques, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), in childhood and adolescent syndromes. TMS has realistic utility as an experimental tool tested in a range of pediatric neuropathologies such as perinatal stroke, depression, Tourette syndrome, and autism spectrum disorder (ASD). tDCS has also been tested as a treatment for a number of pediatric neurologic conditions, including ASD, attention-deficit/hyperactivity disorder, epilepsy, and cerebral palsy. Here, we complement recent reviews with an update of published TMS and tDCS results in children, and discuss developmental neuroscience considerations that should inform pediatric transcranial stimulation.
Collapse
Affiliation(s)
- Mustafa Q Hameed
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital Harvard Medical School, Boston, MA, 02115, USA
| | - Sameer C Dhamne
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Roman Gersner
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Harper L Kaye
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Beth Israel Deaconness Medical Center Harvard Medical School, Boston, MA, USA
- Institut Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Alexander Rotenberg
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| |
Collapse
|
19
|
Assenza G, Campana C, Colicchio G, Tombini M, Assenza F, Di Pino G, Di Lazzaro V. Transcutaneous and invasive vagal nerve stimulations engage the same neural pathways: In-vivo human evidence. Brain Stimul 2017; 10:853-854. [DOI: 10.1016/j.brs.2017.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/15/2017] [Accepted: 03/14/2017] [Indexed: 10/20/2022] Open
|
20
|
Giovanni A, Capone F, di Biase L, Ferreri F, Florio L, Guerra A, Marano M, Paolucci M, Ranieri F, Salomone G, Tombini M, Thut G, Di Lazzaro V. Oscillatory Activities in Neurological Disorders of Elderly: Biomarkers to Target for Neuromodulation. Front Aging Neurosci 2017; 9:189. [PMID: 28659788 PMCID: PMC5468377 DOI: 10.3389/fnagi.2017.00189] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/26/2017] [Indexed: 12/13/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) has been under investigation as adjunct treatment of various neurological disorders with variable success. One challenge is the limited knowledge on what would be effective neuronal targets for an intervention, combined with limited knowledge on the neuronal mechanisms of NIBS. Motivated on the one hand by recent evidence that oscillatory activities in neural systems play a role in orchestrating brain functions and dysfunctions, in particular those of neurological disorders specific of elderly patients, and on the other hand that NIBS techniques may be used to interact with these brain oscillations in a controlled way, we here explore the potential of modulating brain oscillations as an effective strategy for clinical NIBS interventions. We first review the evidence for abnormal oscillatory profiles to be associated with a range of neurological disorders of elderly (e.g., Parkinson's disease (PD), Alzheimer's disease (AD), stroke, epilepsy), and for these signals of abnormal network activity to normalize with treatment, and/or to be predictive of disease progression or recovery. We then ask the question to what extent existing NIBS protocols have been tailored to interact with these oscillations and possibly associated dysfunctions. Our review shows that, despite evidence for both reliable neurophysiological markers of specific oscillatory dis-functionalities in neurological disorders and NIBS protocols potentially able to interact with them, there are few applications of NIBS aiming to explore clinical outcomes of this interaction. Our review article aims to point out oscillatory markers of neurological, which are also suitable targets for modification by NIBS, in order to facilitate in future studies the matching of technical application to clinical targets.
