Berger Alexandre, Vespa Simone, Dricot Laurence, Dumoulin Manon, Iachim Evelina, Doguet Pascal, Vandewalle Gilles, El Tahry Riëm
Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
Synergia Medical SA, Mont-Saint-Guibert, Belgium.
Front Neurosci. 2021 Dec 2;15:790943. doi: 10.3389/fnins.2021.790943. eCollection 2021.
Vagus Nerve Stimulation (VNS) is an adjunctive treatment for patients suffering from inoperable drug-resistant epilepsy. Although a complete understanding of the mediators involved in the antiepileptic effects of VNS and their complex interactions is lacking, VNS is known to trigger the release of neurotransmitters that have seizure-suppressing effects. In particular, norepinephrine (NE) is a neurotransmitter that has been associated with the clinical effects of VNS by preventing seizure development and by inducing long-term plastic changes that could restore a normal function of the brain circuitry. However, the biological requisites to become responder to VNS are still unknown. In this review, we report evidence of the critical involvement of NE in the antiepileptic effects of VNS in rodents and humans. Moreover, we emphasize the hypothesis that the functional integrity of the noradrenergic system could be a determining factor to obtain clinical benefits from the therapy. Finally, encouraging avenues of research involving NE in VNS treatment are discussed. These could lead to the personalization of the stimulation parameters to maximize the antiepileptic effects and potentially improve the response rate to the therapy.
迷走神经刺激（VNS）是一种针对患有无法手术的耐药性癫痫患者的辅助治疗方法。尽管目前尚缺乏对参与VNS抗癫痫作用的介质及其复杂相互作用的全面了解，但已知VNS会触发具有抑制癫痫发作作用的神经递质的释放。特别是去甲肾上腺素（NE），它是一种神经递质，通过预防癫痫发作的发展以及诱导长期的可塑性变化来恢复大脑回路的正常功能，从而与VNS的临床效果相关联。然而，成为VNS反应者的生物学必要条件仍然未知。在本综述中，我们报告了NE在啮齿动物和人类VNS抗癫痫作用中关键作用的证据。此外，我们强调这样一种假设，即去甲肾上腺素能系统的功能完整性可能是从该疗法中获得临床益处的决定性因素。最后，讨论了涉及NE在VNS治疗中的令人鼓舞的研究途径。这些可能会导致刺激参数的个性化，以最大限度地提高抗癫痫效果，并有可能提高对该疗法的反应率。
