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Waris A, Asim M, Ullah A, Alhumaydhi FA. Various pharmacological agents in the pipeline against intractable epilepsy. Arch Pharm (Weinheim) 2024:e2400229. [PMID: 38767508 DOI: 10.1002/ardp.202400229] [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: 03/27/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Epilepsy is a noncommunicable chronic neurological disorder affecting people of all ages, with the highest prevalence in low and middle-income countries. Despite the pharmacological armamentarium, the plethora of drugs in the market, and other treatment options, 30%-35% of individuals still show resistance to the current medication, termed intractable epilepsy/drug resistance epilepsy, which contributes to 50% of the mortalities due to epilepsy. Therefore, the development of new drugs and agents is needed to manage this devastating epilepsy. We reviewed the pipeline of drugs in "ClinicalTrials. gov," which is the federal registry of clinical trials to identify drugs and other treatment options in various phases against intractable epilepsy. A total of 31 clinical trials were found regarding intractable epilepsy. Among them, 48.4% (15) are about pharmacological agents, of which 26.6% are in Phase 1, 60% are in Phase 2, and 13.3% are in Phase 3. The mechanism of action or targets of the majority of these agents are different and are more diversified than those of the approved drugs. In this article, we summarized various pharmacological agents in clinical trials, their backgrounds, targets, and mechanisms of action for the treatment of intractable epilepsy. Treatment options other than pharmacological ones, such as devices for brain stimulation, ketogenic diets, gene therapy, and others, are also summarized.
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Affiliation(s)
- Abdul Waris
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Muhammad Asim
- Department of Neurosciences, City University of Hong Kong, Kowloon Tong, Hong Kong
- Centre for Regenerative Medicine and Health (CRMH), Hong Kong SAR
| | - Ata Ullah
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
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2
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Teckentrup V, Kroemer NB. Mechanisms for survival: vagal control of goal-directed behavior. Trends Cogn Sci 2024; 28:237-251. [PMID: 38036309 DOI: 10.1016/j.tics.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023]
Abstract
Survival is a fundamental physiological drive, and neural circuits have evolved to prioritize actions that meet the energy demands of the body. This fine-tuning of goal-directed actions based on metabolic states ('allostasis') is deeply rooted in our brain, and hindbrain nuclei orchestrate the vital communication between the brain and body through the vagus nerve. Despite mounting evidence for vagal control of allostatic behavior in animals, its broader function in humans is still contested. Based on stimulation studies, we propose that the vagal afferent pathway supports transitions between survival modes by gating the integration of ascending bodily signals, thereby regulating reward-seeking. By reconceptualizing vagal signals as catalysts for goal-directed behavior, our perspective opens new avenues for theory-driven translational work in mental disorders.
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Affiliation(s)
- Vanessa Teckentrup
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72076 Tübingen, Germany; School of Psychology and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Nils B Kroemer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, 72076 Tübingen, Germany; Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany; German Center for Mental Health (DZPG), 72076 Tübingen, Germany.
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3
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Gonçalves-Sánchez J, Sancho C, López DE, Castellano O, García-Cenador B, Servilha-Menezes G, Corchado JM, García-Cairasco N, Gonçalves-Estella JM. Effect of Vagus Nerve Stimulation on the GASH/Sal Audiogenic-Seizure-Prone Hamster. Int J Mol Sci 2023; 25:91. [PMID: 38203262 PMCID: PMC10778912 DOI: 10.3390/ijms25010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Vagus nerve stimulation (VNS) is an adjuvant neuromodulation therapy for the treatment of refractory epilepsy. However, the mechanisms behind its effectiveness are not fully understood. Our aim was to develop a VNS protocol for the Genetic Audiogenic Seizure Hamster from Salamanca (GASH/Sal) in order to evaluate the mechanisms of action of the therapy. The rodents were subject to VNS for 14 days using clinical stimulation parameters by implanting a clinically available neurostimulation device or our own prototype for laboratory animals. The neuroethological assessment of seizures and general behavior were performed before surgery, and after 7, 10, and 14 days of VNS. Moreover, potential side effects were examined. Finally, the expression of 23 inflammatory markers in plasma and the left-brain hemisphere was evaluated. VNS significantly reduced seizure severity in GASH/Sal without side effects. No differences were observed between the neurostimulation devices. GASH/Sal treated with VNS showed statistically significant reduced levels of interleukin IL-1β, monocyte chemoattractant protein MCP-1, matrix metalloproteinases (MMP-2, MMP-3), and tumor necrosis factor TNF-α in the brain. The described experimental design allows for the study of VNS effects and mechanisms of action using an implantable device. This was achieved in a model of convulsive seizures in which VNS is effective and shows an anti-inflammatory effect.
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Affiliation(s)
- Jaime Gonçalves-Sánchez
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Consuelo Sancho
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Dolores E. López
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Orlando Castellano
- Department of Cellular Biology and Pathology, School of Medicine, University of Salamanca, 37007 Salamanca, Spain; (D.E.L.); (O.C.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Institute of Neuroscience of Castilla y León, 37007 Salamanca, Spain
| | - Begoña García-Cenador
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Department of Surgery, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Gabriel Servilha-Menezes
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, SP, Brazil; (G.S.-M.); (N.G.-C.)
| | - Juan M. Corchado
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Bioinformatics, Intelligent Systems and Educational Technology (BISITE) Research Group, 37007 Salamanca, Spain
| | - Norberto García-Cairasco
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, SP, Brazil; (G.S.-M.); (N.G.-C.)
| | - Jesús M. Gonçalves-Estella
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.S.); (B.G.-C.); (J.M.C.); (J.M.G.-E.)
- Department of Surgery, School of Medicine, University of Salamanca, 37007 Salamanca, Spain
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Ghosh S, Sinha JK, Ghosh S, Sharma H, Bhaskar R, Narayanan KB. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci 2023; 13:1305. [PMID: 37759906 PMCID: PMC10527076 DOI: 10.3390/brainsci13091305] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy is a complex neurological disorder affecting millions worldwide, with a substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone of epilepsy treatment, but their limitations necessitate alternative approaches. The review delves into cutting-edge therapies such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), highlighting their mechanisms of action and promising clinical outcomes. Additionally, the potential of gene therapies and optogenetics in epilepsy research is discussed, revealing groundbreaking findings that shed light on seizure mechanisms. Insights into cannabidiol (CBD) and the ketogenic diet as adjunctive therapies further broaden the spectrum of epilepsy management. Challenges in achieving seizure control with traditional therapies, including treatment resistance and individual variability, are addressed. The importance of staying updated with emerging trends in epilepsy management is emphasized, along with the hope for improved therapeutic options. Future research directions, such as combining therapies, AI applications, and non-invasive optogenetics, hold promise for personalized and effective epilepsy treatment. As the field advances, collaboration among researchers of natural and synthetic biochemistry, clinicians from different streams and various forms of medicine, and patients will drive progress toward better seizure control and a higher quality of life for individuals living with epilepsy.
