Resting-state functional connectivity changes with microburst vagus nerve stimulation therapy.

IF 2.8 3区 医学 Q2 CLINICAL NEUROLOGY
Epilepsia Open Pub Date : 2025-05-27 DOI:10.1002/epi4.70059
Jane B Allendorfer, Rodolphe Nenert, Elhum Shamshiri, Giovanni Ranuzzi, Jason Begnaud, Ryan Verner, Jerzy P Szaflarski
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Abstract

Objective: Microburst vagus nerve stimulation (μVNS) may reduce seizure frequency in drug-resistant epilepsy (DRE) via targeted thalamic plasticity. We prospectively investigated the role of thalamic resting-state functional connectivity (rsFC) in μVNS effects and hypothesized a relationship between thalamic rsFC and long-term seizure frequency changes.

Methods: Eighteen patients with focal (Foc) and 10 with generalized (Gen) DRE underwent 3T resting-state fMRI at 2 weeks post-implantation and before starting (baseline) and after 6 months of μVNS. Resting-state fMRI analyses were performed using in-house Matlab scripts. Nonparametric permutation tests assessed baseline group differences in rsFC between automated anatomical atlas (AAL) brain regions and longitudinal rsFC changes. Spearman correlations were performed between baseline thalamus rsFC and percent change in seizures after 12 months of μVNS (PCHG-12).

Results: Gen had stronger baseline rsFC between AAL regions compared with Foc. Gen showed significant baseline-to-6-month rsFC changes, including a decrease between the left thalamus and left superior parietal lobule. Foc showed significant rsFC changes, including increases between the left thalamus and four regions: right middle cingulum (Lthal-Rmidcing), right angular gyrus (Lthal-Rangular), left angular gyrus (Lthal-Langular), and left precuneus (Lthal-Lprecuneus), and increases between the right thalamus and left angular gyrus (Rthal-Langular). Foc showed negative correlations between PCHG-12 and baseline rsFC for Lthal-Rmidcing (ρ = -0.61; p = 0.007), Lthal-Rangular (ρ = -0.51; p = 0.032), and Rthal-Langular (ρ = -0.52; p = 0.028).

Significance: Baseline thalamic rsFC is correlated with long-term seizure frequency reduction with μVNS in focal DRE. RsFC may be a potential biomarker for μVNS response in focal-onset seizure patients; this relationship may be different in DRE with generalized seizures.

Plain language summary: We investigated how stimulating the vagus nerve in a specific manner may reduce seizure frequency in people with drug-resistant epilepsy through its actions on how a part of the brain called the thalamus is functionally connected to other brain regions. People with focal seizures showed a different pattern of changes in thalamus functional connectivity than those with generalized seizures after 6 months of stimulation. People with focal seizures also showed that stronger functional connectivity between the thalamus and other brain regions at baseline was related to a greater decrease in seizure frequency after 12 months of stimulation.

微脉冲迷走神经刺激治疗静息状态功能连通性的改变。
目的:微脉冲迷走神经刺激(μVNS)可能通过靶向丘脑可塑性降低耐药癫痫(DRE)的发作频率。我们前瞻性地研究了丘脑静息状态功能连接(rsFC)在μVNS效应中的作用,并假设了丘脑静息状态功能连接与长期发作频率变化之间的关系。方法:18例局灶性(Foc)和10例全身性(Gen) DRE患者在植入后2周、开始(基线)前和6个月μVNS后行3T静息态功能磁共振成像(fMRI)。静息状态fMRI分析使用内部Matlab脚本进行。非参数排列测试评估了自动解剖图谱(AAL)脑区和纵向rsFC变化之间rsFC的基线组差异。对基线丘脑rsFC与12个月μVNS后癫痫发作百分比变化(PCHG-12)进行Spearman相关性分析。结果:Gen与Foc相比,AAL区域之间的基线rsFC更强。Gen显示出显著的基线至6个月rsFC变化,包括左丘脑和左顶叶上小叶之间的减少。Foc表现出显著的rsFC变化,包括左丘脑与右侧中扣带(Lthal-Rmidcing)、右侧角回(Lthal-Rangular)、左侧角回(Lthal-Langular)、左侧楔前叶(Lthal-Lprecuneus)四个区域之间的增加,以及右侧丘脑与左侧角回(Rthal-Langular)之间的增加。PCHG-12与基线rsFC之间的Foc呈负相关(ρ = -0.61;p = 0.007),左矩形(ρ = -0.51;p = 0.032), rthal - langle (ρ = -0.52;p = 0.028)。意义:在局灶性DRE中,基线丘脑rsFC与μVNS降低长期癫痫发作频率相关。RsFC可能是局发性癫痫患者μVNS反应的潜在生物标志物;这种关系在DRE伴全身性癫痫发作时可能有所不同。简单的语言总结:我们研究了以特定的方式刺激迷走神经如何通过大脑中称为丘脑的部分与其他大脑区域的功能连接来减少耐药癫痫患者的癫痫发作频率。在6个月的刺激后,局灶性癫痫患者的丘脑功能连通性变化模式与全身性癫痫患者不同。局灶性癫痫患者还显示,在基线时丘脑和其他大脑区域之间更强的功能连通性,与刺激12个月后癫痫发作频率的大幅下降有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epilepsia Open
Epilepsia Open Medicine-Neurology (clinical)
CiteScore
4.40
自引率
6.70%
发文量
104
审稿时长
8 weeks
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