Epilepsy and Neuromodulation—Randomized Controlled Trials

Kwon, Churl‐Su; Ripa, Valeria; Al-Awar, Omar; Panov, Fedor; Ghatan, Saadi

doi:10.3390/brainsci8040069

Cited by 42 publications

(28 citation statements)

References 98 publications

(144 reference statements)

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“…Vagus nerve stimulation (VNS) has been successfully used to reduce epileptic seizures in patients with drug-resistant epilepsy since 1988 (Krahl and Clark, 2012) and is clinically effective for many patients treated with invasive VNS (Boon et al, 2018;Kwon et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous vagus nerve stimulation in humans induces pupil dilation and attenuates alpha oscillations

Sharon

Fahoum

Nir

2020

Preprint

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Vagus nerve stimulation (VNS) is widely used to treat drug-resistant epilepsy and depression. While the precise mechanisms mediating its long-term therapeutic effects are not fully resolved, they likely involve Locus Coeruleus (LC) stimulation via the nucleus of the solitary tract (NTS) that receives afferent vagal inputs. In rats, VNS elevates LC firing and forebrain noradrenaline (NE) levels, whereas LC lesions suppress VNS therapeutic efficacy. Non-invasive transcutaneous VNS (tVNS) employs electrical stimulation targeting the auricular branch of the vagus nerve at the Cymba Conchae of the ear, but it remains unclear to what extent tVNS mimics VNS. Here, we investigated the short-term effects of tVNS in healthy human male volunteers (n=24) using high-density EEG and pupillometry during visual fixation at rest, comparing short (3.4s) trials of tVNS to sham electrical stimulation at the earlobe (far from the vagus nerve branch) to control for somatosensory stimulation. Although tVNS and sham stimulation did not differ in subjective intensity ratings, tVNS led to robust pupil dilation (peaking 4-5s after trial onset) that was significantly higher than following sham stimulation. We further quantified how tVNS modulates idle occipital alpha (8-13Hz) activity, identified in each participant using parallel factor analysis. We found that tVNS attenuates alpha oscillations to a greater extent than does sham stimulation. Thus, tVNS reliably induces pupillary and EEG markers of arousal beyond the effects of somatosensory stimulation, supporting the hypothesis that it elevates noradrenaline and acetylcholine signaling and mimics invasive VNS.

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Section: Introductionmentioning

confidence: 99%

Transcutaneous vagus nerve stimulation in humans induces pupil dilation and attenuates alpha oscillations

Sharon

Fahoum

Nir

2020

Preprint

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“…Careful mapping of the cortical function in conjunction with a thorough delineation of the epileptogenic zone (the minimum amount of cortex that must be resected to produce seizure freedom 81 ) may yield the possibility to perform surgery safely and without significant morbidity. If a resection would result in a functional deficit, the patient could be offered alternatives, such as neuromodulation in the form of responsive neurostimulation, vagal nerve stimulation (VNS), or deep brain stimulation, all of which have been shown to yield meaningful reductions in seizure frequency 82 (►Fig. 1).…”

Section: Treatment Of Drug-resistant Epilepsymentioning

confidence: 99%

Epilepsy: Workup and Management in Adults

O’Dwyer

2020

Semin Neurol

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When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.

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“…Weiter sind das Zerebellum als Teil motorischer Netzwerke und der zentromediane Nukleus des Thalamus als Teil des kortikostriatothalamischen Regelkreises als THS-Zielstrukturen bei der Epilepsiebehandlung untersucht worden. Entsprechend den unterschiedlichen Entstehungsmechanismen und -orten der Epilepsie könnten sich möglicherweise eine Vielzahl von Stimulationsorten als sinnvoll erweisen [21].…”

Section: Merkeunclassified