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Owens MM, Jacquemet V, Napadow V, Lewis N, Beaumont E. Brainstem neuronal responses to transcutaneous auricular and cervical vagus nerve stimulation in rats. J Physiol 2024; 602:4027-4052. [PMID: 39031516 PMCID: PMC11326965 DOI: 10.1113/jp286680] [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: 04/02/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) targets subcutaneous axons in the auricular branch of the vagus nerve at the outer ear. Its non-invasive nature makes it a potential treatment for various disorders. taVNS induces neuromodulatory effects within the nucleus of the solitary tract (NTS), and due to its widespread connectivity, the NTS acts as a gateway to elicit neuromodulation in both higher-order brain regions and other brainstem nuclei (e.g. spinal trigeminal nucleus; Sp5). Our objective was to examine stimulation parameters on single-neuron electrophysiological responses in α-chloralose-anaesthetized Sprague-Dawley rats within NTS and Sp5. taVNS was also compared to traditional cervical VNS (cVNS) on single neuronal activation. Specifically, electrophysiological extracellular recordings were evaluated for a range of frequency and intensity parameters (20-250 Hz, 0.5-1.0 mA). Neurons were classified as positive, negative or non-responders based on increased activity, decreased activity or no response during stimulation, respectively. Frequency-dependent analysis showed that 20 and 100 Hz generated the highest proportion of positive responders in NTS and Sp5 with 1.0 mA intensities eliciting the greatest magnitude of response. Comparisons between taVNS and cVNS revealed similar parameter-specific activation for caudal NTS neuronal populations; however, individual neurons showed different activation profiles. The latter suggests that cVNS and taVNS send afferent input to NTS via different neuronal pathways. This study demonstrates differential parameter-specific taVNS responses and begins an investigation of the mechanisms responsible for taVNS modulation. Understanding the neuronal pathways responsible for eliciting neuromodulatory effects will enable more tailored taVNS treatments in various clinical disorders. KEY POINTS: Transcutaneous auricular vagus nerve stimulation (taVNS) offers a non-invasive alternative to invasive cervical vagus nerve stimulation (cVNS) by activating vagal afferents in the ear to induce neuromodulation. Our study evaluated taVNS effects on neuronal firing patterns in the nucleus of the solitary tract (NTS) and spinal trigeminal nucleus (Sp5) and found that 20 and 100 Hz notably increased neuronal activity during stimulation in both nuclei. Increasing taVNS intensity not only increased the number of neurons responding in Sp5 but also increased the magnitude of response, suggesting a heightened sensitivity to taVNS compared to NTS. Comparisons between cVNS and taVNS revealed similar overall activation but different responses on individual neurons, indicating distinct neural pathways. These results show parameter-specific and nuclei-specific responses to taVNS and confirm that taVNS can elicit responses comparable to cVNS at the neuronal level, but it does so through different neuronal pathways.
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Affiliation(s)
- Misty M Owens
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Research Center, Sacred Heart Hospital of Montreal, Montreal, Quebec, Canada
| | - Vitaly Napadow
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole Lewis
- Department of Medical Education, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Eric Beaumont
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Yang S, Wu YR, Zhan Z, Pan YH, Jiang JF. State- and frequency-dependence in autonomic rebalance mediated by intradermal auricular electroacupuncture stimulation. Front Neurosci 2024; 18:1367266. [PMID: 38846714 PMCID: PMC11153749 DOI: 10.3389/fnins.2024.1367266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Background Vagus nerve stimulation (VNS) improves diseases such as refractory epilepsy and treatment-resistant depression, likely by rebalancing the autonomic nervous system (ANS). Intradermal auricular electro-acupuncture stimulation (iaES) produces similar effects. The aim of this study was to determine the effects of different iaES frequencies on the parasympathetic and sympathetic divisions in different states of ANS imbalance. Methods We measured heart rate variability (HRV) and heart rate (HR) of non-modeled (normal) rats with the treatment of various frequencies to determine the optimal iaES frequency. The optimized iaES frequency was then applied to ANS imbalance model rats to elucidate its effects. Results 30 Hz and 100 Hz iaES clearly affected HRV and HR in normal rats. 30 Hz iaES increased HRV, and decreased HR. 100 Hz iaES decreased HRV, and increased HR. In sympathetic excited state rats, 30 Hz iaES increased HRV. 100 Hz iaES increased HRV, and decreased HR. In parasympathetic excited state rats, 30 Hz and 100 Hz iaES decreased HRV. In sympathetic inhibited state rats, 30 Hz iaES decreased HRV, while 100 Hz iaES decreased HR. In parasympathetic inhibited rats, 30 Hz iaES decreased HR and 100 Hz iaES increased HRV. Conclusion 30 Hz and 100 Hz iaES contribute to ANS rebalance by increasing vagal and sympathetic activity with different amplifications. The 30 Hz iaES exhibited positive effects in all the imbalanced states. 100 Hz iaES suppressed the sympathetic arm in sympathetic excitation and sympathetic/parasympathetic inhibition and suppressed the vagal arm and promoted the sympathetic arm in parasympathetic excitation and normal states.
