Brain blood flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: I. Acute effects at high and low levels of stimulation
Brain blood flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: I. Acute effects at high and low levels of stimulation
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DOI：
10.1111/j.1528-1157.1998.tb01448.x
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发表时间：
1998-09-01
期刊：
影响因子：
5.6
通讯作者：
Hoffman, JM
中科院分区：
文献类型：
--
作者：
Henry, TR;Bakay, RAE;Hoffman, JM
目的：左颈模糊神经刺激(VNS)减少复杂部分性发作(CPS)，其作用机制尚不清楚。我们假设治疗性VNS改变了迷走神经传入终末和接受这些延髓核多突触投射的部位的突触活动。方法：10例部分癫痫患者在VNS前和期间分别进行了三次正电子发射断层扫描(PET)脑血流量(BF)测量。VNS的参数有5例处于高水平，5例处于低水平。每个受试者在VNS期间的测量中减去静息BF。两组各5例患者的平均减影数据。对接受迷走神经传入和投射的脑区的BF变化进行t检验(P<；0.05，重复测量校正)。结果：在VNS期间，低刺激组和高刺激组的脑BF均增加：(A)在吻侧、背侧-中央延髓；(B)在右侧中央后回；(C)在双侧下丘脑、丘脑、岛叶皮质和下部小脑半球；(D)在双侧海马、杏仁核和后扣带回，BF降低。高刺激组有更多的激活和失活部位。结论：我们的研究结果表明，左侧颈部迷走神经刺激显著增加了由中央迷走神经结构直接支配的结构和处理左侧体感信息的区域的突触活动，但迷走神经刺激也显著改变了双侧多个边缘系统结构的突触活动。这些发现可能反映了VNS的治疗作用部位。
Purpose: Left cervical vague nerve stimulation (VNS) decreases complex partial seizures (CPS) by unknown mechanisms of action. We hypothesized that therapeutic VNS alters synaptic activities at vagal afferent terminations and in sites that receive polysynaptic projections from these medullary nuclei.Methods: Ten patients with partial epilepsy underwent positron emission tomographic (PET) measurements of cerebral blood flow (BF) three times before and three times during VNS. Parameters for VNS were at high levels for 5 patients and at low levels for 5. Resting BF measurements were subtracted from measurements during VNS in each subject. Subtraction data were averaged in each of 2 groups of 5 patients. t Tests were applied to BF changes in brain regions that receive vagal afferents and projections (significant at p < 0.05, corrected for repeated measures).Results: In both the low- and high-stimulation groups during VNS, brain BF was (a) increased in the rostral, dorsal-central medulla; (b) increased in the right postcentral gyrus, (c) increased bilaterally in the hypothalami, thalami, and insular cortexes, and in cerebellar hemispheres inferiorly; and (d) de creased bilaterally in hippocampus, amygdala, and posterior cingulate gyri. The high-stimulation group had greater volumes of activation and deactivation sites.Conclusions: Our findings suggest that left cervical VNS acutely increases synaptic activity in structures directly innervated by central vagal structures and areas that process left-sided somatosensory information, but VNS also acutely alters synaptic activity in multiple limbic system structures bilaterally. These findings may reflect sites of therapeutic actions of VNS.