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Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy.

ABSTRACT: We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear.The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy.ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA.VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 ?V (95% confidence interval [CI] 0.93-1.18) in lead I and 1.13 ?V (95% CI 0.99-1.27) in lead II, which was significantly lower than 1.38 ?V (95% CI 1.01-1.75; P = .036) and 1.38 ?V (95% CI 0.98-1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95% CI 59-71) in the VNS group, which was significantly lower than 77 bpm (95% CI 71-83) in the control group.Patients with VNS had significantly lower SKNA than those without VNS.

SUBMITTER: Yuan Y

PROVIDER: S-EPMC5712260 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy.

Yuan Yuan Y Hassel Jonathan L JL Doytchinova Anisiia A Adams David D Wright Keith C KC Meshberger Chad C Chen Lan S LS Guerra Maria P MP Shen Changyu C Lin Shien-Fong SF Everett Thomas H TH Salanova Vicenta V Chen Peng-Sheng PS

Heart rhythm 20170801 12

<h4>Background</h4>We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear.<h4>Objective</h4>The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy.<h4 ...[more]

PMID: 28778733

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Project description:BackgroundVagal nerve stimulation (VNS) can be indicated in patients with drug-resistant epilepsy, who are not eligible for resective epilepsy surgery. In VNS therapy, the responder rate (i.e., percentage of subjects experiencing ≥50% seizure reduction) is ~50%. At the moment, there is no widely-accepted possibility to predict VNS efficacy in a particular patient based on pre-implantation data, which can lead to unnecessary surgery and improper allocation of financial resources. The principal aim of PRediction of vagal nerve stimulation EfficaCy In drug-reSistant Epilepsy (PRECISE) study is to verify the predictability of VNS efficacy by analysis of pre-implantation routine electroencephalogram (EEG).MethodsPRECISE is designed as a prospective multicentric study in which patients indicated to VNS therapy will be recruited. Patients will be classified as predicted responders vs. predicted non-responders using pre-implantation EEG analyses. After the first and second year of the study, the real-life outcome (responder vs. non-responder) will be determined. The real-life outcome and predicted outcome will be compared in terms of accuracy, specificity, and sensitivity. In the meantime, the patients will be managed according to the best clinical practice to obtain the best therapeutic response. The primary endpoint will be the accuracy of the statistical model for prediction of response to VNS therapy in terms of responders and non-responders. The secondary endpoint will be the quantification of differences in EEG power spectra (Relative Mean Power, %) between real-life responders and real-life non-responders to VNS therapy in drug-resistant epilepsy and the sensitivity and specificity of the model.DiscussionPRECISE relies on the results of our previous work, through which we developed a statistical classifier for VNS response (responders vs. non-responders) based on differences in EEG power spectra dynamics (Pre-X-Stim).Trial registrationwww.ClinicalTrials.gov, identifier: NCT04935567.

Dataset Information

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy.

Publications

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy.

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