Optimization of epilepsy treatment with vagus nerve stimulation

摘要: Epilepsy is one of the most common chronic neurological disorders that affects close to 50 million people worldwide. Antiepilepsy drugs (AEDs), main stay epilepsy treatment, control seizures in two thirds patients only. Other therapies include ketogenic diet, ablative surgery, hormonal treatments and neurostimulation. While other approaches stimulation brain are currently experimental phase vagus nerve (VNS) has been approved by FDA since July 1997 for adjunctive treatment intractable partial onset with without secondary generalization twelve years age or older. The safety efficacy VNS have proven duplicated subsequent double‐blinded controlled studies after pilot demonstrated feasibility man. Long term observational confirmed its effectiveness sustained over time. AEDs influence seizure thresholds via blockade modulation ionic channels, inhibit excitatory neurotransmitters enhance inhibitory exact mechanism action not known. Neuroimaging revealed increases blood flow certain regions such as thalamus. Chemical lesions rat brains showed norepinephrine an important link anticonvulsant effect VNS. Analysis cerebrospinal fluid obtained from before modest decreases neurotransmitters. Although Hammond et al. reported no on scalp EEG visual analysis Salinsky found spectral analysis, Kuba suggested reduces interictal epileptiform activity. Further, nonlinear dynamical electroencephalogram man reportedly shown predictable changes (decrease short Lyapunov exponent STLmax T‐index) more than hour prior clinical electroencephalographic onset. It possible intermittent maintains chaoticity activity respond this therapy. optimal parameters known further study dynamics may shed some light effective interception prevention seizures. Online real time allow on‐demand rather hit‐or‐miss approach