迷走神经刺激诱发的喉运动诱发电位:有效神经激活的一种可能生物标志物。
Vagus Nerve Stimulation-Induced Laryngeal Motor Evoked Potentials: A Possible Biomarker of Effective Nerve Activation.
作者信息
Vespa Simone, Stumpp Lars, Bouckaert Charlotte, Delbeke Jean, Smets Hugo, Cury Joaquin, Ferrao Santos Susana, Rooijakkers Herbert, Nonclercq Antoine, Raedt Robrecht, Vonck Kristl, El Tahry Riëm
机构信息
Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
4Brain, Institute for Neurosciences, Ghent University, Ghent, Belgium.
出版信息
Front Neurosci. 2019 Aug 27;13:880. doi: 10.3389/fnins.2019.00880. eCollection 2019.
Vagus nerve stimulation (VNS) therapy is associated with laryngeal muscle activation and induces voice modifications, well-known side effects of the therapy resulting from co-activation of the recurrent laryngeal nerve. In this study, we describe the non-invasive transcutaneous recording of laryngeal motor evoked potentials (LMEPs), which could serve as a biomarker of effective nerve activation and individual titration in patients with drug-resistant epilepsy. We recruited drug-resistant epileptic patients treated for at least 6 months with a VNS. Trains of 600-1200 VNS pulses were delivered with increasing current outputs. We placed six skin electrodes on the ventral surface of the neck, in order to record LMEPs whenever the laryngeal muscular threshold was reached. We studied the internal consistency and the variability of LMEP recordings, and compared different methods for amplitude calculation. Recruitment curves were built based on the stimulus-response relationship. We also determined the electrical axis of the LMEPs dipole in order to define the optimal electrode placement for LMEPs recording in a clinical setting. LMEPs were successfully recorded in 11/11 patients. The LMEPs threshold ranged from 0.25 to 1 mA (median 0.50 mA), and onset latency was between 5.37 and 8.77 ms. The signal-to-noise ratio was outstanding in 10/11 patients. In these cases, excellent reliability (Intraclass correlation coefficient, ICC > 0.90 across three different amplitude measurements) was achieved with 10 sample averages. Moreover, our recordings showed very good internal consistency (Cronbach's alpha > 0.95 for 10 epochs). Area-under-the-curve and peak-to-peak measurement proved to be complementary methods for amplitude calculation. Finally, we determined that an optimal derivation requires only two recording electrodes, aligned on a horizontal axis around the laryngeal prominence. In conclusion, we describe here an optimal methodology for the recording of VNS-induced motor evoked responses from the larynx. Although further clinical validation is still necessary, LMEPs might be useful as a non-invasive marker of effective nerve activation, and as an aid for the clinician to perform a more rational titration of VNS parameters.
迷走神经刺激(VNS)疗法与喉肌激活有关,并会引起声音改变,这是该疗法因喉返神经共同激活而产生的众所周知的副作用。在本研究中,我们描述了喉运动诱发电位(LMEP)的非侵入性经皮记录,其可作为耐药性癫痫患者有效神经激活和个体滴定的生物标志物。我们招募了接受VNS治疗至少6个月的耐药性癫痫患者。以递增的电流输出发送600 - 1200个VNS脉冲序列。我们在颈部腹侧放置了六个皮肤电极,以便在达到喉肌阈值时记录LMEP。我们研究了LMEP记录的内部一致性和变异性,并比较了不同的幅度计算方法。基于刺激 - 反应关系构建募集曲线。我们还确定了LMEP偶极子的电轴,以便在临床环境中确定LMEP记录的最佳电极放置位置。11名患者中有11名成功记录到LMEP。LMEP阈值范围为0.25至1 mA(中位数0.50 mA),起始潜伏期在5.37至8.77 ms之间。11名患者中有10名的信噪比出色。在这些情况下,通过10次样本平均值实现了出色的可靠性(组内相关系数,ICC在三种不同幅度测量中均> 0.90)。此外,我们的记录显示出非常好的内部一致性(10个epoch的Cronbach's alpha> 0.95)。曲线下面积和峰峰值测量被证明是幅度计算的互补方法。最后,我们确定最佳推导仅需要两个记录电极,围绕喉结在水平轴上对齐。总之,我们在此描述了一种记录VNS诱发的喉部运动诱发电反应的最佳方法。尽管仍需要进一步的临床验证,但LMEP可能作为有效神经激活的非侵入性标志物有用,并有助于临床医生更合理地滴定VNS参数。
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