Collapse
Affiliation(s)
- Assenza Giovanni
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | | | - Lazzaro di Biase
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Nuffield Department of Clinical Neurosciences, University of OxfordOxford, United Kingdom
| | - Florinda Ferreri
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern FinlandKuopio, Finland
| | - Lucia Florio
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Andrea Guerra
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
- Nuffield Department of Clinical Neurosciences, University of OxfordOxford, United Kingdom
| | - Massimo Marano
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Matteo Paolucci
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Federico Ranieri
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Gaetano Salomone
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Mario Tombini
- Clinical Neurology, Campus Biomedico University of RomeRome, Italy
| | - Gregor Thut
- Centre for Cognitive Neuroimaging (CCNi), Institute of Neuroscience and Psychology, University of GlasgowGlasgow, United Kingdom
| | | |
Collapse
|
21
|
Cota VR, Drabowski BMB, de Oliveira JC, Moraes MFD. The epileptic amygdala: Toward the development of a neural prosthesis by temporally coded electrical stimulation. J Neurosci Res 2017; 94:463-85. [PMID: 27091311 DOI: 10.1002/jnr.23741] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
Many patients with epilepsy do not obtain proper control of their seizures through conventional treatment. We review aspects of the pathophysiology underlying epileptic phenomena, with a special interest in the role of the amygdala, stressing the importance of hypersynchronism in both ictogenesis and epileptogenesis. We then review experimental studies on electrical stimulation of mesiotemporal epileptogenic areas, the amygdala included, as a means to treat medically refractory epilepsy. Regular high-frequency stimulation (HFS) commonly has anticonvulsant effects and sparse antiepileptogenic properties. On the other hand, HFS is related to acute and long-term increases in excitability related to direct neuronal activation, long-term potentiation, and kindling, raising concerns regarding its safety and jeopardizing in-depth understanding of its mechanisms. In turn, the safer regular low-frequency stimulation (LFS) has a robust antiepileptogenic effect, but its pro- or anticonvulsant effect seems to vary at random among studies. As an alternative, studies by our group on the development and investigation of temporally unstructured electrical stimulation applied to the amygdala have shown that nonperiodic stimulation (NPS), which is a nonstandard form of LFS, is capable of suppressing both acute and chronic spontaneous seizures. We hypothesize two noncompetitive mechanisms for the therapeutic role of amygdala in NPS, 1) a direct desynchronization of epileptic circuitry in the forebrain and brainstem and 2) an indirect desynchronization/inhibition through nucleus accumbens activation. We conclude by reintroducing the idea that hypersynchronism, rather than hyperexcitability, may be the key for epileptic phenomena and epilepsy treatment.
Collapse
Affiliation(s)
- Vinícius Rosa Cota
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Bruna Marcela Bacellar Drabowski
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Jasiara Carla de Oliveira
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Márcio Flávio Dutra Moraes
- Núcleo de Neurociências, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
22
|
Carrette S, Boon P, Vonck K. A prestimulation evaluation protocol for patients with drug resistant epilepsy. Seizure 2017; 44:137-142. [DOI: 10.1016/j.seizure.2016.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 12/29/2022] Open
|
23
|
Larsen LE, Lysebettens WV, Germonpré C, Carrette S, Daelemans S, Sprengers M, Thyrion L, Wadman WJ, Carrette E, Delbeke J, Boon P, Vonck K, Raedt R. Clinical Vagus Nerve Stimulation Paradigms Induce Pronounced Brain and Body Hypothermia in Rats. Int J Neural Syst 2016; 27:1750016. [PMID: 28178853 DOI: 10.1142/s0129065717500162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vagus nerve stimulation (VNS) is a widely used neuromodulation technique that is currently used or being investigated as therapy for a wide array of human diseases such as epilepsy, depression, Alzheimer's disease, tinnitus, inflammatory diseases, pain, heart failure and many others. Here, we report a pronounced decrease in brain and core temperature during VNS in freely moving rats. Two hours of rapid cycle VNS (7s on/18s off) decreased brain temperature by around [Formula: see text]C, while standard cycle VNS (30[Formula: see text]s on/300[Formula: see text]s off) was associated with a decrease of around [Formula: see text]C. Rectal temperature similarly decreased by more than [Formula: see text]C during rapid cycle VNS. The hypothermic effect triggered by VNS was further associated with a vasodilation response in the tail, which reflects an active heat release mechanism. Despite previous evidence indicating an important role of the locus coeruleus-noradrenergic system in therapeutic effects of VNS, lesioning this system with the noradrenergic neurotoxin DSP-4 did not attenuate the hypothermic effect. Since body and brain temperature affect most physiological processes, this finding is of substantial importance for interpretation of several previously published VNS studies and for the future direction of research in the field.
