Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Neurosci Lett. 2021 Apr 23;751:135815. doi: 10.1016/j.neulet.2021.135815. Epub 2021 Mar 9.
Vagal nerve stimulation (VNS) is an effective treatment for patients with drug-resistant epilepsy who are unsuitable for surgical epilepsy treatment. However, the mechanism of action of VNS remains unclear, and the efficacy of VNS treatment regarding seizure frequency reduction cannot be assessed before surgery. This study measured changes in functional connectivity between thalamus and precentral gyrus which are activated as vital targets of deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) using resting-state functional MRI to evaluate the effects of VNS. 16 epilepsy patients who underwent VNS were collected and scanned by resting-state functional MRI before and after operation. The functional connections (regions of interest: thalamus, precentral gyrus) were examined. After three months of stimulation, there were eight responders (≥50 % seizure reduction) and eight non-responders to VNS. No significant difference in thalamus-precentral gyrus functional connectivity was found between responders and nonresponders before operation. Enhanced functional connections were observed between bilateral thalamus and bilateral precentral gyrus in responders, which decreased in nonresponders, while functional connections between bilateral thalamus decreased in both responders and nonresponders. Short-term stimulation may cause thalamus-precentral gyrus functional connectivity changes in DRE patients, and control seizures by enhancing functional connections between bilateral thalamus and bilateral precentral gyrus.
迷走神经刺激（VNS）是一种有效的治疗方法，适用于不适合手术治疗的耐药性癫痫患者。然而，VNS 的作用机制尚不清楚，并且在手术前无法评估 VNS 治疗对减少癫痫发作频率的疗效。本研究使用静息态功能磁共振成像（rs-fMRI）测量丘脑和中央前回之间的功能连接变化，这些区域是深部脑刺激（DBS）和经颅磁刺激（TMS）的重要靶点，以评估 VNS 的效果。收集了 16 名接受 VNS 的癫痫患者，并在手术前后进行了 rs-fMRI 扫描。检查了功能连接（感兴趣区域：丘脑、中央前回）。在刺激三个月后，有 8 名患者（癫痫发作减少≥50%）为 VNS 反应者，8 名患者为无反应者。在手术前，反应者和无反应者之间的丘脑-中央前回功能连接没有显著差异。反应者双侧丘脑与双侧中央前回之间的功能连接增强，而无反应者的功能连接减少，而双侧丘脑之间的功能连接在反应者和无反应者中均减少。短期刺激可能导致 DRE 患者丘脑-中央前回功能连接变化，并通过增强双侧丘脑和双侧中央前回之间的功能连接来控制癫痫发作。