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Affiliation(s)
| | | | | | | | - Jin-Feng Jiang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
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Szaflarski JP, Allendorfer JB, Begnaud J, Ranuzzi G, Shamshiri E, Verner R. Optimized microburst VNS elicits fMRI responses beyond thalamic-specific response from standard VNS. Ann Clin Transl Neurol 2024; 11:1135-1147. [PMID: 38532258 DOI: 10.1002/acn3.52029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE In parallel to standard vagus nerve stimulation (VNS), microburst stimulation delivery has been developed. We evaluated the fMRI-related signal changes associated with standard and optimized microburst stimulation in a proof-of-concept study (NCT03446664). METHODS Twenty-nine drug-resistant epilepsy patients were prospectively implanted with VNS. Three 3T fMRI scans were collected 2 weeks postimplantation. The maximum tolerated VNS intensity was determined prior to each scan starting at 0.125 mA with 0.125 mA increments. FMRI scans were block-design with alternating 30 sec stimulation [ON] and 30 sec no stimulation [OFF]: Scan 1 utilized standard VNS and Scan 3 optimized microburst parameters to determine target settings. Semi-automated on-site fMRI data processing utilized ON-OFF block modeling to determine VNS-related fMRI activation per stimulation setting. Anatomical thalamic mask was used to derive highest mean thalamic t-value for determination of microburst stimulation parameters. Paired t-tests corrected at P < 0.05 examined differences in fMRI responses to each stimulation type. RESULTS Standard and microburst stimulation intensities at Scans 1 and 3 were similar (P = 0.16). Thalamic fMRI responses were obtained in 28 participants (19 with focal; 9 with generalized seizures). Group activation maps showed standard VNS elicited thalamic activation while optimized microburst VNS showed widespread activation patterns including thalamus. Comparison of stimulation types revealed significantly greater cerebellar, midbrain, and parietal fMRI signal changes in microburst compared to standard VNS. These differences were not associated with seizure responses. INTERPRETATION While standard and optimized microburst VNS elicited thalamic activation, microburst also engaged other brain regions. Relationship between these fMRI activation patterns and clinical response warrants further investigation. CLINICAL TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT03446664).
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Drees C, Afra P, Verner R, Kaye L, Keith A, Jiang M, Szaflarski JP, Nichol K. Feasibility study of microburst VNS therapy in drug-resistant focal and generalized epilepsy. Brain Stimul 2024; 17:382-391. [PMID: 38499287 DOI: 10.1016/j.brs.2024.03.010] [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: 09/20/2023] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) at low frequencies (≤30 Hz) has been an established treatment for drug-resistant epilepsy (DRE) for over 25 years. OBJECTIVE To examine the initial safety and efficacy performance of an investigational, high-frequency (≥250 Hz) VNS paradigm herein called "Microburst VNS" (μVNS). μVNS consists of short, high-frequency bursts of electrical pulses believed to preferentially modulate certain brain regions. METHODS Thirty-three (33) participants were enrolled into an exploratory feasibility study, 21 with focal-onset seizures and 12 with generalized-onset seizures. Participants were titrated to a personalized target dose of μVNS using an investigational fMRI protocol. Participants were then followed for up to 12 months, with visits every 3 months, and monitored for side-effects at all time points. This study was registered as NCT03446664 on February 27th, 2018. RESULTS The device was well-tolerated. Reported adverse events were consistent with typical low frequency VNS outcomes and tended to diminish in severity over time, including dysphonia, cough, dyspnea, and implant site pain. After 12 months of μVNS, the mean seizure frequency reduction for all seizures was 61.3% (median reduction: 70.4%; 90% CI of median: 48.9%-83.3%). The 12-month responder rate (≥50% reduction) was 63.3% (90% CI: 46.7%-77.9%) and the super-responder rate (≥80% reduction) was 40% (90% CI: 25.0%-56.6%). Participants with focal-onset seizures appeared to benefit similarly to participants with generalized-onset seizures (mean reduction in seizures at 12 months: 62.6% focal [n = 19], versus 59.0% generalized [n = 11]). CONCLUSION Overall, μVNS appears to be safe and potentially a promising therapeutic alternative to traditional VNS. It merits further investigation in randomized controlled trials which will help determine the impact of investigational variables and which patients are most suitable for this novel therapy.
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Affiliation(s)
- Cornelia Drees
- Mayo Clinic Arizona, Department of Neurology, Phoenix, AZ, USA; University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA
| | - Pegah Afra
- University of Utah School of Medicine, Department of Neurology, Salt Lake City, UT, USA; Weill-Cornell Medicine, Department of Neurology, New York, NY, USA; University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ryan Verner
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK
| | - Lesley Kaye
- University of Colorado School of Medicine, Department of Neurology, Aurora, CO, USA
| | - Amy Keith
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK
| | - Mei Jiang
- LivaNova PLC (or a Subsidiary), Department Statistics and Data Science, London, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham School of Medicine, Department of Neurology, Birmingham, AL, USA
| | - Kathryn Nichol
- LivaNova PLC (or a Subsidiary), Department of Clinical and Medical Affairs, London, UK.
