[en] [en] OBJECTIVE: The objective of the study was to record Laryngeal Motor Evoked Potentials (LMEPs) in Vagus Nerve Stimulation (VNS)-implanted patients suffering from Drug-Resistant Epilepsy (DRE). Based on these recordings, LMEPs characteristics were evaluated and compared between responders (R) and non-responders (NR). Finally, possible under- or over-stimulation was assessed based on a physiological indicator of fiber engagement.
METHODS: Mean dose-response curves were compared between R and NR. A Support Vector Machine (SVM) model was built based on both LMEP and dose-response curves features, to discriminate R from NR. For the exploration of possible under- or over-stimulation, a ratio between the clinically applied stimulation intensity and the intensity yielding to LMEP saturation was computed for each patient.
RESULTS: A trend towards a greater excitability of the nerve was observed in R compared to NR. The SVM classifier discriminated R and NR with an accuracy of 80%. An ineffective attempt to overstimulate at current levels above what is usually necessary to obtain clinical benefits was suggested in NR.
CONCLUSIONS: The SVM model built emphasizes a possible link between vagus nerve recruitment characteristics and treatment effectiveness. Most of the clinically responding patients receive VNS at a stimulation intensity 1-fold and 2-fold the intensity inducing LMEP saturation.
SIGNIFICANCE: LMEP saturation could be a practical help in guiding the titration of the stimulation parameters using a physiological indicator of fiber engagement.
Disciplines :
Neurosciences & behavior
Author, co-author :
Berger, Alexandre ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Sleep and chronobiology
Carapancea, Evelina ; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium
Vespa, Simone; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium
Danthine, Venethia; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium
Doguet, Pascal; Synergia Medical SA, Mont-Saint-Guibert, Belgium
Delbeke, Jean; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium, Institute of Neuroscience, LCEN3, Department of Neurology, Ghent University, Ghent, Belgium
Nonclercq, Antoine ; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium, Bio, Electro and Mechanical Systems Department (BEAMS), Ecole Polytechnique de Bruxelles, Brussels, Belgium
El Tahry, Riëm; Institute of Neuroscience (IoNS), Department of Clinical Neuroscience, Université Catholique de Louvain, Brussels, Belgium, Center for Refractory Epilepsy, Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium, Walloon Excellence in Life Sciences and Biotechnology (WELBIO) Department, WEL Research Institute, Avenue Pasteur 6, 1300 Wavre, Belgium
Language :
English
Title :
Vagus nerve stimulation-induced laryngeal motor evoked potentials for response prediction and intensity titration in drug-resistant epilepsy.
AB received funding from Synergia Medical and the Walloon Region as part of an Industrial Doctorate Program (n°8193). PD is employed by Synergia Medical. AN is a member of the Scientific Council and a shareholder at Synergia Medical. The funder was not involved in the study design, data collection and analysis, interpretation of the data, the writing of the article, or the decision to submit it for publication.This work was supported by the Walloon Region and Synergia Medical SA (Industrial Doctorate Program, convention n°8193). RET is funded by the Walloon Excellence in Life Sciences and Biotechnology (WELBIO) department of the WEL Research Institute (X.2001.22) and the Queen Elisabeth Medical Foundation (QEMF).
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