Selective Neuromodulation of the Vagus Nerve.
Selective Neuromodulation of the Vagus Nerve.
复制标题
迷走神经的选择性神经调节。
DOI：
10.3389/fnins.2021.685872
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发表时间：
2021
影响因子：
4.3
通讯作者：
Aristovich K
中科院分区：
文献类型：
--
作者：
Fitchett A;Mastitskaya S;Aristovich K
迷走神经刺激（VNS）是治疗难治性癫痫的有效技术，并显示出治疗一系列其他严重疾病的潜力。然而，到目前为止，刺激通常是超最大和非选择性的，导致一系列副作用。选择性VNS（sVNS）旨在通过靶向神经内的特定纤维类型以产生功能特异性效应来减轻这种情况。近年来，sVNS的几个关键范例已经开发空间选择性，纤维选择性，阳极阻滞，神经滴定，和千赫电刺激块，以及各种刺激脉冲参数和电极阵列几何形状。sVNS可以显著降低副作用的严重程度，并且在某些情况下增加治疗的功效。虽然大多数研究都集中在纤维选择性sVNS，空间选择性sVNS已经证明了相当的缓解副作用。它有可能实现更大的特异性，并提供有关迷走神经生理学的重要信息。阳极阻断也实现了强有力的副作用缓解，但远不如纤维和空间选择性范例的特异性。迷走神经的功能解剖组织的知识有限是实现更好的选择性迷走神经刺激的主要障碍。优化电极阵列几何形状和脉冲形状，以及将sVNS的应用扩展到目前关注的心血管疾病之外也至关重要。
Vagus nerve stimulation (VNS) is an effective technique for the treatment of refractory epilepsy and shows potential for the treatment of a range of other serious conditions. However, until now stimulation has generally been supramaximal and non-selective, resulting in a range of side effects. Selective VNS (sVNS) aims to mitigate this by targeting specific fiber types within the nerve to produce functionally specific effects. In recent years, several key paradigms of sVNS have been developed—spatially selective, fiber-selective, anodal block, neural titration, and kilohertz electrical stimulation block—as well as various stimulation pulse parameters and electrode array geometries. sVNS can significantly reduce the severity of side effects, and in some cases increase efficacy of the treatment. While most studies have focused on fiber-selective sVNS, spatially selective sVNS has demonstrated comparable mitigation of side-effects. It has the potential to achieve greater specificity and provide crucial information about vagal nerve physiology. Anodal block achieves strong side-effect mitigation too, but is much less specific than fiber- and spatially selective paradigms. The major hurdle to achieving better selectivity of VNS is a limited knowledge of functional anatomical organization of vagus nerve. It is also crucial to optimize electrode array geometry and pulse shape, as well as expand the applications of sVNS beyond the current focus on cardiovascular disease.
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