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Sperling MR, Wu C, Kang J, Makhalova J, Bartolomei F, Southwell D. The Temporal Lobe Club: Newer Approaches to Treat Temporal Lobe Epilepsy. Epilepsy Curr 2024; 24:10-15. [PMID: 38327532 PMCID: PMC10846515 DOI: 10.1177/15357597231213161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
This brief review summarizes presentations at the Temporal Lobe Club Special Interest Group session held in December 2022 at the American Epilepsy Society meeting. The session addressed newer methods to treat temporal epilepsy, including methods currently in clinical use and techniques under investigation. Brief summaries are provided for each of 4 lectures. Dr Chengyuan Wu discussed ablative techniques such as laser interstitial thermal ablation, radiofrequency ablation, focused ultrasound; Dr Joon Kang reviewed neuromodulation techniques including electrical stimulation and focused ultrasound; Dr Julia Makhalova discussed network effects of the aforementioned techniques; and Dr Derek Southwell reviewed inhibitory interneuron transplantation. These summaries are intended to provide a brief overview and references are provided for the reader to learn more about each topic.
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Affiliation(s)
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joon Kang
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Makhalova
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Derek Southwell
- Department of Neurosurgery, Duke University, Durham, NC, USA
- Department of Neurobiology, Duke University, Durham, NC, USA
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Verner R, Szaflarski JP, Allendorfer JB, Vonck K, Giannicola G. Modulation of the thalamus by microburst vagus nerve stimulation: a feasibility study protocol. Front Neurol 2023; 14:1169161. [PMID: 37384278 PMCID: PMC10299807 DOI: 10.3389/fneur.2023.1169161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) was the first device-based therapy for epilepsy, having launched in 1994 in Europe and 1997 in the United States. Since then, significant advances in the understanding of the mechanism of action of VNS and the central neurocircuitry that VNS modulates have impacted how the therapy is practically implemented. However, there has been little change to VNS stimulation parameters since the late 1990s. Short bursts of high frequency stimulation have been of increasing interest to other neuromodulation targets e.g., the spine, and these high frequency bursts elicit unique effects in the central nervous system, especially when applied to the vagus nerve. In the current study, we describe a protocol design that is aimed to assess the impact of high frequency bursts of stimulation, called "Microburst VNS", in subjects with refractory focal and generalized epilepsies treated with this novel stimulation pattern in addition to standard anti-seizure medications. This protocol also employed an investigational, fMRI-guided titration protocol that permits personalized dosing of Microburst VNS among the treated population depending on the thalamic blood-oxygen-level-dependent signal. The study was registered on clinicaltrials.gov (NCT03446664). The first subject was enrolled in 2018 and the final results are expected in 2023.
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Affiliation(s)
- Ryan Verner
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Gaia Giannicola
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
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Farrand A, Jacquemet V, Verner R, Owens M, Beaumont E. Vagus nerve stimulation parameters evoke differential neuronal responses in the locus coeruleus. Physiol Rep 2023; 11:e15633. [PMID: 36905173 PMCID: PMC10006695 DOI: 10.14814/phy2.15633] [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: 01/19/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Vagus nerve stimulation (VNS) is used to treat drug-resistant epilepsy and depression, with additional applications under investigation. The noradrenergic center locus coeruleus (LC) is vital for VNS effects; however, the impact of varying stimulation parameters on LC activation is poorly understood. This study characterized LC activation across VNS parameters. Extracellular activity was recorded in rats' left LC while 11 VNS paradigms, utilizing variable frequencies and bursting characteristics, were pseudorandomly delivered to the left cervical vagus for five cycles. Neurons' change from baseline firing rate and timing response profiles were assessed. The proportion of neurons categorized as responders over 5 VNS cycles doubled in comparison to the first VNS cycle (p < 0.001) for all VNS paradigms, demonstrating an amplification effect. The percentage of positively consistent/positive responders increased for standard VNS paradigms with frequencies ≥10 Hz and for bursting paradigms with shorter interburst intervals and more pulses per burst. The synchrony between pairs of LC neurons increased during bursting VNS but not standard paradigms. Also, the probability of evoking a direct response during bursting VNS was higher with longer interburst intervals and a higher number of pulses per burst. Standard paradigms between 10-30 Hz best positively activates LC with consistency to VNS while the best bursting paradigm to increase activity was 300 Hz, seven pulses per burst separated by 1 s. Bursting VNS was effective in increasing synchrony between pairs of neurons, suggesting a common network recruitment originating from vagal afferents. These results indicate differential activation of LC neurons depending on the VNS parameters delivered.