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Affiliation(s)
- Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
- ICMR—National Institute of Nutrition, Tarnaka, Hyderabad 500007, India
| | | | - Soumya Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | | | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kannan Badri Narayanan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
- Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
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5
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Tamura K, Sasaki R, Sakakibara T, Dahal R, Takeshima Y, Matsuda R, Yamada S, Nishimura F, Nakagawa I, Park YS, Hirabayashi H, Nakase H. Additional Effect of High-output Current and/or High-duty Cycle in Vagus Nerve Stimulation for Adolescent/Adult Intractable Epilepsy. Neurol Med Chir (Tokyo) 2023; 63:273-282. [PMID: 37045770 PMCID: PMC10406457 DOI: 10.2176/jns-nmc.2022-0280] [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: 08/31/2022] [Accepted: 02/20/2023] [Indexed: 04/14/2023] Open
Abstract
A vagus nerve stimulation (VNS) device delivers electrical pulses to the vagus nerve at a rhythm defined by the duty cycle. The standard therapeutic range is advocated for an output current of 1.5-2.25 mA and a duty cycle of 10%. As the optimal settings vary from patient to patient, some patients may benefit from additional seizure reduction when stimulated beyond the standard range. A total of 74 patients (15 children aged <12 years and 59 adolescents/adults) who underwent VNS implantation between 2011 and 2020 and who were followed up for at least 2 years were included in this retrospective study. Stimulation parameters exceeding 2.25 mA of output current, 25% of duty cycle, and 0.5625 (2.25 mA × 25%) of current × duty cycle were defined as high stimulation. The proportion achieved an additional seizure reduction of 20%, and the 50% seizure reduction rate at the last follow-up was compared between adolescents/adults and children. Approximately 40% of patients in adolescents/adults treated with high stimulation experienced an additional acute effect, resulting in a 50% or greater reduction in seizures in almost all patients. Moreover, in adolescents/adults, 22.2%-41.9% of the patients were treated with high stimulation, and the responder rate was 69.5%. Conversely, the responder rate in children was 26.7%, significantly worse than that in adolescents/adults, despite higher stimulation. VNS with high-stimulation settings is effective for adolescent and adult patients with intractable epilepsy. Even high stimulation may not be effective in extremely refractory pediatric epilepsy with a high seizure frequency.
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Affiliation(s)
- Kentaro Tamura
- Department of Neurosurgery, Nara Medical University
- Epilepsy Center, National Hospital Organization Nara Medical Center
| | - Ryota Sasaki
- Department of Neurosurgery, Nara Medical University
- Epilepsy Center, National Hospital Organization Nara Medical Center
| | - Takafumi Sakakibara
- Epilepsy Center, National Hospital Organization Nara Medical Center
- Department of Pediatrics, Nara Medical University
| | - Riju Dahal
- Department of Neurosurgery, Nara Medical University
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6
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Skrehot HC, Englot DJ, Haneef Z. Neuro-stimulation in focal epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2023; 142:109182. [PMID: 36972642 DOI: 10.1016/j.yebeh.2023.109182] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES Different neurostimulation modalities are available to treat drug-resistant focal epilepsy when surgery is not an option including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS). Head-to-head comparisons of efficacy do not exist between them nor are likely to be available in the future. We performed a meta-analysis on VNS, RNS, and DBS outcomes to compare seizure reduction efficacy for focal epilepsy. METHODS We systematically reviewed the literature for reported seizure outcomes following implantation with VNS, RNS, and DBS in focal-onset seizures and performed a meta-analysis. Prospective or retrospective clinical studies were included. RESULTS Sufficient data were available at years one (n = 642, two (n = 480), and three (n = 385) for comparing the three modalities with each other. Seizure reduction for the devices at years one, two, and three respectively were: RNS: 66.3%, 56.0%, 68.4%; DBS- 58.4%, 57.5%, 63.8%; VNS 32.9%, 44.4%, 53.5%. Seizure reduction at year one was greater for RNS (p < 0.01) and DBS (p < 0.01) compared to VNS. CONCLUSIONS Our findings indicate the seizure reduction efficacy of RNS is similar to DBS, and both had greater seizure reductions compared to VNS in the first-year post-implantation, with the differences diminishing with longer-term follow-up. SIGNIFICANCE The results help guide neuromodulation treatment in eligible patients with drug-resistant focal epilepsy.
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Affiliation(s)
- Henry C Skrehot
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dario J Englot
- Departments of Neurological Surgery, Neurology, Radiology, Electrical Engineering, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA; Neurology Care Line, VA Medical Center, Houston, TX 77030, USA.
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7
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Hiendlmeier L, Zurita F, Vogel J, Del Duca F, Al Boustani G, Peng H, Kopic I, Nikić M, F Teshima T, Wolfrum B. 4D-Printed Soft and Stretchable Self-Folding Cuff Electrodes for Small-Nerve Interfacing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2210206. [PMID: 36594106 DOI: 10.1002/adma.202210206] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Peripheral nerve interfacing (PNI) has a high clinical potential for treating various diseases, such as obesity or diabetes. However, currently existing electrodes present challenges to the interfacing procedure, which limit their clinical application, in particular, when targeting small peripheral nerves (<200 µm). To improve the electrode handling and implantation, a nerve interface that can fold itself to a cuff around a small nerve, triggered by the body moisture during insertion, is fabricated. This folding is achieved by printing a bilayer of a flexible polyurethane printing resin and a highly swelling sodium acrylate hydrogel using photopolymerization. When immersed in an aqueous liquid, the hydrogel swells and folds the electrode softly around the nerve. Furthermore, the electrodes are robust, can be stretched (>20%), and bent to facilitate the implantation due to the use of soft and stretchable printing resins as substrates and a microcracked gold film as conductive layer. The straightforward implantation and extraction of the electrode as well as stimulation and recording capabilities on a small peripheral nerve in vivo are demonstrated. It is believed that such simple and robust to use self-folding electrodes will pave the way for bringing PNI to a broader clinical application.
