EEG Reactivity Predicts Individual Efficacy of Vagal Nerve Stimulation in Intractable Epileptics

Frontiers in Neurology

卷:10

Daniel J. Shaw¹  Robert Roman¹  Milan Brázdil¹  Jan Chrastina²  Martin Pail²  Irena Doležalová²  Eva Koritáková³  Jan Chládek⁴  Pavel Jurák⁴ 

[1] Behavioral and Social Neuroscience Research Group, CEITEC–Central European Institute of Technology, Masaryk University, Brno, Czechia;

[2] Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia;

[3] Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia;

[4] Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia;

关键词: vagal nerve stimulation;    neurostimulation;    epilepsy;    efficacy prediction;    EEG reactivity;    epilepsy treatment;   

DOI  :  10.3389/fneur.2019.00392

来源: DOAJ

【 摘 要 】

Background: Chronic vagal nerve stimulation (VNS) is a well-established non-pharmacological treatment option for drug-resistant epilepsy. This study sought to develop a statistical model for prediction of VNS efficacy. We hypothesized that reactivity of the electroencephalogram (EEG) to external stimuli measured during routine preoperative evaluation differs between VNS responders and non-responders.Materials and Methods: Power spectral analyses were computed retrospectively on pre-operative EEG recordings from 60 epileptic patients with VNS. Thirty five responders and 25 non-responders were compared on the relative power values in four standard frequency bands and eight conditions of clinical assessment—eyes opening/closing, photic stimulation, and hyperventilation. Using logistic regression, groups of electrodes within anatomical areas identified as maximally discriminative by n leave-one-out iterations were used to classify patients. The reliability of the predictive model was verified with an independent data-set from 22 additional patients.Results: Power spectral analyses revealed significant differences in EEG reactivity between responders and non-responders; specifically, the dynamics of alpha and gamma activity strongly reflected VNS efficacy. Using individual EEG reactivity to develop and validate a predictive model, we discriminated between responders and non-responders with 86% accuracy, 83% sensitivity, and 90% specificity.Conclusion: We present a new statistical model with which EEG reactivity to external stimuli during routine presurgical evaluation can be seen as a promising avenue for the identification of patients with favorable VNS outcome. This novel method for the prediction of VNS efficacy might represent a breakthrough in the management of drug-resistant epilepsy, with wide-reaching medical and economic implications.

【 授权许可】

Unknown