Collapse
Affiliation(s)
- Lars Emil Larsen
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Wouter Van Lysebettens
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Charlotte Germonpré
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Sofie Carrette
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Sofie Daelemans
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Mathieu Sprengers
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Lisa Thyrion
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Wytse Jan Wadman
- 2 Swammerdam Institute of Life Sciences, University of Amsterdam, Science Park 904, Amsterdam, 1090GE, The Netherlands
| | - Evelien Carrette
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Jean Delbeke
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Paul Boon
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Kristl Vonck
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| | - Robrecht Raedt
- 1 Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology, Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium
| |
Collapse
|
24
|
Akhtar H, Bukhari F, Nazir M, Anwar MN, Shahzad A. Therapeutic Efficacy of Neurostimulation for Depression: Techniques, Current Modalities, and Future Challenges. Neurosci Bull 2016; 32:115-26. [PMID: 26781880 PMCID: PMC5563754 DOI: 10.1007/s12264-015-0009-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/20/2015] [Indexed: 01/30/2023] Open
Abstract
Depression is the most prevalent debilitating mental illness; it is characterized as a disorder of mood, cognitive function, and neurovegetative function. About one in ten individuals experience depression at some stage of their lives. Antidepressant drugs are used to reduce the symptoms but relapse occurs in ~20% of patients. However, alternate therapies like brain stimulation techniques have shown promising results in this regard. This review covers the brain stimulation techniques electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation, which are used as alternatives to antidepressant drugs, and elucidates their research and clinical outcomes.
Collapse
Affiliation(s)
- Hafsah Akhtar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Faiza Bukhari
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Misbah Nazir
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan.
| | - Adeeb Shahzad
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| |
Collapse
|
25
|
Mercante B, Pilurzi G, Ginatempo F, Manca A, Follesa P, Tolu E, Deriu F. Trigeminal nerve stimulation modulates brainstem more than cortical excitability in healthy humans. Exp Brain Res 2015; 233:3301-11. [DOI: 10.1007/s00221-015-4398-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 07/27/2015] [Indexed: 12/30/2022]
|
26
|
Conway CR, Colijn MA, Schachter SC. Vagus Nerve Stimulation for Epilepsy and Depression. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
27
|
Abstract
This article reviews the current status of surgical treatment of epilepsy and introduces the ongoing challenges. Seizure outcome of resective surgery for focal seizures associated with focal lesions is satisfactory. Particularly for mesial temporal lobe epilepsy, surgical treatment should be considered from the earlier stage of the disease. Meanwhile, surgical outcome in nonlesional extratemporal lobe epilepsy is still to be improved using various approaches. Disconnective surgeries reduce surgical complications of extensive resections while achieving equivalent or better seizure outcomes. Multiple subpial transection is still being modified expecting a better outcome by transection to the vertical cortices along the sulci- and multi-directional transection from a single entry point. Hippocampal transection is expected to preserve memory function while interrupting the abnormal epileptic synchronization. Proper selection or combination of subdural and depth electrodes and a wide-band analysis of electroencephalography may improve the accurate localization of epileptogenic region. Patients for whom curative resective surgery is not indicated because of generalized or bilateral multiple nature of their epilepsies, neuromodulation therapies are options of treatment which palliate their seizures.
Collapse
Affiliation(s)
- Kensuke Kawai
- Department of Neurosurgery and Epilepsy Center, NTT Medical Center Tokyo
| |
Collapse
|
28
|
Capone F, Assenza G, Di Pino G, Musumeci G, Ranieri F, Florio L, Barbato C, Di Lazzaro V. The effect of transcutaneous vagus nerve stimulation on cortical excitability. J Neural Transm (Vienna) 2014; 122:679-85. [DOI: 10.1007/s00702-014-1299-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
|
29
|
Trigeminal Nerve Stimulation Does Not Acutely Affect Cortical Excitability in Healthy Subjects. Brain Stimul 2014; 7:613-7. [DOI: 10.1016/j.brs.2014.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/23/2014] [Accepted: 04/30/2014] [Indexed: 11/17/2022] Open
|
30
|
Philip NS, Carpenter SL, Carpenter LL. Safe Use of Repetitive Transcranial Magnetic Stimulation in Patients With Implanted Vagus Nerve Stimulators. Brain Stimul 2014; 7:608-12. [DOI: 10.1016/j.brs.2014.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/31/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022] Open
|
31
|
Does the region of epileptogenicity influence the pattern of change in cortical excitability? Clin Neurophysiol 2014; 126:249-56. [PMID: 25002368 DOI: 10.1016/j.clinph.2014.05.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate whether cortical excitability measures on transcranial magnetic stimulation (TMS) differed between groups of patients with different focal epilepsy syndromes. METHODS 85 Patients with focal epilepsy syndromes divided into temporal and extra-temporal lobe epilepsy were studied. The cohorts were further divided into drug naïve-new onset, refractory and seizure free groups. Motor threshold (MT) and paired pulse TMS at short (2, 5, 10, 15 ms) and long (100-300 ms) interstimulus intervals (ISIs) were measured. Results were compared to those of 20 controls. RESULTS Cortical excitability was higher at 2 & 5 ms and 250, 300 ms ISIs (p<0.01) in focal epilepsy syndromes compared to controls however significant inter-hemispheric differences in MT and the same ISIs were only seen in the drug naïve state early at onset and were much more prominent in temporal lobe epilepsy. CONCLUSION Disturbances in cortical excitability are more confined to the affected hemisphere in temporal lobe epilepsy but only early at onset in the drug naïve state. SIGNIFICANCE Group TMS studies show that cortical excitability measures are different in temporal lobe epilepsy and can be distinguished from other focal epilepsies early at onset in the drug naïve state. Further studies are needed to determine whether these results can be applied clinically as the utility of TMS in distinguishing between epilepsy syndromes at an individual level remains to be determined.