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Affiliation(s)
- Lukas Hiendlmeier
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
| | - Francisco Zurita
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
| | - Jonas Vogel
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
| | - Fulvia Del Duca
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
| | - George Al Boustani
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
| | - Hu Peng
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
| | - Inola Kopic
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
| | - Marta Nikić
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
| | - Tetsuhiko F Teshima
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
| | - Bernhard Wolfrum
- Neuroelectronics, Munich Institute of Biomedical Engineering, School of Computation, Informatics and Technology, Technical University of Munich, Hans-Piloty-Str. 1, 85748, Garching, Germany
- Medical & Health Informatics Laboratories, NTT Research Incorporated, 940 Stewart Dr, Sunnyvale, CA, 94085, USA
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8
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Guo M, Xie P, Liu S, Luan G, Li T. Epilepsy and Autism Spectrum Disorder (ASD): The Underlying Mechanisms and Therapy Targets Related to Adenosine. Curr Neuropharmacol 2023; 21:54-66. [PMID: 35794774 PMCID: PMC10193761 DOI: 10.2174/1570159x20666220706100136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/23/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Epilepsy and autism spectrum disorder (ASD) are highly mutually comorbid, suggesting potential overlaps in genetic etiology, pathophysiology, and neurodevelopmental abnormalities. Adenosine, an endogenous anticonvulsant and neuroprotective neuromodulator of the brain, has been proved to affect the process of epilepsy and ASD. On the one hand, adenosine plays a crucial role in preventing the progression and development of epilepsy through adenosine receptordependent and -independent ways. On the other hand, adenosine signaling can not only regulate core symptoms but also improve comorbid disorders in ASD. Given the important role of adenosine in epilepsy and ASD, therapeutic strategies related to adenosine, including the ketogenic diet, neuromodulation therapy, and adenosine augmentation therapy, have been suggested for the arrangement of epilepsy and ASD. There are several proposals in this review. Firstly, it is necessary to further discuss the relationship between both diseases based on the comorbid symptoms and mechanisms of epilepsy and ASD. Secondly, it is important to explore the role of adenosine involved in epilepsy and ASD. Lastly, potential therapeutic value and clinical approaches of adenosine-related therapies in treating epilepsy and ASD need to be emphasized.
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Affiliation(s)
- Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Pandeng Xie
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Guoming Luan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
| | - Tianfu Li
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
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9
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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.
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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
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10
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Olsen LK, Moore RJ, Bechmann NA, Ethridge VT, Gargas NM, Cunningham SD, Kuang Z, Whicker JK, Rohan JG, Hatcher-Solis CN. Vagus nerve stimulation-induced cognitive enhancement: Hippocampal neuroplasticity in healthy male rats. Brain Stimul 2022; 15:1101-1110. [PMID: 35970317 DOI: 10.1016/j.brs.2022.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) improves cognition in humans and rodents, but the effects of a single session of VNS on performance and plasticity are not well understood. OBJECTIVE Behavioral performance and hippocampal (HC) electrophysiology/neurotrophin expression were measured in healthy adult rats after VNS paired training to investigate changes in cognition and synaptic plasticity. METHODS Platinum/iridium electrodes were surgically implanted around the left cervical branch of the VN of anesthetized male Sprague-Dawley rats (N = 47). VNS (100 μs biphasic pulses, 30 Hz, 0.8 mA) paired Novel Object Recognition (NOR)/Passive Avoidance Task (PAT) were assessed 24 h after training and post-mortem tissue was collected 48 h after VNS (N = 28). Electrophysiology recordings were collected using a microelectrode array system to assess functional effects on HC slices 90 min after VNS (N = 19). Sham received the same treatment without VNS and experimenters were blinded. RESULTS Stimulated rats exhibited improved performance in NOR (p < 0.05, n = 12) and PAT (p < 0.05, n = 14). VNS enhanced long-term potentiation (p < 0.05, n = 7-12), and spontaneous spike amplitude (p < 0.05, n = 7-12) and frequency (p < 0.05, n = 7-12) in the CA1. Immunohistochemical analysis found increased brain-derived neurotrophic factor expression in the CA1 (p < 0.05, n = 8-9) and CA2 (p < 0.01, n = 7-8). CONCLUSION These findings suggest that our VNS parameters promote synaptic plasticity and target the CA1, which may mediate the positive cognitive effects of VNS. This study significantly contributes to a better understanding of VNS mediated HC synaptic plasticity, which may improve clinical utilization of VNS for cognitive enhancement.
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Affiliation(s)
- Laura K Olsen
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Raquel J Moore
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Infoscitex, Inc., Dayton, OH, USA
| | - Naomi A Bechmann
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Infoscitex, Inc., Dayton, OH, USA
| | - Victoria T Ethridge
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA; Odyssey Systems Consulting Group, Wakefield, MA, USA
| | - Nathan M Gargas
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA; Odyssey Systems Consulting Group, Wakefield, MA, USA
| | - Sylvia D Cunningham
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Zhanpeng Kuang
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA
| | - Joshua K Whicker
- Cognitive Neuroscience, 711th HPW, AFRL, Wright-Patterson AFB, OH, USA
| | - Joyce G Rohan
- Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH, USA
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11
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解 虎, 张 建. [Neuromodulation: Past, Present, and Future]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:559-563. [PMID: 35871723 PMCID: PMC10409452 DOI: 10.12182/20220760101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 06/15/2023]
Abstract
Neuromodulation technology is one of the medical fields currently experiencing the most rapid development, witnessing a surge in the types of modulation techniques and a constant expansion of indications. Consequently, hundreds of thousands of patients with functional neurological disorders have benefited from the advancements in the field all over the world. Nevertheless, some challenges remain, for exmaple, the lack of a thorough understanding of the mechanism of neuromodulation, the long-standing controversy over the optimal targets of neuromodulation, the lack of reliable efficacy predictors, and the cumbersome and inefficient mode of postoperative programming. We anticipate that these issues will be resolved with the continued advancement in medical technology and the gradual revelation of the neural network mechanism of brain disorders. More individualized, precise, and intelligent neuromodulation technology will be the main direction of development in the future. Herein, we reviewed and commented on the evolution of neuromodulation technology, the current status of its applications, and its prospective development.
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Affiliation(s)
- 虎涛 解
- 首都医科大学附属北京天坛医院 神经外科 (北京 100070)Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - 建国 张
- 首都医科大学附属北京天坛医院 神经外科 (北京 100070)Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- 北京市神经外科研究所 (北京 100070)Beijing Institute of Neurosurgery, Beijing 100070, China
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12
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Habibagahi I, Omidbeigi M, Hadaya J, Lyu H, Jang J, Ardell JL, Bari AA, Babakhani A. Vagus nerve stimulation using a miniaturized wirelessly powered stimulator in pigs. Sci Rep 2022; 12:8184. [PMID: 35581302 PMCID: PMC9114380 DOI: 10.1038/s41598-022-11850-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/26/2022] [Indexed: 11/09/2022] Open
Abstract
Neuromodulation of peripheral nerves has been clinically used for a wide range of indications. Wireless and batteryless stimulators offer important capabilities such as no need for reoperation, and extended life compared to their wired counterparts. However, there are challenging trade-offs between the device size and its operating range, which can limit their use. This study aimed to examine the functionality of newly designed wirelessly powered and controlled implants in vagus nerve stimulation for pigs. The implant used near field inductive coupling at 13.56 MHz industrial, scientific, and medical band to harvest power from an external coil. The circular implant had a diameter of 13 mm and weighed 483 mg with cuff electrodes. The efficiency of the inductive link and robustness to distance and misalignment were optimized. As a result, the specific absorption rate was orders of magnitude lower than the safety limit, and the stimulation can be performed using only 0.1 W of external power. For the first time, wireless and batteryless VNS with more than 5 cm operation range was demonstrated in pigs. A total of 84 vagus nerve stimulations (10 s each) have been performed in three adult pigs. In a quantitative comparison of the effectiveness of VNS devices, the efficiency of systems on reducing heart rate was similar in both conventional (75%) and wireless (78.5%) systems. The pulse width and frequency of the stimulation were swept on both systems, and the response for physiological markers was drawn. The results were easily reproducible, and methods used in this study can serve as a basis for future wirelessly powered implants.