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Affiliation(s)
- Ariana Farrand
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Vincent Jacquemet
- Department of Pharmacology and PhysiologyInstitute of Biomedical Engineering, University of MontrealMontrealQuebecCanada
- Research CenterSacred Heart Hospital of MontrealMontrealQuebecCanada
| | - Ryan Verner
- Neuromodulation DivisionLivaNova PLCHoustonTexasUSA
| | - Misty Owens
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
| | - Eric Beaumont
- Department of Biomedical SciencesQuillen College of Medicine, East Tennessee State UniversityJohnson CityTennesseeUSA
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Yokota H, Edama M, Hirabayashi R, Sekine C, Otsuru N, Saito K, Kojima S, Miyaguchi S, Onishi H. Effects of Stimulus Frequency, Intensity, and Sex on the Autonomic Response to Transcutaneous Vagus Nerve Stimulation. Brain Sci 2022; 12:brainsci12081038. [PMID: 36009101 PMCID: PMC9405815 DOI: 10.3390/brainsci12081038] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/10/2022] Open
Abstract
This study aimed to determine how transcutaneous vagus nerve stimulation (tVNS) alters autonomic nervous activity by comparing the effects of different tVNS frequencies and current intensities. We also investigated the sex-dependent autonomic response to tVNS. Thirty-five healthy adult participants were stimulated using a tVNS stimulator at the left cymba conchae while sitting on a reclining chair; tVNS-induced waveform changes were then recorded for different stimulus frequencies (Experiment 1: 3.0 mA at 100 Hz, 25 Hz, 10 Hz, 1 Hz, and 0 Hz (no stimulation)) and current intensities (Experiment 2: 100 Hz at 3.0 mA, 1.0 mA, 0.2 mA (below sensory threshold), and 0 mA (no stimulation)) using an electrocardiogram. Pulse widths were set at 250 µs in both experiment 1 and 2. Changes in heart rate (HR), root-mean-square of the difference between two successive R waves (RMSSD), and the ratio between low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.40 Hz) bands (LF/HF) in spectral analysis, which indicates sympathetic and parasympathetic activity, respectively, in heart rate variability (HRV), were recorded for analysis. Although stimulation at all frequencies significantly reduced HR (p = 0.001), stimulation at 100 Hz had the most pronounced effect (p = 0.001) in Experiment 1 and was revealed to be required to deliver at 3.0 mA in Experiment 2 (p = 0.003). Additionally, participants with higher baseline sympathetic activity experienced higher parasympathetic response during stimulation, and sex differences may exist in the autonomic responses by the application of tVNS. Therefore, our findings suggest that optimal autonomic changes induced by tVNS to the left cymba conchae vary depending on stimulating parameters and sex.
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Affiliation(s)
- Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Correspondence: ; Tel.: +81-25-257-4723
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Shota Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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Shen LL, Sun JB, Yang XJ, Deng H, Qin W, Du MY, Meng LX, Li N, Guo XY, Qiao WZ, Yang WQ, Liu P, Zeng X. Reassessment of the Effect of Transcutaneous Auricular Vagus Nerve Stimulation Using a Novel Burst Paradigm on Cardiac Autonomic Function in Healthy Young Adults. Neuromodulation 2021; 25:433-442. [PMID: 35396073 DOI: 10.1111/ner.13521] [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] [Received: 02/23/2021] [Revised: 06/14/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) may modulate cardiac autonomic function. However, the response rate of the traditional tonic paradigm is low, and the results remain inconsistent. A recent pilot study presented a novel burst paradigm to activate the cardiac parasympathetic system, which might offer a new approach to treat cardiac autonomic function. The present study reassessed the effect of burst taVNS on modulating heart rate variability and explored the difference between burst and traditional tonic paradigms. MATERIALS AND METHODS Forty-two young adults were recruited for this study. Each participant underwent three types of taVNS with sham (30 sec of stimulation), tonic (25 Hz, 500 μsec), and burst (five pulses at 500 Hz every 200 msec) paradigms, respectively, with simultaneous electrocardiogram recording. One-way analysis of variance, multivariate analysis of variance, and linear regression were used for analysis. Multiple testing was performed using Bonferroni correction. RESULTS Both burst and tonic paradigms induced a significant decrease in heart rate, which continued until poststimulation, and increased cardiac parasympathetic activity. Moreover, two parasympathetic system indicators showed significant increase only in burst taVNS. The response rates during burst (35.7%) and tonic (38.1%) stimulations were both higher than that during sham stimulation (11.9%). The response to taVNS showed parameter specificity with few nonresponders to the tonic paradigm responding to the burst paradigm. The overall response rate increased from 38.1% in tonic taVNS to 54.8% in taVNS using both burst and tonic paradigms. For both burst and tonic responders, baseline cardiac parasympathetic activity was found to be significantly negatively correlated with changes during stimulation. CONCLUSION The burst parameter could be used as an alternative strategy for regulating cardiac parasympathetic function by taVNS, which has the potential to be used as a complementary paradigm to traditional tonic taVNS for promoting clinical treatment efficacy.
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Affiliation(s)
- Lin-Lin Shen
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Hui Deng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wei Qin
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Meng-Yu Du
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Ling-Xia Meng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Nan Li
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiao-Yu Guo
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wen-Zhou Qiao
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wei-Qi Yang
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Peng Liu
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiao Zeng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
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10
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Farrand AQ, Verner RS, McGuire RM, Helke KL, Hinson VK, Boger HA. Differential effects of vagus nerve stimulation paradigms guide clinical development for Parkinson's disease. Brain Stimul 2020; 13:1323-1332. [PMID: 32629028 DOI: 10.1016/j.brs.2020.06.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) modifies brain rhythms in the locus coeruleus (LC) via the solitary nucleus. Degeneration of the LC in Parkinson's disease (PD) is an early catalyst of the spreading neurodegenerative process, suggesting that stimulating LC output with VNS has the potential to modify disease progression. We previously showed in a lesion PD model that VNS delivered twice daily reduced neuroinflammation and motor deficits, and attenuated tyrosine hydroxylase (TH)-positive cell loss. OBJECTIVE The goal of this study was to characterize the differential effects of three clinically-relevant VNS paradigms in a PD lesion model. METHODS Eleven days after DSP-4 (N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine, noradrenergic lesion, administered systemically)/6-OHDA (6-hydroxydopamine, dopaminergic lesion, administered intrastriatally) rats were implanted with VNS devices, and received either low-frequency VNS, standard-frequency VNS, or high-frequency microburst VNS. After 10 days of treatment and behavioral assessment, rats were euthanized, right prefrontal cortex (PFC) was dissected for norepinephrine assessment, and the left striatum, bilateral substantia nigra (SN), and LC were sectioned for immunohistochemical detection of catecholamine neurons, α-synuclein, astrocytes, and microglia. RESULTS At higher VNS frequencies, specifically microburst VNS, greater improvements occurred in motor function, attenuation of TH-positive cell loss in SN and LC, and norepinephrine concentration in the PFC. Additionally, higher VNS frequencies resulted in lower intrasomal α-synuclein accumulation and glial density in the SN. CONCLUSIONS These data indicate that higher stimulation frequencies provided the greatest attenuation of behavioral and pathological markers in this PD model, indicating therapeutic potential for these VNS paradigms.
