Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy.
Clin Neurophysiol. 2021 Jun;132(6):1274-1282. doi: 10.1016/j.clinph.2021.01.033. Epub 2021 Mar 24.
To explore the cortical areas targeted by acute transcutaneous trigeminal nerve stimulation (TNS) in patients with drug-resistant epilepsy (DRE) using single photon emission computed tomography (SPECT).
Ten patients with DRE underwent brain SPECT at baseline and immediately after a 20-minute TNS (0.25 ms; 120 Hz; 30 s ON and 30 s OFF) applied bilaterally to the infraorbital nerve. The French Color Standard International Scale was used for qualitative analyses and z-scores were used to calculate the Odds Ratio (OR).
At baseline global hypoperfusion (mainly in temporo-mesial, temporo-parietal and fronto-temporal and temporo-occipital areas) was detected in all patients. Following TNS, a global increase in cortical tracer uptake and a significant decrease in median hypoperfusion score were observed. A significant effect favoring a general TNS-induced increase in cortical perfusion (OR = 4.96; p = 0.0005) was detected in 70% of cases, with significant effects in the limbic (p = 0.003) and temporal (p = 0.003) lobes. Quantitative analyses of z-scores confirmed significant TNS-induced increases in perfusion in the temporal (+0.59 SDs; p = 0.001), and limbic (+0.43 SDs; p = 0.03) lobes.
Short-term TNS is followed a global increase in cortical perfusion, namely in the temporal and limbic lobes.
The TNS-induced perfusion increase may reflect neurons' activity changes in cortical areas implicated in the epilepsy network.
使用单光子发射计算机断层扫描（SPECT）探索经皮三叉神经刺激（TNS）治疗耐药性癫痫（DRE）患者的皮质区。
10 例 DRE 患者在基线和双侧眶下神经 20 分钟 TNS（0.25 ms；120 Hz；30 s ON 和 30 s OFF）后立即进行脑 SPECT。使用法国国际颜色标准进行定性分析，并使用 z 分数计算优势比（OR）。
基线时所有患者均检测到全局低灌注（主要位于颞内侧、颞顶和额颞及颞枕区域）。TNS 后，皮质示踪剂摄取增加，中位数低灌注评分显著降低。70%的病例中发现 TNS 诱导的皮质灌注普遍增加有显著效果（OR=4.96；p=0.0005），在边缘叶（p=0.003）和颞叶（p=0.003）有显著效果。z 分数的定量分析证实 TNS 诱导的颞叶（+0.59 标准差；p=0.001）和边缘叶（+0.43 标准差；p=0.03）灌注显著增加。
短期 TNS 后皮质灌注呈全球性增加，主要在颞叶和边缘叶。
TNS 诱导的灌注增加可能反映了癫痫网络中涉及的皮质区域神经元活动的变化。