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Affiliation(s)
- Iman Habibagahi
- Electrical and Computer Engineering Department, University of California Los Angeles, Los Angeles, CA, USA.
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Joseph Hadaya
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA.,UCLA Neurocardiology Research Program of Excellence, University of California Los Angeles, Los Angeles, CA, USA.,Molecular, Cellular and Integrative Physiology Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Hongming Lyu
- Electrical and Computer Engineering Department, University of California Los Angeles, Los Angeles, CA, USA
| | - Jaeeun Jang
- Electrical and Computer Engineering Department, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey L Ardell
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA.,UCLA Neurocardiology Research Program of Excellence, University of California Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Aydin Babakhani
- Electrical and Computer Engineering Department, University of California Los Angeles, Los Angeles, CA, USA.
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13
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Clinical perspectives on vagus nerve stimulation: present and future. Clin Sci (Lond) 2022; 136:695-709. [PMID: 35536161 PMCID: PMC9093220 DOI: 10.1042/cs20210507] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
The vagus nerve, the great wanderer, is involved in numerous processes throughout the body and vagus nerve stimulation (VNS) has the potential to modulate many of these functions. This wide-reaching capability has generated much interest across a range of disciplines resulting in several clinical trials and studies into the mechanistic basis of VNS. This review discusses current preclinical and clinical evidence supporting the efficacy of VNS in different diseases and highlights recent advancements. Studies that provide insights into the mechanism of VNS are considered.
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14
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Shlobin NA, Volovici V, Ikram MK. Case-Control Studies in Neurosurgery: the Issue of Effect Estimates. World Neurosurg 2022; 163:e187-e191. [PMID: 35367643 DOI: 10.1016/j.wneu.2022.03.097] [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: 03/02/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Clinical research questions are commonly answered using a case-control design. The decision to use this design is usually justified due to low cost, feasibility, and ease of execution. However, the case-control design presents challenges in execution, selection of cases/controls, and interpretation of effect measures (odds ratios, among others). In this paper, we clarify for a neurosurgical audience the design and appropriate effect size measures obtained from case-control studies. METHODS A narrative review was conducted of published literature on the topic. The future implementation of such studies was discussed and highlighted with several examples from neurosurgical practice. RESULTS In a case-control design, participants are selected for a study based on their outcome status. Some participants have the outcome of interest (cases), whereas others do not (controls). Controls can be selected from a variety of sources, such as the general population, relatives/friends, or hospital patients without the disease under investigation. The most important criterion is that these controls come from the same study base as cases. Furthermore, it is essential to realize that measures of association obtained from a case-control study depend on the sampling strategy of the controls and, as such, have equivalent counterparts available from cohort studies. We delineate traditional case-control, case-cohort, and incidence-density sampled case-control studies and their applicability to common conditions encountered in daily neurosurgical practice (e.g. glioblastoma, aneurysms, and epilepsy). CONCLUSIONS Neurosurgeons must understand the types of case-control studies and their associated effect measures to properly conduct research and incorporate research findings into clinical practice.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands; Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
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15
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Marmerstein JT, McCallum GA, Durand DM. Decoding Vagus-Nerve Activity with Carbon Nanotube Sensors in Freely Moving Rodents. BIOSENSORS 2022; 12:bios12020114. [PMID: 35200374 PMCID: PMC8870245 DOI: 10.3390/bios12020114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 05/07/2023]
Abstract
The vagus nerve is the largest autonomic nerve and a major target of stimulation therapies for a wide variety of chronic diseases. However, chronic recording from the vagus nerve has been limited, leading to significant gaps in our understanding of vagus nerve function and therapeutic mechanisms. In this study, we use a carbon nanotube yarn (CNTY) biosensor to chronically record from the vagus nerves of freely moving rats for over 40 continuous hours. Vagal activity was analyzed using a variety of techniques, such as spike sorting, spike-firing rates, and interspike intervals. Many spike-cluster-firing rates were found to correlate with food intake, and the neural-firing rates were used to classify eating and other behaviors. To our knowledge, this is the first chronic recording and decoding of activity in the vagus nerve of freely moving animals enabled by the axon-like properties of the CNTY biosensor in both size and flexibility and provides an important step forward in our ability to understand spontaneous vagus-nerve function.
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16
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Vagus nerve stimulation alleviated cerebral ischemia and reperfusion injury in rats by inhibiting pyroptosis via α7 nicotinic acetylcholine receptor. Cell Death Dis 2022; 8:54. [PMID: 35136042 PMCID: PMC8825823 DOI: 10.1038/s41420-022-00852-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 12/14/2022]
Abstract
Cumulative evidence suggests that pyroptosis, a new sort of programmed cell death, is closely related to cerebral ischemia/reperfusion (I/R) injury. Our previous studies have testified that vagus nerve stimulation (VNS) was involved in many different neuroprotective and neuroplasticity pathways via α7 nicotinic acetylcholine receptor (α7nAchR), a vital node of the cholinergic anti-inflammatory pathway during cerebral I/R injury. We aimed to determine the neuroprotective effects of VNS through α7nAchR-mediated inhibition of pyroptosis. Focal cerebral ischemic stroke rat models were obtained by middle cerebral artery occlusion for 120 min. Expression of the NLRP3 inflammasome was evaluated using western blotting and immunofluorescence (IF) staining. The neurological deficit score, infarct volume, TUNEL staining findings, transmission electron microscopy findings, and expression of inflammatory cytokines were assessed 3 days after I/R injury. Our findings suggested that the protein expression levels of NLRP3, GSDMD-N, cleaved caspase-1, and ASC gradually increased until they peaked on day 3 after I/R injury. VNS inhibited the expression of pyroptosis-related molecules and decreased the number of pyroptotic cells and membrane pores. Administration of α7nAchR-antagonist and agonist helped in further assessment of the role of α7nAchR in pyroptosis. α7nAchR-agonist mimicked VNS’s neuroprotective effects on the improvement of neurological deficits, the reduction of infarct volumes, and the inhibition of neuronal pyroptosis after cerebral I/R injury. Conversely, the neuroprotection provided by VNS could be reversed by the administration of α7nAchR-antagonist. In conclusion, VNS-induced neuroprotection via inhibition of neuronal pyroptosis was α7nAchR-dependent, highlighting the pivotal role of α7nAChR in suppressing cellular pyroptosis and neuroinflammation. These findings may allow a better understanding of treatment principles for cerebral I/R injury.
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Abstract
Three neuromodulation therapies, all using implanted device and electrodes, have been
approved to treat adults with drug-resistant focal epilepsy, namely, the vagus nerve
stimulation in 1995, deep brain stimulation of the anterior nucleus of the thalamus
(ANT-DBS) in 2018 (2010 in Europe), and responsive neurostimulation (RNS) in 2014.
