Empirically Based Guidelines for Selecting Vagus Nerve Stimulation Parameters in Epilepsy and Heart Failure.
Empirically Based Guidelines for Selecting Vagus Nerve Stimulation Parameters in Epilepsy and Heart Failure.
复制标题
癫痫和心力衰竭迷走神经刺激参数选择的经验指南。
DOI：
10.1101/cshperspect.a034264
复制
发表时间：
2019
影响因子：
5.4
通讯作者：
Grill,WarrenM
中科院分区：
文献类型：
--
作者：
Musselman,EricD;Pelot,NicoleA;Grill,WarrenM
迷走神经刺激（VNS）是治疗癫痫和心力衰竭患者的一种有前途的疗法。临床前研究和临床试验的结果表明，刺激参数的选择对治疗效果和患者耐受性有直接影响，这表明VNS的疗效和耐受性都可能随着刺激参数的变化而改善。在这篇综述中，成功的翻译刺激参数癫痫和心力衰竭从临床前研究的动物模型在临床上用于人类使用的基础上，患者的结果和刺激引起的副作用进行了评估。数据表明，接受VNS治疗癫痫的患者可能会通过增加刺激的频率和/或占空比以及纳入闭环系统以在更接近癫痫发作时提供刺激来改善癫痫发作减少。此外，数据表明，用于心力衰竭的VNS受限于不能激活介导治疗益处的神经纤维而没有副作用诱导纤维的共激活。这可能解释了为什么尽管在动物模型中有良好的临床前结果，但VNS治疗心力衰竭的关键试验未能达到主要疗效结果。刺激参数空间和基础纤维群体的募集之间的关系的改进表征将可能扩展VNS的使用以治疗各种疾病，并且还改进对VNS基础的作用机制的当前理解。
Vagus nerve stimulation (VNS) is a promising therapy to treat patients with epilepsy and heart failure. Outcomes of preclinical studies and clinical trials indicate that the selection of stimulation parameters has a direct impact on therapeutic efficacy and patient tolerability, suggesting that both the efficacy and tolerability of VNS could potentially be improved with a change in stimulation parameters. In this review, the success of translating stimulation parameters for epilepsy and heart failure from preclinical studies in animal models to human use in the clinic is evaluated on the basis of patient outcomes and stimulation-induced side effects. Data suggest that patients receiving VNS for epilepsy may experience improved seizure reduction by increasing the frequency and/or duty cycle of stimulation as well as incorporating closed-loop systems to deliver stimulation closer to seizure onset. Further, data suggest that VNS for heart failure is limited by the inability to activate the nerve fibers mediating therapeutic benefit without co-activation of side effect–inducing fibers. This may explain why pivotal trials of VNS for heart failure failed to meet primary efficacy outcomes despite promising preclinical outcomes in animal models. Improved characterization of the relationship between the stimulation parameter space and recruitment of the underlying fiber populations will likely expand the use of VNS to treat a variety of diseases and also improve upon current understanding of the mechanisms of action underlying VNS.