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Affiliation(s)
- Ariana Q Farrand
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA
| | - Ryan S Verner
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Ryan M McGuire
- Neuromodulation Division of LivaNova, PLC, 100 Cyberonics Blvd, Houston, TX, 77058, USA
| | - Kristi L Helke
- Department of Comparative Medicine, 114 Doughty St, STB 648, MSC 777; Department of Pathology and Laboratory Medicine, 165 Ashley Ave, Children's Hospital 309, MSC 908, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Vanessa K Hinson
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 309, MSC 606, Charleston, SC, 29425, USA
| | - Heather A Boger
- Department of Neuroscience and Center on Aging, Medical University of South Carolina, 173 Ashley Ave, BSB Suite 403, MSC 510, Charleston, SC, 29425, USA.
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11
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Fan J, Shan W, Wu J, 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] [MESH Headings] [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 HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Wei Shan
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Jian‐Ping Wu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
| | - Qun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
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12
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Brázdil M, Doležalová I, Koritáková E, Chládek J, Roman R, Pail M, Jurák P, Shaw DJ, Chrastina J. EEG Reactivity Predicts Individual Efficacy of Vagal Nerve Stimulation in Intractable Epileptics. Front Neurol 2019; 10:392. [PMID: 31118916 PMCID: PMC6507513 DOI: 10.3389/fneur.2019.00392] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Chronic vagal nerve stimulation (VNS) is a well-established non-pharmacological treatment option for drug-resistant epilepsy. This study sought to develop a statistical model for prediction of VNS efficacy. We hypothesized that reactivity of the electroencephalogram (EEG) to external stimuli measured during routine preoperative evaluation differs between VNS responders and non-responders. Materials and Methods: Power spectral analyses were computed retrospectively on pre-operative EEG recordings from 60 epileptic patients with VNS. Thirty five responders and 25 non-responders were compared on the relative power values in four standard frequency bands and eight conditions of clinical assessment-eyes opening/closing, photic stimulation, and hyperventilation. Using logistic regression, groups of electrodes within anatomical areas identified as maximally discriminative by n leave-one-out iterations were used to classify patients. The reliability of the predictive model was verified with an independent data-set from 22 additional patients. Results: Power spectral analyses revealed significant differences in EEG reactivity between responders and non-responders; specifically, the dynamics of alpha and gamma activity strongly reflected VNS efficacy. Using individual EEG reactivity to develop and validate a predictive model, we discriminated between responders and non-responders with 86% accuracy, 83% sensitivity, and 90% specificity. Conclusion: We present a new statistical model with which EEG reactivity to external stimuli during routine presurgical evaluation can be seen as a promising avenue for the identification of patients with favorable VNS outcome. This novel method for the prediction of VNS efficacy might represent a breakthrough in the management of drug-resistant epilepsy, with wide-reaching medical and economic implications.
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Affiliation(s)
- Milan Brázdil
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Irena Doležalová
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Eva Koritáková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia.,Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Robert Roman
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Martin Pail
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Jurák
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Daniel J Shaw
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Jan Chrastina
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
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13
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Hachem LD, Yan H, Ibrahim GM. Invasive Neuromodulation for the Treatment of Pediatric Epilepsy. Neurotherapeutics 2019; 16:128-133. [PMID: 30378003 PMCID: PMC6361060 DOI: 10.1007/s13311-018-00685-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neuromodulatory strategies are increasingly adopted for the treatment of intractable epilepsy in children. These encompass a wide range of treatments aimed at externally stimulating neural circuitry in order to decrease seizure frequency. In the current review, the authors discuss the evidence for invasive neuromodulation, namely vagus nerve and deep brain stimulation in affected children. Putative mechanisms of action and biomarkers of treatment success are explored and evidence of the efficacy of invasive neuromodulation is highlighted.
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Affiliation(s)
- Laureen D Hachem
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, 1503 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Han Yan
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, 1503 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, 1503 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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14
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Does emergent implantation of a vagal nerve stimulator stop refractory status epilepticus in children? Seizure 2018; 61:94-97. [DOI: 10.1016/j.seizure.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 11/23/2022] Open
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15
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Hachem LD, Wong SM, Ibrahim GM. The vagus afferent network: emerging role in translational connectomics. Neurosurg Focus 2018; 45:E2. [DOI: 10.3171/2018.6.focus18216] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Vagus nerve stimulation (VNS) is increasingly considered for the treatment of intractable epilepsy and holds potential for the management of a variety of neuropsychiatric conditions. The emergence of the field of connectomics and the introduction of large-scale modeling of neural networks has helped elucidate the underlying neurobiology of VNS, which may be variably expressed in patient populations and related to responsiveness to stimulation. In this report, the authors outline current data on the underlying neural circuitry believed to be implicated in VNS responsiveness in what the authors term the “vagus afferent network.” The emerging role of biomarkers to predict treatment effect is further discussed and important avenues for future work are highlighted.