Indications for VNS have more recently extended to children down to age of 4. Limited or
anecdotal data are available in other epilepsy syndromes and refractory/super-refractory
status epilepticus. Overall, neuromodulation therapies are palliative, with only a
minority of patients achieving long-term seizure freedom, justifying favoring such
treatments in patients who are not good candidates for curative epilepsy surgery. About
half of patients implanted with VNS, ANT-DBS, and RNS have 50% or greater reduction in
seizures, with long-term data suggesting increased efficacy over time. Besides their
impact on seizure frequency, neuromodulation therapies are associated with various
benefits and drawbacks in comparison to antiseizure drugs. Yet, we lack high-level
evidence to best position each neuromodulation therapy in the treatment pathways of
persons with difficult-to-treat epilepsy.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lara E. Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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18
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Human intracranial recordings reveal distinct cortical activity patterns during invasive and non-invasive vagus nerve stimulation. Sci Rep 2021; 11:22780. [PMID: 34815529 PMCID: PMC8611055 DOI: 10.1038/s41598-021-02307-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022] Open
Abstract
Vagus nerve stimulation (VNS) is being used increasingly to treat a wide array of diseases and disorders. This growth is driven in part by the putative ability to stimulate the nerve non-invasively. Despite decades of use and a rapidly expanding application space, we lack a complete understanding of the acute effects of VNS on human cortical neurophysiology. Here, we investigated cortical responses to sub-perceptual threshold cervical implanted (iVNS) and transcutaneous auricular (taVNS) vagus nerve stimulation using intracranial neurophysiological recordings in human epilepsy patients. To understand the areas that are modulated by VNS and how they differ depending on invasiveness and stimulation parameters, we compared VNS-evoked neural activity across a range of stimulation modalities, frequencies, and amplitudes. Using comparable stimulation parameters, both iVNS and taVNS caused subtle changes in low-frequency power across broad cortical networks, which were not the same across modalities and were highly variable across participants. However, within at least some individuals, it may be possible to elicit similar responses across modalities using distinct sets of stimulation parameters. These results demonstrate that both invasive and non-invasive VNS cause evoked changes in activity across a set of highly distributed cortical networks that are relevant to a diverse array of clinical, rehabilitative, and enhancement applications.
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Ryvlin P, Rheims S, Hirsch LJ, Sokolov A, Jehi L. Neuromodulation in epilepsy: state-of-the-art approved therapies. Lancet Neurol 2021; 20:1038-1047. [PMID: 34710360 DOI: 10.1016/s1474-4422(21)00300-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022]
Abstract
Three neuromodulation therapies have been appropriately tested and approved in refractory focal epilepsies: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS), and closed-loop responsive neurostimulation of the epileptogenic zone or zones. These therapies are primarily palliative. Only a few individuals have achieved complete freedom from seizures for more than 12 months with these therapies, whereas more than half have benefited from long-term reduction in seizure frequency of more than 50%. Implantation-related adverse events primarily include infection and pain at the implant site. Intracranial haemorrhage is a frequent adverse event for ANT-DBS and responsive neurostimulation. Other stimulation-specific side-effects are observed with VNS and ANT-DBS. Biomarkers to predict response to neuromodulation therapies are not available, and high-level evidence to aid decision making about when and for whom these therapies should be preferred over other antiepileptic treatments is scant. Future studies are thus needed to address these shortfalls in knowledge, approve other forms of neuromodulation, and develop personalised closed-loop therapies with embedded machine learning. Until then, neuromodulation could be considered for individuals with intractable seizures, ideally after the possibility of curative surgical treatment has been carefully assessed and ruled out or judged less appropriate.
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Affiliation(s)
- Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon 1 University Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale U1028/CNRS UMR 5292 Epilepsy Institute, Lyon, France
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Arseny Sokolov
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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20
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Wu ML, Hu DM, Wang JJ, Liu XL, Liu L, Li Y, Jing W. Pre- and postoperative heart rate variability and vagus nerve stimulation in patients with drug-resistant epilepsy - A meta-analysis. Epilepsy Behav 2021; 123:108247. [PMID: 34418640 DOI: 10.1016/j.yebeh.2021.108247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy. METHODS We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were "vagal nerve stimulation," "epilepsy" and "heart rate variability". Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis. RESULTS Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from -1.00 to -0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from -0.74 to -0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups. CONCLUSION VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.
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Affiliation(s)
- Mao-Lin Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | - Dan-Mei Hu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | | | - Xiao-Lei Liu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China
| | - Lei Liu
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Yuan Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China.
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China; Key Laboratory of Cellular Physiology (Shanxi Medical University), Ministry of Education, Taiyuan, Shanxi, China.
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21
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Wei W, Zhang Z, Chen N, Zuo M, Yu T. On disturbance rejection control of the epileptiform spikes. Cogn Neurodyn 2021; 16:425-441. [PMID: 35401872 PMCID: PMC8934905 DOI: 10.1007/s11571-021-09704-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/27/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022] Open
Abstract
Epilepsy is a neurological disorder resulting from a sudden development of synchronous firing in a massive group of neurons. For the particularity of the epilepsy, a neural mass model (NMM) is commonly utilized to understand and simulate the mechanism and evolution of the epilepsy. In this paper, based on a multi-coupling NMM and real EEGs of an epileptic mouse, a computational epileptic model is established to simulate the abnormal discharges of a mouse during seizures. Thus, rather than make animal experiments directly, numerical tests can be performed first. It reduces risks and helps improve the closed-loop neuromodulation. In addition, considering that no epileptic model can be utilized for neuromodulation in clinic, and even if a model exists, it still cannot describe the dynamics of the epilepsy faithfully, a scalable observer bandwidth and phase leading active disturbance rejection control (SOB-PLADRC) is proposed. Accordingly, a timelier and more accurate total disturbance estimation can be obtained by a scalable observer bandwidth and phase leading extended state observer, and an expected closed-loop neuromodulation can be realized without an accurate epileptic model. Numerical simulations based on the established model also show that the SOB-PLADRC suppresses seizures best among the PI and other active disturbance rejection approaches. More powerful disturbance rejection ability and more satisfactory closed-loop neuromodulation make the SOB-PLADRC more promising in the seizure control.
