Electrocorticography Analysis in Patients With Dual Neurostimulators Supports Desynchronization as a Mechanism of Action for Acute Vagal Nerve Stimulator Stimulation

Lia D. Ernst, Paul J. Steffan, Priya Srikanth, Jack Wiedrick, David Spencer, Proleta Datta, Navya M. Joseph, Magda Wernovsky, Danielle A. Becker

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose: Both vagal nerve stimulation (VNS) and responsive neurostimulation (RNS System) are treatment options for medically refractory focal epilepsy. The mechanism of action of both devices remains poorly understood. Limited prior evidence suggests that acute VNS stimulation may reduce epileptiform activity and cause EEG desynchronization on electrocorticography (ECoG). Our study aims to isolate effects of VNS on ECoG as recorded by RNS System in patients who have both devices, by comparing ECoG samples with and without acute VNS stimulation. Methods: Ten 60-second ECoGs each from 22 individuals at 3 epilepsy centers were obtainedd5 ECoGs with VNS “off” and 5 ECoGs with VNS “on.” Electrocorticograps containing seizures or loss of telemetry connection artifact were excluded from analysis (total of 169 ECoGs were included). Electrocorticographs were analyzed for differences in spectral content by generating average spectrograms for “on” and “off” states and using a linear mixed-effects model to isolate effects of VNS stimulation. Results: Acute VNS stimulation reduced average power in the theta band by 4.9%, beta band by 3.8%, and alpha band by 2.5%. The reduction in theta power reached statistical significance with a P value of,0.05. Conclusions: Our results provide evidence that acute VNS stimulation results in desynchronization of specific frequency bands (salient decrease in theta and beta bands, smaller decrease in alpha band) in ECoGs recorded by the RNS device in patients with dual (VNS and RNS) neurostimulators. This finding offers support for desynchronization as a theorized mechanism of action of VNS. Further research may lead to future improved neurostimulator efficacy by informing optimal stimulation programming parameters.

Original languageEnglish (US)
JournalJournal of Clinical Neurophysiology
DOIs
StateAccepted/In press - 2021

Keywords

  • Focal epilepsy
  • Neurostimulation
  • Responsive neurostimulation
  • Vagal nerve stimulation

ASJC Scopus subject areas

  • Medicine(all)

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