Collapse
|
32
|
TMS, cortical excitability and epilepsy: The clinical impact. Epilepsy Res 2014; 108:153-61. [DOI: 10.1016/j.eplepsyres.2013.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 01/07/2023]
|
33
|
Felisati G, Gardella E, Schiavo P, Saibene AM, Pipolo C, Bertazzoli M, Chiesa V, Maccari A, Franzini A, Canevini MP. Endoscopic laryngeal patterns in vagus nerve stimulation therapy for drug-resistant epilepsy. Eur Arch Otorhinolaryngol 2013; 271:117-23. [DOI: 10.1007/s00405-013-2568-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/16/2013] [Indexed: 11/28/2022]
|
34
|
Rocha L. Interaction between electrical modulation of the brain and pharmacotherapy to control pharmacoresistant epilepsy. Pharmacol Ther 2013; 138:211-28. [DOI: 10.1016/j.pharmthera.2013.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/07/2013] [Indexed: 12/15/2022]
|
35
|
Abstract
Noninvasive brain stimulation, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), are emerging as realistic tools for seizure control. Numerous open-label trials and a few recent randomized controlled trials suggest the capacity of both techniques to suppress seizures. Additionally, specialized TMS protocols aimed to map cortical function and to measure cortical excitability may have realistic roles as diagnostic tools in epilepsy. As the prevalence of drug-resistant epilepsy has not changed in recent years, TMS and tDCS offer noninvasive and nonpharmacological options to improve control of intractable seizures.
Collapse
Affiliation(s)
- Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
36
|
BADAWY RADWAAB, JACKSON GRAEMED, BERKOVIC SAMUELF, MACDONELL RICHARDAL. CORTICAL EXCITABILITY AND REFRACTORY EPILEPSY: A THREE-YEAR LONGITUDINAL TRANSCRANIAL MAGNETIC STIMULATION STUDY. Int J Neural Syst 2012; 23:1250030. [DOI: 10.1142/s012906571250030x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transcranial magnetic stimulation was used to study the effect of recurrent seizures on cortical excitability over time in epilepsy. 77 patients with firm diagnoses of idiopathic generalized epilepsy (IGE) or focal epilepsy were repeatedly evaluated over three years. At onset, all groups had increased cortical excitability. At the end of follow-up the refractory group was associated with a broad increase in cortical excitability. Conversely, cortical excitability decreased in all seizure free groups after introduction of an effective medication.