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22
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Zhu J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. Altered topological properties of brain functional networks in drug-resistant epilepsy patients with vagus nerve stimulators. Seizure 2021; 92:149-154. [PMID: 34521062 DOI: 10.1016/j.seizure.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/19/2021] [Accepted: 09/05/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To explore abnormalities of topological properties in drug-resistant epilepsy (DRE) patients after vagus nerve stimulation (VNS) by analyzing brain functional networks using graph theory. METHODS Fifteen patients and eight healthy controls (HC) were scanned separately with resting-state functional magnetic resonance imaging (rs-fMRI). Graph theoretical analyses were chosen to compare the global (small-world parameters [γ, λ, σ, Cp, and Lp], and network efficiency [Eg and Eloc]), and nodal (BC, DC, and NE) properties in preoperative patients (EPpre), postoperative patients (EPpost) and HC. RESULTS HC, EPpre and EPpost all satisfied the criteria for small-world properties (σ > 1) within the sparsity range of 0.05-0.5. Compared with EPpre, EPpost performed higher in λ and Eloc but lower in γ, σ, and Cp. Compared with HC, EPpre exhibited decreased BC, DC or NE in the right inferior frontal gyrus, right superior temporal gyrus, bilateral cingulate gyri, right supplementary motor area, right superior occipital gyrus, right Heschl gyrus, and left calcarine fissure; increased BC in the left postcentral/precentral gyrus, right paracentral lobule, left rolandic operculum, and left supramarginal gyrus, and increased NE in the right caudate nucleus. Compared with EPpre, EPpost showed increased BC, DC or NE in the bilateral inferior frontal gyrus, right middle frontal gyrus, bilateral cingulate gyri, right superior temporal gyrus, and right Heschl gyrus and decreased BC in the left fusiform gyrus. CONCLUSION VNS downregulated small-world properties in DRE, and caused changes in some key nodes to reorganize the transmission ability of the large-scale network.
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Affiliation(s)
- Jin Zhu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China.
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Grey and white matter microstructure changes in epilepsy patients with vagus nerve stimulators. Clin Neurol Neurosurg 2021; 209:106918. [PMID: 34500340 DOI: 10.1016/j.clineuro.2021.106918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/15/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Vagus nerve stimulation (VNS) has been widely used as an effective treatment for patients with drug-resistant epilepsy (DRE). However, little is known about grey matter (GM) and white matter (WM) microstructure changes caused by VNS. This study aimed to detect consistent GM and WM alterations in epilepsy patients with vagus nerve stimulators. METHODS The diffusion tensor imaging data was acquired from 15 patients who underwent VNS implantation. The voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) were used to detect group differences in GM and WM microstructure and explore their correlation with postoperative seizure reduction. RESULTS After 3 months of stimulation, GM density reduced in right cerebellum, left superior temporal gyrus, right inferior temporal gyrus and left thalamus, and increased in left cerebellum, left inferior parietal lobule, left middle occipital gyrus and left gyrus rectus. No significant volume changes had been found in 14 subcortical nuclei. The fractional anisotropy (FA) values reduced in left superior longitudinal fasciculus and left corticospinal tract, and increased in bilateral cingulum and body of corpus callosum. The mean diffusivity (MD) values reduced in right retrolenticular part of internal capsule, right posterior corona radiata and right superior longitudinal fasciculus. The seizure reduction had positive correlation trends with the volume reduction in left nucleus accumbens and right amygdala, and MD reduction in right medial lemniscus and right posterior corona radiata. CONCLUSIONS The results showed that VNS could cause changes of GM density, WM FA and MD values in epilepsy patients. The volume and MD reduction in some subcortical structures might participate in the seizure frequency reduction of VNS.
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Parihar J, Agrawal M, Samala R, Chandra PS, Tripathi M. Role of Neuromodulation for Treatment of Drug-Resistant Epilepsy. Neurol India 2021; 68:S249-S258. [PMID: 33318359 DOI: 10.4103/0028-3886.302476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The choice of neuromodulation techniques has greatly increased over the past two decades. While vagal nerve stimulation (VNS) has become established, newer variations of VNS have been introduced. Following the SANTE's trial, deep brain stimulation (DBS) is now approved for clinical use. In addition, responsive neurostimulation (RNS) has provided exciting new opportunities for treatment of drug-resistant epilepsy. While neuromodulation mostly offers only a 'palliative' measure, it still provides a significant reduction of frequency and intensity of epilepsy. We provide an overview of all the techniques of neuromodulation which are available, along with long-term outcomes. Further research is required to delineate the exact mechanism of action, the indications and the stimulation parameters to extract the maximum clinical benefit from these techniques.
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Affiliation(s)
- Jasmine Parihar
- Department of Neurology, Lady Harding Medical College, New Delhi, India
| | | | - Raghu Samala
- Department of Neurosurgery, AIIMS, New Delhi, India
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Shan W, Mao X, Wang X, Hogan RE, Wang Q. Potential surgical therapies for drug-resistant focal epilepsy. CNS Neurosci Ther 2021; 27:994-1011. [PMID: 34101365 PMCID: PMC8339538 DOI: 10.1111/cns.13690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.
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Affiliation(s)
- Wei Shan
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
| | - Xuewei Mao
- Shandong Key Laboratory of Industrial Control TechnologySchool of AutomationQingdao UniversityQingdaoChina
| | - Xiu Wang
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
| | - Robert E. Hogan
- Departments of Neurology and NeurosurgerySchool of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Qun Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
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Lampros M, Vlachos N, Zigouris A, Voulgaris S, Alexiou GA. Transcutaneous Vagus Nerve Stimulation (t-VNS) and epilepsy: A systematic review of the literature. Seizure 2021; 91:40-48. [PMID: 34090145 DOI: 10.1016/j.seizure.2021.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Transcutaneous auricular vagus nerve stimulation (t-VNS) has been proposed as an alternative method for the treatment of various neurological and psychiatric disorders. Contrary to the classic invasive vagus nerve stimulation (i-VNS), t-VNS does not require surgical intervention. The application of t-VNS for the treatment of epilepsy has been poorly studied. Hence, we performed a systematic review of the literature to elucidate efficacy, adverse effects and technical features of t-VNS in patients with epilepsy. MATERIAL AND METHODS We systematically searched MEDLINE and SCOPUS databases using the following keywords: [TRANSCUTANEOUS VAGUS NERVE STIMULATION OR TRANSCUTANEOUS VAGAL NERVE STIMULATION] AND [EPILEPSY OR SEIZURES]. We searched for observational studies in English concerning the application of t-VNS for the treatment of epilepsy in humans. The full-text version of relevant studies was obtained and reviewed. Technical parameters of the stimulation, percentage of seizure frequency reduction, QOLIE-31(Quality of Life In Epilepsy-31) and LSSS (Liverpool Seizure Severity Scale) questionnaires and adverse effects were recorded and analyzed. RESULTS A total of 10 studies with 350 patients were included. Both bilateral and unilateral placement of the electrode were applied. Stimulation frequency varied from 10-30Hz, while treatment intensity was usually adjusted according to patients' preferences and tolerance (around 1mA) and below the pain threshold. In the clinical trials included in our review, the mean seizure frequency reduction varied from 30 to 65%. Eight and four studies provided information about QOLIE-31 and LSSS questionnaires respectively. Three studies reported a statistically significant (p<0,05) improvement in patients' quality of life and two studies reported statistically significant (p<0,05) seizure severity reduction. The most common side effect was headache (8,9%), followed by skin irritation at the placement site (7,1%) and nasopharyngitis (5,1%). No serious or life-threatening side effects were reported. CONCLUSION Due to the heterogeneity of the included studies, no safe conclusions could be extracted concerning the efficacy of t-VNS. However, the results of this review suggest that patients with epilepsy could possibly benefit from the use of t-VNS. The present study also emphasizes the limitations of previous clinical trials concerning the applications of t-VNS in people with epilepsy and thus could be a guidance for the conduction of future trials.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Vlachos
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Zigouris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece.
