Acute blood flow changes and efficacy of vagus nerve stimulation in partial epilepsy
Acute blood flow changes and efficacy of vagus nerve stimulation in partial epilepsy
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DOI：
10.1212/wnl.52.6.1166
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发表时间：
1999-04-12
期刊：
影响因子：
9.9
通讯作者：
Hoffman, JM
中科院分区：
文献类型：
--
作者：
Henry, TR;Votaw, JR;Hoffman, JM
目的：通过关联急性 VNS 诱导的局部脑血流 (rCBF) 变化和慢性治疗反应，确定迷走神经刺激 (VNS) 可能的治疗作用位点。背景.- Sire 之前发现 VNS 会在接受迷走神经传入和高阶投射的部位急性诱导 rCBF 改变，包括背侧髓质、体感皮层（刺激对侧）、双侧丘脑和小脑以及一些边缘结构（包括双侧海马和杏仁核）。方法：通过从 rCBF 中减去静息 rCBF 来测量 VNS 诱导的 rCBF 变化在 VNS 期间，使用 [0-15] 水和 PET，在正在进行的 VNS 开始之前，对 II 型部分性癫痫患者进行治疗。 T 统计图建立了每个患者的相对 rCBF 增加和减少。与 VNS 前基线相比，VNS 三个月期间复杂部分性癫痫发作（伴或不伴继发性全身性发作）的频率变化百分比以及 T 阈值 rCBF 变化（针对先前观察到的 25 个显着 CBF 变化的区域）对患者进行排序。 Spearman 等级相关系数评估了癫痫发作频率变化与 t 阈值 rCBF 变化之间的关联。结果：VNS 期间癫痫发作频率变化范围从减少 71% 到增加 12%。只有左右丘脑显示 rCBF 变化与癫痫发作频率变化显着相关。左右丘脑 CBF 增加与癫痫发作减少相关 (p < 0.001)。结论：丘脑突触活动的增加可能介导了 VNS 的一些抗癫痫作用。未来的研究应该检查 VNS 期间网状核和特定丘脑核中神经递质受体的变化。
Objective: To determine possible sites of therapeutic action of vagus nerve stimulation (VNS), by correlating acute VNS-induced regional cerebral blood flow (rCBF) alterations and chronic therapeutic responses. Background.- Sire previously found that VNS acutely induces rCBF alterations at sites that receive vagal afferents and higher-order projections, including dorsal medulla, somatosensory cortex (contralateral to stimulation), thalamus and cerebellum bilaterally, and several limbic structures (including hippocampus and amygdala bilaterally), Methods: VNS-induced rCBF changes were measured by subtracting resting rCBF from rCBF during VNS, using [0-15]water and PET, immediately before ongoing VNS began, in II partial epilepsy patients. T-statistical mapping established relative rCBF increases and decreases for each patient. Percent changes in frequency of complex partial seizures (with or without secondary generalization) during three months of VNS compared with pre-VNS baseline, and T-thresholded rCBF changes (for each of the 25 regions of previously observed significant CBF change), were rank ordered across patients. Spearman rank correlation coefficients assessed associations of seizure-frequency change and t-thresholded rCBF change. Results: Seizure-frequency changes ranged from 71% decrease to 12% increase during VNS. Only the right and left thalami showed significant associations of rCBF change with seizure-frequency change. Increased right and left thalamic CBF correlated with decreased seizures (p < 0.001). Conclusions: Increased thalamic synaptic activities probably mediate some antiseizure effects of VNS. Future studies should examine neurotransmitter-receptor alterations in reticular and specific thalamic nuclei during VNS.