Collapse
Affiliation(s)
- RADWA A. B. BADAWY
- Department of Neurology, Austin Health, Heidelberg, Epilepsy Research Centre, Australia
- Department of Medicine, University of Melbourne, Brain Research Institute, Australia
- Florey Neuroscience Institutes Heidelberg West, Victoria, Australia
| | - GRAEME D. JACKSON
- Department of Neurology, Austin Health, Heidelberg, Epilepsy Research Centre, Australia
- Department of Medicine, University of Melbourne, Brain Research Institute, Australia
- Florey Neuroscience Institutes Heidelberg West, Victoria, Australia
| | - SAMUEL F. BERKOVIC
- Department of Neurology, Austin Health, Heidelberg, Epilepsy Research Centre, Australia
- Department of Medicine, University of Melbourne, Brain Research Institute, Australia
- Florey Neuroscience Institutes Heidelberg West, Victoria, Australia
| | - RICHARD A. L. MACDONELL
- Department of Neurology, Austin Health, Heidelberg, Epilepsy Research Centre, Australia
- Department of Medicine, University of Melbourne, Brain Research Institute, Australia
- Florey Neuroscience Institutes Heidelberg West, Victoria, Australia
| |
Collapse
|
37
|
Usami K, Kawai K, Sonoo M, Saito N. Scalp-recorded evoked potentials as a marker for afferent nerve impulse in clinical vagus nerve stimulation. Brain Stimul 2012; 6:615-23. [PMID: 23088852 DOI: 10.1016/j.brs.2012.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/19/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a palliative treatment for drug resistant epilepsy for which the efficacy and safety are well established. Accumulating evidence suggests that ascending vagal signals modulate abnormal cortical excitability via various pathways. However, there is no direct evidence for an ascending conduction of neural impulses in a clinical case of VNS. OBJECTIVE We recorded and analyzed the short-latency components of the vagus nerve (VN) evoked potential (EP) from the viewpoint of determining whether or not it is a marker for the ascending neural conduction. METHODS EPs within 20 ms were prospectively recorded simultaneously from a surgical wound in the neck and at multiple scalp sites during implantation surgery in 25 patients with drug-resistant epilepsy. Electrical stimulation was delivered using the clinical VNS Therapy system. A recording was made before and after a muscle relaxant was administered, when changing the rostrocaudal position of stimulation, or when stimulating the ansa cervicalis instead of the VN. RESULTS The short-latency components consisted of four peaks. The early component around 3 ms, which was most prominent in A1-Cz, remained unchanged after muscle relaxation while the later peaks disappeared. Rostral transition of the stimulation resulted in an earlier shift of the early component. The estimated conduction velocity was 27.4 ± 10.2 m/s. Stimulation of the ansa cervicalis induced no EP. CONCLUSIONS The early component was regarded as directly resulting from ascending neural conduction of A fibers of the VN, probably originating around the jugular foramen. Recording of VN-EP might document the cause of treatment failure in some patients.
Collapse
Affiliation(s)
- Kenichi Usami
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | | | | | | |
Collapse
|
38
|
Badawy RAB, Macdonell RAL, Vogrin SJ, Lai A, Cook MJ. Cortical excitability decreases in Lennox-Gastaut syndrome. Epilepsia 2012; 53:1546-53. [DOI: 10.1111/j.1528-1167.2012.03599.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
Schlaier JR, Eichhammer P, Langguth B, Doenitz C, Binder H, Hajak G, Brawanski A. Effects of spinal cord stimulation on cortical excitability in patients with chronic neuropathic pain: A pilot study. Eur J Pain 2012; 11:863-8. [PMID: 17331763 DOI: 10.1016/j.ejpain.2007.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 10/22/2006] [Accepted: 01/21/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite a broad clinical use, the mechanism of action of SCS is poorly understood. Current information suggests that the effects of SCS are mediated by a complex set of interactions at several levels of the nervous system including spinal and supraspinal mechanisms. AIMS The study was undertaken to investigate the influence of SCS on distinct parameters of cortical excitability using single- and paired-pulse transcranial magnetic stimulation (TMS). METHODS Five patients with chronic neuropathic pain were examined with the SCS stimulator on and off by means of TMS. Pain was assessed using a visual-analogue scale. Electrophysiological and pain parameters of patients during this procedure were compared by means of a linear mixed effect model. RESULTS SCS induced a significant modulation of cortical excitability, especially by influencing the parameter "intracortical facilitation" (t=-2.657; df=8; p=0.029). A significant relationship between this parameter and "perceived pain" could be obtained (t=-4.798; df=8; p=0.002). CONCLUSIONS These results suggest that SCS is able to influence neurobiological processes at the supraspinal level and that clinical effects of SCS may be at least in part of cortical origin.
