Estimated EEG functional connectivity and aperiodic component induced by vagal nerve stimulation in patients with drug-resistant epilepsy

Coa, Roberta; Cava, Simone Maurizio La; Baldazzi, Giulia; Polizzi, Lorenzo; Pinna, G.; Conti, C; Defazio, Giovanni; Pani, Danilo; Puligheddu, Monica

doi:10.3389/fneur.2022.1030118

Cited by 11 publications

(3 citation statements)

References 56 publications

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“…Responders to vagus nerve stimulation treatment showed decreased periodic component derived from scalp electroencephalography compared to nonresponders. 21 Additionally, if the running down phenomenon indicates decoupling and deactivation of other epileptogenic sites after the primary focus was resected, decreased detections may also be a biomarker of seizure freedom. Data from additional patients are needed to explore these questions.…”

Section: Discussionmentioning

confidence: 99%

Chronic intracranial recordings after resection for epilepsy reveal a "running down" of epileptiform activity

et al. 2023

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We describe an electrical "running down" phenomenon and also a consistent spectral change (in the aperiodic component of the power spectrum) derived from chronic interictal electrocorticography (ECoG) after surgery in a patient with drug‐resistant epilepsy. These data were recorded using a closed‐loop neurostimulation system that was implanted after resection. The patient has been seizure‐free for 2.5 years since resection without requiring the neurostimulator to be turned on to stimulate. Concurrently, there was an exponential decrease in the number of epileptiform electrographic detections recorded by the device, particularly over the first 26 weeks, indicative of an electrical running down phenomenon as the brain adapted to an extended period of seizure freedom. We also find that the aperiodic exponent of the power spectrum gradually decreases over time. The aperiodic component of intracranial ECoG may represent a novel marker of epileptogenicity, independent of seizures.

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Section: Discussionmentioning

confidence: 99%

Chronic intracranial recordings after resection for epilepsy reveal a "running down" of epileptiform activity

et al. 2023

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“…Moreover, changes in the brain's functional connectivity have been proposed as another possible effect of VNS. Recent studies have shown that changes in synchronization in specific frequency bands are different between responders and non-responders ( 69 ). Alteration of functional connectivity was also seen in a study using data from stereo-EEG recordings in patients with VNS.…”

Section: Discussionmentioning

confidence: 99%

Neuromodulation in new-onset refractory status epilepticus

2023

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BackgroundNew-onset refractory status epilepticus (NORSE) and its subset of febrile infection-related epilepsy syndrome (FIRES) are devastating clinical presentations with high rates of mortality and morbidity. The recently published consensus on the treatment of these conditions includes anesthetics, antiseizure drugs, antivirals, antibiotics, and immune therapies. Despite the internationally accepted treatment, the outcome remains poor for a significant percentage of patients.MethodsWe conducted a systematic review of the use of neuromodulation techniques in the treatment of the acute phase of NORSE/FIRES using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsOur search strategy brought up 74 articles of which 15 met our inclusion criteria. A total of 20 patients were treated with neuromodulation. Thirteen cases represented FIRES and in 17 cases the NORSE remained cryptogenic. Ten had electroconvulsive therapy (ECT), seven had vagal nerve stimulation (VNS), and four had deep brain stimulation (DBS); one patient had initially VNS and later DBS. Eight patients were female and nine were children. In 17 out of 20 patients, the status epilepticus was resolved after neuromodulation, while three patients died.ConclusionNORSE can have a catastrophic course and the first treatment goal should be the fastest possible termination of status epilepticus. The data presented are limited by the small number of published cases and the variability of neuromodulation protocols used. However, they show some potential clinical benefits of early neuromodulation therapy, suggesting that these techniques could be considered within the course of FIRES/NORSE.

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“…As a minimally invasive neuromodulation therapy, VNS has been widely used in the treatment of DRE with large or uncertain epileptic focus unsuitable for surgical resection, or when surgery has not been curative and seizures recur after surgery. It has been shown to be safe and effective [4]. However, as the number of patients receiving VNS has increased, so has the number of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

U-shaped Loop：A Strain Relief Loop for Preventing Vagal Nerve Stimulator Lead Fracture

Mei

Chen

Shi

2023

Preprint

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Background: Vagal nerve electrical stimulation (VNS) is one of the effective neuromodulatory therapies for drug resistant epilepsy (DRE). Common device complications include lead fracture, device failure or battery dislodgement, resulting in various clinical symptoms. We report a case of lead fracture after VNS surgery, which provides inspiration during VNS surgery. Case presentation: The patient was a 10-year-old child treated with VNS for DRE. The child's body was still growing, and after surgery, he occasionally engaged in physical activity, which led to an increase in the number of seizures after a neck rotation. An examination of the VNS device was performed, which showed that the wire lead was broken. The patient decided to have a VNS replacement surgery. During the operation, we maintain a certain degree of relaxation of the lead through two U-shaped loops as strain relief loops in the neck to prevent the lead fracture during neck activity. Postoperative epilepsy was well controlled, and no more seizures occurred during physical activity and neck rotation. Conclusions: Maintaining a certain degree of relaxation of the lead in the neck during VNS operation can reduce the occurrence of lead fracture caused by the patient's body growth and neck rotation after surgery.

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Estimated EEG functional connectivity and aperiodic component induced by vagal nerve stimulation in patients with drug-resistant epilepsy

Cited by 11 publications

References 56 publications

Chronic intracranial recordings after resection for epilepsy reveal a "running down" of epileptiform activity

Chronic intracranial recordings after resection for epilepsy reveal a "running down" of epileptiform activity

Neuromodulation in new-onset refractory status epilepticus

U-shaped Loop：A Strain Relief Loop for Preventing Vagal Nerve Stimulator Lead Fracture

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