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Dougherty MI, Zarroli K, Kapur J. Improvement in Symptomatic Gastroparesis With Increased Vagal Nerve Stimulation. Neurol Clin Pract 2021; 11:e18-e19. [PMID: 33968483 DOI: 10.1212/cpj.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/25/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Michael I Dougherty
- Department of Neurology (MID, KZ, JK), University of Virginia School of Medicine, Charlottesville
| | - Katherine Zarroli
- Department of Neurology (MID, KZ, JK), University of Virginia School of Medicine, Charlottesville
| | - Jaideep Kapur
- Department of Neurology (MID, KZ, JK), University of Virginia School of Medicine, Charlottesville
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Direct measurement of vagal tone in rats does not show correlation to HRV. Sci Rep 2021; 11:1210. [PMID: 33441733 PMCID: PMC7807082 DOI: 10.1038/s41598-020-79808-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
The vagus nerve is the largest autonomic nerve, innervating nearly every organ in the body. “Vagal tone” is a clinical measure believed to indicate overall levels of vagal activity, but is measured indirectly through the heart rate variability (HRV). Abnormal HRV has been associated with many severe conditions such as diabetes, heart failure, and hypertension. However, vagal tone has never been directly measured, leading to disagreements in its interpretation and influencing the effectiveness of vagal therapies. Using custom carbon nanotube yarn electrodes, we were able to chronically record neural activity from the left cervical vagus in both anesthetized and non-anesthetized rats. Here we show that tonic vagal activity does not correlate with common HRV metrics with or without anesthesia. Although we found that average vagal activity is increased during inspiration compared to expiration, this respiratory-linked signal was not correlated with HRV either. These results represent a clear advance in neural recording technology but also point to the need for a re-interpretation of the link between HRV and “vagal tone”.
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Zhu J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. The changes in the topological properties of brain structural network based on diffusion tensor imaging in pediatric epilepsy patients with vagus nerve stimulators: A graph theoretical analysis. Brain Dev 2021; 43:97-105. [PMID: 32713660 DOI: 10.1016/j.braindev.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to analyze the topological characteristics of brain structural network in pediatric epilepsy patients with vagus nerve stimulation (VNS) by applying graph theoretical approaches. METHODS Nine patients with generalized seizures and eight normal controls (NC) were enrolled. Based on diffusion tensor imaging, graph theory analysis was used to characterize the topological properties in preoperative patients (EP-pre), postoperative patients (EP-post) and NC. The global properties included clustering coefficient (Cp), shortest path length (Lp), small-worldness (γ, λ, δ), global network efficiency (Eg) and local network efficiency (Eloc). The regional properties included degree centrality (DC), nodal efficiency (NE), nodal local efficiency (NLE) and nodal shortest path length (Np). Two sample t-test and paired sample t-test were utilized to compare properties difference. RESULTS All three groups followed small-world characteristics. There was no significant difference in small-worldness, Cp, Lp, Eg or Eloc between EP-pre and EP-post. Compared with EP-pre: DC in EP-post decreased in the right cuneus and right temporal gyri, while increased in the right paracentral lobule; NE in EP-post decreased in the left dorsolateral superior frontal gyrus, right cuneus, right supramarginal gyrus, and right rolandic operculum, while increased in the right paracentral lobule; NLE in EP-post decreased in the left posterior cingulate gyrus and right supramarginal gyrus, while increased in the left parahippocampal gyrus; NP in EP-post decreased in the right paracentral lobule, while increased in the right cuneus. CONCLUSION VNS causes topological characteristics changes in pediatric patients with generalized seizures through regulating regional properties in some brain structures.
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Affiliation(s)
- Jin Zhu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Wang Z, Feng Z, Yuan Y, Zheng L. Suppressing synchronous firing of epileptiform activity by high-frequency stimulation of afferent fibers in rat hippocampus. CNS Neurosci Ther 2020; 27:352-362. [PMID: 33325622 PMCID: PMC7871785 DOI: 10.1111/cns.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 12/18/2022] Open
Abstract
Aims Deep brain stimulation (DBS) is a promising technology for treating epilepsy. However, the efficacy and underlying mechanisms of the high‐frequency stimulation (HFS) utilized by DBS to suppress epilepsy remain uncertain. Previous studies have shown that HFS can desynchronize the firing of neurons. In this study, we investigated whether the desynchronization effects of HFS can suppress epileptiform events. Methods HFS trains with seconds of duration (short) and a minute of duration (long) were applied at the afferent fibers (ie, Schaffer collaterals) of the hippocampal CA1 region in anesthetized rats in vivo. The amplitude and the rate of population spikes (PS) appeared in the downstream of stimulation were calculated to evaluate the intensity of synchronized firing of neuronal populations between short and long HFS groups. A test of paired‐pulse depression (PPD) was used to assess the alteration of inhibitory neuronal circuits. Results The sustained stimulation of a 60‐s long HFS suppressed the afterdischarges that were induced by a 5‐s short HFS to impair the local inhibitions. During the sustained HFS, the mean PS amplitude reduced significantly and the burst firing decreased, while the amount of neuronal firing did not change significantly. The paired‐pulse tests showed that with a similar baseline level of small PS2/PS1 ratio indicating a strong PPD, the 5‐s HFS increased the PS2/PS1 ratio to a value that was significantly greater than the corresponding ratio during sustained HFS, indicating that the PPD impaired by a short HFS may be restored by a sustained HFS. Conclusions The sustained HFS can desynchronize the population firing of epileptiform activity and accelerate a recovery of inhibitions to create a balance between the excitation and the inhibition of local neuronal circuits. The study provides new clues for further understanding the mechanism of DBS and for advancing the clinical application of DBS in treating epilepsy.