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Affiliation(s)
- Laureen D. Hachem
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Simeon M. Wong
- 2Department of Diagnostic Imaging, Hospital for Sick Children, Toronto; and
| | - George M. Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 3Division of Neurosurgery, Hospital for Sick Children, Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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16
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Szabó CÁ, Salinas FS, Papanastassiou AM, Begnaud J, Ravan M, Eggleston KS, Shade R, Lutz C, De La Garza M. High-frequency burst vagal nerve simulation therapy in a natural primate model of genetic generalized epilepsy. Epilepsy Res 2017; 138:46-52. [PMID: 29059589 PMCID: PMC5856459 DOI: 10.1016/j.eplepsyres.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/24/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Since the approval of Vagal Nerve Stimulation (VNS) Therapy for medically refractory focal epilepsies in 1997, it has been also reported to be effective for a wide range of generalized seizures types and epilepsy syndromes. Instead of conventional VNS Therapy delivered at 20-30Hz signal frequencies, this study evaluates efficacy and tolerability of high-frequency burst VNS in a natural animal model for genetic generalized epilepsy (GGE), the epileptic baboon. METHODS Two female baboons (B1 P.h. Hamadryas and B2 P.h. Anubis x Cynocephalus) were selected because of frequently witnessed generalized tonic-clonic seizures (GTCS) for VNS implantation. High-frequency burst VNS Therapy was initiated after a 4-5 week baseline; different VNS settings (0.25, 2 or 2.5mA, 300Hz, 4 vs 7 pulses, 0.5-2.5s interburst interval, and intermittent stimulation for 1-2 vs for 24h per day) were tested over the subsequent 19 weeks, which included a 4-6 week wash-out period. GTCS frequencies were quantified for each setting, while seizure duration and postictal recovery times were compared to baseline. Scalp EEG studies were performed at almost every setting, including intermittent light stimulation (ILS) to evaluate photosensitivity. Pre-ILS ictal and interictal discharge rates, as well as ILS responses were compared between trials. The Novel Object test was used to assess potential treatment effects on behavior. RESULTS High-frequency burst VNS Therapy reduced GTCS frequencies at all treatment settings in both baboons, except when output currents were reduced (0.25mA) or intermittent stimulation was restricted (to 1-2h/day). Seizure duration and postictal recovery times were unchanged. Scalp EEG studies did not demonstrate treatment-related decrease of ictal or interictal epileptic discharges or photosensitivity, but continuous treatment for 120-180s during ILS appeared to reduce photoparoxysmal responses. High-frequency burst VNS Therapy was well-tolerated by both baboons, without cardiac or behavioral changes. Repetitive muscle contractions involving the neck and left shoulder girdle were observed intermittently, most commonly at 0.5 interburst intervals, but these were transient, resolving with a few cycles of stimulation and not noted in wakefulness. CONCLUSIONS This preclinical pilot study demonstrates efficacy and tolerability of high-frequency burst VNS Therapy in the baboon model of GGE. The muscle contractions may be due to aberrant propagation of the stimulus along the vagal nerve or to the ansa cervicalis, but can be reduced by minimal adjustment of current output or stimulus duration.
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Affiliation(s)
- C Á Szabó
- Department of Neurology, UT Health San Antonio, San Antonio, TX, United States; South Texas Comprehensive Epilepsy Center, University Health System, San Antonio, TX, United States.
| | - F S Salinas
- Research Imaging Institute, UT Health San Antonio, San Antonio, TX, United States
| | - A M Papanastassiou
- South Texas Comprehensive Epilepsy Center, University Health System, San Antonio, TX, United States; Department of Neurosurgery, UT Health San Antonio, San Antonio, TX, United States
| | - J Begnaud
- LivaNova, Houston, TX, United States
| | - M Ravan
- LivaNova, Houston, TX, United States
| | | | - R Shade
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
| | - C Lutz
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
| | - M De La Garza
- Southwest National Primate Research Center, Texas Biomed, San Antonio, TX, United States
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17
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Sevcencu C, Jiao J, Harreby KR, Jensen W. A New Rat Model of Seizures Suitable for Screening Antiepileptic Electrical Stimulation Therapies. Artif Organs 2017. [PMID: 28621831 DOI: 10.1111/aor.12945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The antiepileptic effects of the electrical stimulation therapies developed for patients with intractable epilepsies depend critically on the stimulation parameters, including the pulse duration, current, and frequency. Consequently, optimization of such therapies requires many animals for testing each of the stimulation parameters alone or in combination, which is costly and time consuming. This drawback could be reduced by testing several stimulation paradigms in each animal, but this requires an animal model of long-lasting seizures allowing such repetitive tests. This study was performed to validate such a model of long-lasting seizures. The present analysis was performed on electrocorticogram and intracortical signals collected from the somatosensory cortex of 11 Sprague Dawley rats. A protocol of controlled intravenous infusion of pentylenetetrazol (PTZ) was developed to induce spike-and-wave (SW) seizures and maintain stable those seizures for the whole experimental time. SW discharges were induced and maintained stable for 2 h in all rats through a two-stage infusion of PTZ. During the first stage, the SW discharges were induced by 2.5 min infusion of 10 mg/kg/min PTZ. During the second stage, the SW discharges were maintained at a stable level of frequency and power for 2 h via a 0.21 mg/kg/min PTZ infusion rate. The proposed animal model of seizures is characterized by SW discharges which remain stable for 2 h. This 2-h long time interval allows repetitive tests with different stimulation parameters in each animal, which may lead to a significant reduction of the number of animals necessary for optimizing electrical stimulation therapies developed to inhibit seizures.