Collapse
Affiliation(s)
- Jürgen R Schlaier
- Department of Neurosurgery, University of Regensburg, 93053 Regensburg, Franz-Josef-Strauss-Allee 11, Germany.
| | | | | | | | | | | | | |
Collapse
|
40
|
Vonck K, de Herdt V, Sprengers M, Ben-Menachem E. Neurostimulation for epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:955-970. [PMID: 22939078 DOI: 10.1016/b978-0-444-52899-5.00040-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kristl Vonck
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | |
Collapse
|
41
|
Kawai K, Usami K, Saito N. [Vagus nerve stimulation for epilepsy]. Rinsho Shinkeigaku 2011; 51:990-992. [PMID: 22277453 DOI: 10.5692/clinicalneurol.51.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Vagus nerve stimulation is the first electrical stimulation therapy for epilepsy. While its clinical use was approved by the European Union in 1994 and by the United States in 1997, it was approved last year and coverage by public insurance started last July in Japan. Owing to less invasiveness and broad indication, it is expected that vagus nerve stimulation will be increasingly used in Japan as well. Its efficacy for refractory partial seizures in patients older than 13 years was validated by two randomized control trials. Although it has been used for children and generalized seizures broadly, the efficacy for these subpopulations of patients has not been validated by randomized control trials, necessitating those studies in the near future. Afferent neural impulses generated by vagus nerve stimulation transmit to the solitary tract nucleus, then via multiple pathways including the monoamine system, vagus nerve stimulation affects the excitability of the cortical neurons. It likely exerts the anti-epileptic and anti-seizure effects using these pathways, but the detailed mechanisms underlying the effect remains to be elucidated further in future.
Collapse
Affiliation(s)
- Kensuke Kawai
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo
| | | | | |
Collapse
|
42
|
De Herdt V, De Waele J, Raedt R, Wyckhuys T, El Tahry R, Vonck K, Wadman W, Boon P. Modulation of seizure threshold by vagus nerve stimulation in an animal model for motor seizures. Acta Neurol Scand 2010; 121:271-6. [PMID: 20003088 DOI: 10.1111/j.1600-0404.2009.01223.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The precise mechanism of action of vagus nerve stimulation (VNS) in suppressing epileptic seizures remains to be elucidated. This study investigates whether VNS modulates cortical excitability by determining the threshold for provoking focal motor seizures by cortical electrical stimulation before and after VNS. MATERIAL AND METHODS Male Wistar rats (n = 8) were implanted with a cuff-electrode around the left vagus nerve and with stimulation electrodes placed bilaterally on the rat motor cortex. Motor seizure threshold (MST) was assessed for each rat before and immediately after 1 h of VNS with standard stimulation parameters, during two to three sessions on different days. RESULTS An overall significant increase of the MST was observed following 1 h of VNS compared to the baseline value (1420 microA and 1072 microA, respectively; P < 0.01). The effect was reproducible over time with an increase in MST in each experimental session. CONCLUSIONS VNS significantly increases the MST in a cortical stimulation model for motor seizures. These data indicate that VNS is capable of modulating cortical excitability.
Collapse
|
43
|
Grimm S, Bajbouj M. Efficacy of vagus nerve stimulation in the treatment of depression. Expert Rev Neurother 2010; 10:87-92. [PMID: 20021323 DOI: 10.1586/ern.09.138] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Major depressive disorder is a disease with prominent individual, medical and economic impacts. A relevant proportion of depressive patients suffering from a therapy-resistant course are increasingly being treated with antidepressant brain stimulation techniques. One of these interventions is the vagus nerve stimulation that has recently been tested in a number of clinical trials. To date, the acute and long-term efficacy of vagus nerve stimulation are still under debate. Thus further studies are required, especially since the exact mode of action of vagus nerve stimulation is still not well understood. In this paper we will review the results of existing clinical trials as well as the neurobiological effects measured with neuroimaging, biochemical and electrophysiology approaches.
