Institute of NeuroScience (IoNS), Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.
Bio- Electro- And Mechanical Systems (BEAMS), Université Libre de Bruxelles, Brussels, Belgium.
PLoS One. 2024 Jun 11;19(6):e0304115. doi: 10.1371/journal.pone.0304115. eCollection 2024.
There are currently no established biomarkers for predicting the therapeutic effectiveness of Vagus Nerve Stimulation (VNS). Given that neural desynchronization is a pivotal mechanism underlying VNS action, EEG synchronization measures could potentially serve as predictive biomarkers of VNS response. Notably, an increased brain synchronization in delta band has been observed during sleep-potentially due to an activation of thalamocortical circuitry, and interictal epileptiform discharges are more frequently observed during sleep. Therefore, investigation of EEG synchronization metrics during sleep could provide a valuable insight into the excitatory-inhibitory balance in a pro-epileptogenic state, that could be pathological in patients exhibiting a poor response to VNS. A 19-channel-standard EEG system was used to collect data from 38 individuals with Drug-Resistant Epilepsy (DRE) who were candidates for VNS implantation. An EEG synchronization metric-the Weighted Phase Lag Index (wPLI)-was extracted before VNS implantation and compared between sleep and wakefulness, and between responders (R) and non-responders (NR). In the delta band, a higher wPLI was found during wakefulness compared to sleep in NR only. However, in this band, no synchronization difference in any state was found between R and NR. During sleep and within the alpha band, a negative correlation was found between wPLI and the percentage of seizure reduction after VNS implantation. Overall, our results suggest that patients exhibiting a poor VNS efficacy may present a more pathological thalamocortical circuitry before VNS implantation. EEG synchronization measures could provide interesting insights into the prerequisites for responding to VNS, in order to avoid unnecessary implantations in patients showing a poor therapeutic efficacy.
目前尚无确定的生物标志物可用于预测迷走神经刺激(Vagus Nerve Stimulation,VNS)的治疗效果。鉴于神经去同步化是 VNS 作用的关键机制,脑电图同步测量指标可能成为 VNS 反应的预测生物标志物。值得注意的是,在睡眠期间观察到 delta 频段的脑同步增加-可能是由于丘脑皮质回路的激活,并且在睡眠期间更容易观察到癫痫样放电。因此,研究睡眠期间的脑电图同步指标可以深入了解致癫痫状态下的兴奋-抑制平衡,对于对 VNS 反应不佳的患者,这种平衡可能是病理性的。使用 19 通道标准脑电图系统从 38 名药物难治性癫痫(Drug-Resistant Epilepsy,DRE)患者中收集数据,这些患者是 VNS 植入的候选者。在 VNS 植入前提取脑电图同步指标-加权相位滞后指数(Weighted Phase Lag Index,wPLI),并在睡眠和清醒时,以及在反应者(Responder,R)和非反应者(Non-Responder,NR)之间进行比较。在 delta 频段中,仅在 NR 中,清醒时的 wPLI 高于睡眠时。然而,在该频段中,R 和 NR 之间在任何状态下均未发现同步差异。在睡眠期间和 alpha 频段内,wPLI 与 VNS 植入后癫痫发作减少的百分比之间存在负相关。总体而言,我们的结果表明,在 VNS 植入前表现出较差 VNS 疗效的患者可能表现出更具病理性的丘脑皮质回路。脑电图同步测量指标可以为 VNS 反应的前提提供有趣的见解,以避免在治疗效果不佳的患者中进行不必要的植入。
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