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Affiliation(s)
- Cristian Sevcencu
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jianhang Jiao
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin, China
| | | | - Winnie Jensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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18
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Alexander GM, Huang YZ, Soderblom EJ, He XP, Moseley MA, McNamara JO. Vagal nerve stimulation modifies neuronal activity and the proteome of excitatory synapses of amygdala/piriform cortex. J Neurochem 2017; 140:629-644. [PMID: 27973753 DOI: 10.1111/jnc.13931] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/13/2016] [Accepted: 12/09/2016] [Indexed: 12/19/2022]
Abstract
Vagal Nerve Stimulation (VNS) Therapy® is a United States Food and Drug Administration approved neurotherapeutic for medically refractory partial epilepsy and treatment-resistant depression. The molecular mechanisms underlying its beneficial effects are unclear. We hypothesized that one mechanism involves neuronal activity-dependent modifications of central nervous system excitatory synapses. To begin to test this hypothesis, we asked whether VNS modifies the activity of neurons in amygdala and hippocampus. Neuronal recordings from adult, freely moving rats revealed that activity in both amygdala and hippocampus was modified by VNS immediately after its application, and changes were detected following 1 week of stimulation. To investigate whether VNS modifies the proteome of excitatory synapses, we established a label-free, quantitative liquid chromatography-tandem mass spectrometry workflow that enables global analysis of the constituents of the postsynaptic density (PSD) proteome. PSD proteins were biochemically purified from amygdala/piriform cortex of VNS- or dummy-treated rats following 1-week stimulation, and individual PSD protein levels were quantified by liquid chromatography-tandem mass spectrometry analysis. We identified 1899 unique peptides corresponding to 425 proteins in PSD fractions, of which expression levels of 22 proteins were differentially regulated by VNS with changes greater than 150%. Changes in a subset of these proteins, including significantly increased expression of neurexin-1α, cadherin 13 and voltage-dependent calcium channel α2δ1, the primary target of the antiepileptic drug gabapentin, and decreased expression of voltage-dependent calcium channel γ3, were confirmed by western blot analysis of PSD samples. These results demonstrate that VNS modulates excitatory synapses through regulating a subset of the PSD proteome. Our study reveals molecular targets of VNS and point to possible mechanisms underlying its beneficial effects, including activity-dependent formation of excitatory synapses.
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Affiliation(s)
- Georgia M Alexander
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yang Zhong Huang
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Erik J Soderblom
- Duke Proteomics Core Facility, Duke University Medical Center, Durham, North Carolina, USA
| | - Xiao-Ping He
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - M Arthur Moseley
- Duke Proteomics Core Facility, Duke University Medical Center, Durham, North Carolina, USA
| | - James O McNamara
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, USA
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19
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Arle JE, Carlson KW, Mei L. Investigation of mechanisms of vagus nerve stimulation for seizure using finite element modeling. Epilepsy Res 2016; 126:109-18. [DOI: 10.1016/j.eplepsyres.2016.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/05/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
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20
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Jiao J, Harreby KR, Sevcencu C, Jensen W. Optimal Vagus Nerve Stimulation Frequency for Suppression of Spike-and-Wave Seizures in Rats. Artif Organs 2015; 40:E120-7. [DOI: 10.1111/aor.12669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jianhang Jiao
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Kristian R. Harreby
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Cristian Sevcencu
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Winnie Jensen
- Center for Sensory-Motor Interaction; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
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21
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Jiao J, Jensen W, Harreby KR, Sevcencu C. The Effect of Spinal Cord Stimulation on Epileptic Seizures. Neuromodulation 2015; 19:154-60. [PMID: 26516727 DOI: 10.1111/ner.12362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/18/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) has been applied to relieve chronic pain for decades. Recent studies suggested that SCS also might alleviate epileptic seizures, but the most effective stimulation parameters are not known. The objective of this work was to investigate the role of SCS frequency in alleviating spike-and-wave (SW) discharges induced in rats by pentylenetetrazole (PTZ) infusion. MATERIALS AND METHODS The SW discharges were induced in nine rats. An epidural electrode was placed in the spinal canal at the cervical level. SCS was delivered at four frequencies (30, 80, 130 and 180 Hz) and compared with control intervals without stimulation. The effect was evaluated by analyzing electrocorticographic and intracortical (IC) signals. The means of normalized SW spike power (mSP) and frequency (mSF) were derived from the IC recordings and used to estimate the seizure severity. RESULTS Compared with the control intervals, SCS conducted at 30 Hz significantly increased the mSP and mSF indicating an increase of the SW spiking activity; 80 Hz did not induce significant changes of the features. In contrast, 130- and 180-Hz SCS reduced both mSP and mSF significantly indicating a reduction of the SW spiking activity. CONCLUSIONS The present results showed that 130-Hz and 180-Hz SCS reduced the SWs power and frequency which may indicate an anticonvulsive effect of these SCS frequencies, whereas 30-Hz SCS induced the opposite effects and, therefore, may be proconvulsive.