Collapse
Affiliation(s)
- Simone Grimm
- Freie Universitaet Berlin, Cluster of Excellence Languages of Emotion and Dahlem Institute for Neuroscience of Emotion, Habelschwerdter Allee 45, 14195 Berlin, Germany. www.languages-of-emotion.de
| | | |
Collapse
|
44
|
Prospects for Clinical Applications of Transcranial Magnetic Stimulation and Real-Time EEG in Epilepsy. Brain Topogr 2009; 22:257-66. [DOI: 10.1007/s10548-009-0116-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 10/26/2009] [Indexed: 11/27/2022]
|
45
|
Lyubashina O, Panteleev S. Effects of cervical vagus nerve stimulation on amygdala-evoked responses of the medial prefrontal cortex neurons in rat. Neurosci Res 2009; 65:122-5. [DOI: 10.1016/j.neures.2009.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 05/29/2009] [Accepted: 06/01/2009] [Indexed: 10/20/2022]
|
46
|
Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. Treatment of depression with transcranial direct current stimulation (tDCS): A Review. Exp Neurol 2009; 219:14-9. [DOI: 10.1016/j.expneurol.2009.03.038] [Citation(s) in RCA: 268] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/22/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
|
47
|
Boon P, Raedt R, de Herdt V, Wyckhuys T, Vonck K. Electrical stimulation for the treatment of epilepsy. Neurotherapeutics 2009; 6:218-27. [PMID: 19332313 PMCID: PMC5084197 DOI: 10.1016/j.nurt.2008.12.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 12/31/2008] [Indexed: 01/24/2023] Open
Abstract
Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.
Collapse
Affiliation(s)
- Paul Boon
- Reference Center for Refractory Epilepsy and Laboratory for Clinical and Experimental Neurophysiology (LCEN), Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | |
Collapse
|
48
|
Vonck K, De Herdt V, Boon P. Vagal nerve stimulation--a 15-year survey of an established treatment modality in epilepsy surgery. Adv Tech Stand Neurosurg 2009; 34:111-46. [PMID: 19368083 DOI: 10.1007/978-3-211-78741-0_5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Neurostimulation is an emerging treatment for neurological diseases. Electrical stimulation of the tenth cranial nerve or vagus nerve stimulation (VNS) has become a valuable option in the therapeutic armamentarium for patients with refractory epilepsy. It is indicated in patients with refractory epilepsy who are unsuitable candidates for epilepsy surgery or who have had insufficient benefit from such a treatment. Vagus nerve stimulation reduces seizure frequency with > 50% in 1/3 of patients and has a mild side effects profile. Research to elucidate the mechanism of action of vagus nerve stimulation has shown that effective stimulation in humans is primarily mediated by afferent vagal A- and B-fibers. Crucial brainstem and intracranial structures include the locus coeruleus, the nucleus of the solitary tract, the thalamus and limbic structures. Neurotransmitters playing a role may involve the major inhibitory neurotransmitter GABA but also serotoninergic and adrenergic systems. This manuscript reviews the clinical studies investigating efficacy and side effects in patients and the experimental studies aiming to elucidate the mechanims of action.
Collapse
Affiliation(s)
- K Vonck
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | | | | |
Collapse
|
49
|
Bajbouj M, Gallinat J, Lang UE, Hellen F, Vesper J, Lisanby SH, Danker-Hopfe H, Neu P. Motor cortex excitability after vagus nerve stimulation in major depression. J Clin Psychopharmacol 2007; 27:156-9. [PMID: 17414238 DOI: 10.1097/jcp.0b013e31803308f3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent data suggest that inhibitory pathways may be involved in the pathophysiology of depression and in the mode of action of some antidepressant interventions. The aim of the present study was to test whether vagus nerve stimulation (VNS) can affect motor cortex excitability. Measures of motor cortical excitability were probed by using single-pulse and paired-pulse transcranial magnetic stimulation at baseline, after 10 weeks of left VNS, and additionally, in an on-off paradigm in 10 patients with treatment-resistant unipolar depression. Ten weeks of VNS was associated with a selective and pronounced increase in intracortical inhibition, whereas no changes occurred in the on-off paradigm. These results suggest that VNS is capable of changing motor cortical excitability in patients with depression.
Collapse
Affiliation(s)
- Malek Bajbouj
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Murphy JV, Patil AA. Improving the lives of patients with medically refractory epilepsy by electrical stimulation of the nervous system. Expert Rev Med Devices 2006; 2:175-89. [PMID: 16293054 DOI: 10.1586/17434440.2.2.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vagal nerve stimulation proved effective in animal models of epilepsy, and in open and double-blinded trials, in over 450 patients. Seizure reduction improved for at least 2 years. Almost 50% of treated patients achieve at least a 50% reduction in seizure frequency. Other advantages include termination of a seizure and improved alertness. Benefits were demonstrated in children, partial and generalized epilepsies, and in specific neurologic syndromes.
Collapse
Affiliation(s)
- Jerome V Murphy
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | | |
Collapse
|