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Affiliation(s)
- Zhaoxiang Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Zhouyan Feng
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Yue Yuan
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Lvpiao Zheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Ding Y, Wang J, Zhou Y, Yu L, Zhang L, Zhou S, Wang Y. Quality of life in children with tuberous sclerosis complex: A pediatric cohort study. CNS Neurosci Ther 2020; 27:280-288. [PMID: 33225634 PMCID: PMC7871787 DOI: 10.1111/cns.13473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
Aims To evaluate the quality‐of‐life (QOL) impairment and identify the possible risk factors in patients with tuberous sclerosis complex (TSC) in China. Methods The parent proxy‐report PedsQL 4.0 Generic Core Scales were administered to 124 caregivers of children with TSC (aged 2‐18 years). For comparison, the survey was also conducted in a demographically group‐matched sample of healthy controls (HCs) (aged 2‐18 years). Results A total of 124 children with TSC and 206 HCs were recruited. The mean parent proxy‐report total scale score, physical health summary score, and psychosocial health summary score for children with TSC were 65.0 (SD 19.7), 77.6 (SD 22.9), and 58.0 (SD 21.3), respectively, compared with the HC values of 83.6 (SD 14.3), 87.2 (SD 16.9), and 82.8 (SD 15.9). There were statistically significant differences between the two groups (P < .0001). TSC2 mutation (P = .033), epilepsy (P = .011), seizure before 2 years old (P = .001), course of epilepsy (more than 2 years) (P = .001), high reported seizure frequency (more than once a month) (HRSF) (P = .007), multiple antiepileptic drugs (≥2) (P = .002), intellectual disability (ID) (mild and moderate ID, P < .0001, and severe and profound ID, P < .0001), and TANDs (P < .0001) (ADHD, P = .004; agoraphobia, P = .007; and social anxiety disorder, P < .0001) were closely related to lower QOL scores. Conclusion This study is the first large cohort study on QOL in children with TSC in China. The results of the PedsQL 4.0 indicated that the QOL of children with TSC is significantly lower than that of HCs. TSC2 mutation, epilepsy, early onset, long disease course and HRSF, ID, and TANDs are risk factors for poor QOL.
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Affiliation(s)
- Yifeng Ding
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Ji Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Lifei Yu
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Linmei Zhang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
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Zhu J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. Epilepsy duration as an independent predictor of response to vagus nerve stimulation. Epilepsy Res 2020; 167:106432. [DOI: 10.1016/j.eplepsyres.2020.106432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022]
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Zhu J, Wang J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. The functional connectivity study on the brainstem-cortical/subcortical structures in responders following cervical vagus nerve stimulation. Int J Dev Neurosci 2020; 80:679-686. [PMID: 32931055 DOI: 10.1002/jdn.10064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical vagus nerve stimulation (VNS) is an effective neuromodulation therapy for patients with drug-resistant epilepsy (DRE). The previous studies reported that VNS may reduce seizures by regulating the functional connectivity (FC) between cortical and subcortical regions. However, no studies on brainstem have been done in responders who achieved ≥50% seizure reduction following VNS. METHODS Eight healthy controls and eight patients who became responders after 3 months of operation were enrolled in this study. Resting-state functional MRI (rs-fMRI) was performed, and two sample and paired sample t test were, respectively, used to detect altered FC between brainstem and cortical/subcortical regions between controls and patients, between preoperative and postoperative patients. RESULTS In the control group, regions with highest FC to brainstem included bilateral anterior cingulate gyri, left basal ganglia, left insula, left cuneus, right precuneus, and bilateral cerebellum. In preoperative patients, right frontal middle gyrus, bilateral basal ganglia, and right cerebellum were showed highest FC to brainstem. Compared with the controls, preoperative patients exhibited increased FC in bilateral inferior frontal gyri, right temporal cortex, while decreased FC in left insula, left postcentral gyrus, right posterior cingulate gyrus, right precuneus, and left superior parietal gyrus. In postoperative patients, regions with increased FC to brainstem were left insula, left precuneus and left cuneus, and those with decreased FC were right inferior occipital gyrus and right cerebellum. CONCLUSIONS Recurrent seizures caused disturbances in brainstem-cortical/subcortical FC, especially in motor executive function related regions and default mode network. VNS could reorganize the altered FC between brainstem and insula, precuneus, and cerebellum in responders.
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Affiliation(s)
- Jin Zhu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingjuan Wang
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Health Technology Assessment Report on Vagus Nerve Stimulation in Drug-Resistant Epilepsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176150. [PMID: 32847092 PMCID: PMC7504285 DOI: 10.3390/ijerph17176150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 01/12/2023]
Abstract
Background: Vagus nerve stimulation (VNS) is a palliative treatment for medical intractable epileptic syndromes not eligible for resective surgery. Health technology assessment (HTA) represents a modern approach to the analysis of technologies used for healthcare. The purpose of this study is to assess the clinical, organizational, financial, and economic impact of VNS therapy in drug-resistant epilepsies and to establish the congruity between costs incurred and health service reimbursement. Methods: The present study used an HTA approach. It is based on an extensive detailed bibliographic search on databases (Medline, Pubmed, Embase and Cochrane, sites of scientific societies and institutional sites). The HTA study includes the following issues: (a) social impact and costs of the disease; (b) VNS eligibility and clinical results; (c) quality of life (QoL) after VNS therapy; (d) economic impact and productivity regained after VNS; and (e) costs of VNS. Results: Literature data indicate VNS as an effective treatment with a potential positive impact on social aspects and on quality of life. The diagnosis-related group (DRG) financing, both on national and regional levels, does not cover the cost of the medical device. There was an evident insufficient coverage of the DRG compared to the full cost of implanting the device. Conclusions: VNS is a palliative treatment for reducing seizure frequency and intensity. Despite its economic cost, VNS should improve patients’ quality of life and reduce care needs.
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The role of chronobiology in drug-resistance epilepsy: The potential use of a variability and chronotherapy-based individualized platform for improving the response to anti-seizure drugs. Seizure 2020; 80:201-211. [DOI: 10.1016/j.seizure.2020.06.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
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Zhu J, Xu C, Zhang X, Qiao L, Wang X, Zhang X, Yan X, Ni D, Yu T, Zhang G, Li Y. A resting-state functional MRI study on the effect of vagal nerve stimulation on spontaneous regional brain activity in drug-resistant epilepsy patients. Behav Brain Res 2020; 392:112709. [DOI: 10.1016/j.bbr.2020.112709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
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Fan JJ, Shan W, Wu JP, Wang Q. Research progress of vagus nerve stimulation in the treatment of epilepsy. CNS Neurosci Ther 2019; 25:1222-1228. [PMID: 31429206 PMCID: PMC6834923 DOI: 10.1111/cns.13209] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022] Open
Abstract
The International League Against Epilepsy (ILAE) defined drug‐resistant epilepsy (DRE) that epilepsy seizure symptoms cannot be controlled with two well‐tolerated and appropriately chosen antiepileptic drugs, whether they are given as monotherapy or in combination. According to the WHO reports, there is about 30%‐40% of epilepsy patients belong to DRE. These patients need some treatments other than drugs, such as epilepsy surgery, and neuromodulation treatment. Traditional surgical approaches may be limited by the patient's clinical status, pathological tissue location, or overall prognosis. Thus, neuromodulation is an alternative choice to control their symptoms. Vagus nerve stimulation (VNS) is one of the neuromodulation methods clinically, which have been approved by the Food and Drug Administration (FDA). In this review, we systematically describe the clinical application, clinical effects, possible antiepileptic mechanisms, and future research directions of VNS for epilepsy.
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Affiliation(s)
- Jing-Jing Fan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Medicine of Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wei Shan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Medicine of Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jian-Ping Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Medicine of Neurological Diseases, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Medicine of Neurological Diseases, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
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