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Affiliation(s)
- Jianhang Jiao
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Winnie Jensen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian R Harreby
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Cristian Sevcencu
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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22
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Conway CR, Colijn MA, Schachter SC. Vagus Nerve Stimulation for Epilepsy and Depression. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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23
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Martlé V, Raedt R, Waelbers T, Smolders I, Vonck K, Boon P, Van Ham L, Duchateau L, Bhatti S. The Effect of Vagus Nerve Stimulation on CSF Monoamines and the PTZ Seizure Threshold in Dogs. Brain Stimul 2015; 8:1-6. [DOI: 10.1016/j.brs.2014.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/31/2014] [Accepted: 07/13/2014] [Indexed: 11/25/2022] Open
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Vagus Nerve Stimulation has Antidepressant Effects in the Kainic Acid Model for Temporal Lobe Epilepsy. Brain Stimul 2015; 8:13-20. [DOI: 10.1016/j.brs.2014.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/04/2014] [Accepted: 09/22/2014] [Indexed: 11/22/2022] Open
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25
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Evaluation of heart rate variability in dogs during standard and microburst vagus nerve stimulation: a pilot study. Vet J 2014; 202:651-3. [PMID: 25296848 DOI: 10.1016/j.tvjl.2014.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
Vagus nerve stimulation (VNS) is an established treatment for epilepsy and depression in human patients, but in both humans and dogs, optimal stimulation parameters remain unknown. Delivering afferent bursts of stimulation may be promising as a means of increasing efficacy, but evaluation of potential effects on the heart due to unavoidable efferent stimulation is required. The present study investigated heart rate variability (HRV) in healthy Beagle dogs treated with 1 h of sham, standard or microburst left-sided VNS in a crossover design. No significant differences were found between the stimulation paradigms for any of the cardiac parameters. Short-term left-sided VNS, including a novel bursting pattern (microburst VNS), had no statistically significant effect on HRV in ambulatory healthy dogs. Studies in a larger number of animals with long-term VNS are recommended.
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26
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Martlé V, Peremans K, Raedt R, Vermeire S, Vonck K, Boon P, Van Ham L, Tshamala M, Caemaert J, Dobbeleir A, Duchateau L, Waelbers T, Gielen I, Bhatti S. Regional brain perfusion changes during standard and microburst vagus nerve stimulation in dogs. Epilepsy Res 2014; 108:616-22. [DOI: 10.1016/j.eplepsyres.2014.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/16/2014] [Accepted: 02/03/2014] [Indexed: 11/16/2022]
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Effect of vagus nerve stimulation on electrical kindling in different stages of seizure severity in freely moving cats. Epilepsy Res 2014; 108:81-9. [DOI: 10.1016/j.eplepsyres.2013.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/19/2013] [Accepted: 10/18/2013] [Indexed: 11/21/2022]
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Yasuhara T, Agari T, Kameda M, Kondo A, Kuramoto S, Jing M, Sasaki T, Toyoshima A, Sasada S, Sato K, Shinko A, Wakamori T, Okuma Y, Miyoshi Y, Tajiri N, Borlongan CV, Date I. Regenerative medicine for epilepsy: from basic research to clinical application. Int J Mol Sci 2013; 14:23390-401. [PMID: 24287913 PMCID: PMC3876052 DOI: 10.3390/ijms141223390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/31/2013] [Accepted: 11/15/2013] [Indexed: 12/20/2022] Open
Abstract
Epilepsy is a chronic neurological disorder, which presents with various forms of seizures. Traditional treatments, including medication using antiepileptic drugs, remain the treatment of choice for epilepsy. Recent development in surgical techniques and approaches has improved treatment outcomes. However, several epileptic patients still suffer from intractable seizures despite the advent of the multimodality of therapies. In this article, we initially provide an overview of clinical presentation of epilepsy then describe clinically relevant animal models of epilepsy. Subsequently, we discuss the concepts of regenerative medicine including cell therapy, neuroprotective agents, and electrical stimulation, which are reviewed within the context of our data.
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Affiliation(s)
- Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +81-86-235-7336; Fax: +81-86-227-0191
| | - Takashi Agari
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Akihiko Kondo
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Satoshi Kuramoto
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Meng Jing
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Atsuhiko Toyoshima
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Susumu Sasada
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Kenichiro Sato
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Aiko Shinko
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Takaaki Wakamori
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Yu Okuma
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Yasuyuki Miyoshi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
| | - Naoki Tajiri
- Department of Neurosurgery, University of South Florida College Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; E-Mails: (N.T.); (C.V.B.)
| | - Cesario V. Borlongan
- Department of Neurosurgery, University of South Florida College Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; E-Mails: (N.T.); (C.V.B.)
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Okayama 700-8558, Japan; E-Mails: (T.A.); (M.K.); (A.K.); (S.K.); (M.J.); (T.S.); (A.T.); (S.S.); (K.S.); (A.S.); (T.W.); (Y.O.); (Y.M.); (I.D.)
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