Institute of Neuroscience (IONS), Université Catholique de Louvain, Avenue Mounier, 53 - 1200, Brussels, Belgium.
Medical Image and Signal Processing Group (MEDISIP), Ghent University, Ghent, Belgium.
Neurotherapeutics. 2021 Oct;18(4):2623-2638. doi: 10.1007/s13311-021-01124-4. Epub 2021 Oct 19.
Neural desynchronization was shown as a key mechanism of vagus nerve stimulation (VNS) action in epilepsy, and EEG synchronization measures are explored as possible response biomarkers. Since brain functional organization in sleep shows different synchrony and network properties compared to wakefulness, we aimed to explore the effects of acute VNS on EEG-derived measures in the two different states of vigilance. EEG epochs were retrospectively analyzed from twenty-four VNS-treated epileptic patients (11 responders, 13 non-responders) in calm wakefulness and stage N2 sleep. Weighted Phase Lag Index (wPLI) was computed as connectivity measure of synchronization, for VNS OFF and VNS ON conditions. Global efficiency (GE) was computed as a network measure of integration. Ratios OFF/ON were obtained as desynchronization/de-integration index. Values were compared between responders and non-responders, and between EEG states. ROC curve and area-under-the-curve (AUC) analysis was performed for response classification. In responders, stronger VNS-induced theta desynchronization (p < 0.05) and decreased GE (p < 0.05) were found in sleep, but not in wakefulness. Theta sleep wPLI Ratio OFF/ON yielded an AUC of 0.825, and 79% accuracy as a response biomarker if a cut-off value is set at 1.05. Considering all patients, the VNS-induced GE decrease was significantly more important in sleep compared to awake EEG state (p < 0.01). In conclusion, stronger sleep EEG desynchronization in theta band distinguishes responders to VNS therapy from non-responders. VNS-induced reduction of network integration occurs significantly more in sleep than in wakefulness.
神经去同步化被认为是迷走神经刺激(VNS)在癫痫中的作用的关键机制,并且脑电图同步测量被探索作为可能的反应生物标志物。由于睡眠中的大脑功能组织表现出与清醒状态不同的同步性和网络特性,我们旨在探索急性 VNS 对警觉状态下两种不同状态的脑电图衍生测量的影响。从 24 名接受 VNS 治疗的癫痫患者(11 名应答者,13 名无应答者)的平静清醒和 N2 睡眠阶段中回顾性分析 EEG 时段。计算加权相位滞后指数(wPLI)作为同步的连通性测量,用于 VNS OFF 和 VNS ON 条件。全局效率(GE)作为网络整合的度量来计算。OFF/ON 比作为去同步/去整合指数获得。在应答者和无应答者之间以及在 EEG 状态之间比较了值。进行了 ROC 曲线和曲线下面积(AUC)分析,以进行响应分类。在应答者中,在睡眠中发现更强的 VNS 诱导的θ去同步(p<0.05)和 GE 降低(p<0.05),而在清醒时则没有。θ睡眠 wPLI Ratio OFF/ON 的 AUC 为 0.825,如果将截断值设置为 1.05,则作为反应生物标志物的准确率为 79%。考虑到所有患者,与清醒 EEG 状态相比,VNS 诱导的 GE 降低在睡眠中更为重要(p<0.01)。总之,θ带中更强的睡眠 EEG 去同步可将对 VNS 治疗有反应的患者与无反应的患者区分开来。与清醒状态相比,VNS 诱导的网络整合减少在睡眠中更为显著。
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