Functional and structural biomarkers to optimize vagus nerve stimulation therapy in drug-resistant epilepsy
(2024)
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- Abstract
- Vagus Nerve Stimulation (VNS) has been used for three decades as an adjunctive treatment for patients with drug-resistant epilepsy. Despite its established use, the precise mechanisms underlying its therapeutic efficacy remain a subject of ongoing investigation. Moreover, a comprehensive understanding of the biological prerequisites for responding to the treatment is yet to be achieved. In the context of optimizing VNS therapy, a novel approach for the titration of the stimulation parameters is proposed in this thesis and relies on the recording of VNS-induced Laryngeal Motor Evoked Potentials (LMEPs). Another key aspect of this research involves the exploration of response biomarkers to deepen our current knowledge about the biological prerequisites linked to the therapeutic response. In this context, electrophysiological recordings of LMEPs and multimodal Magnetic Resonance Imaging (MRI) – including structural and functional analyses – were used to develop response biomarkers. In particular, the research delved into the structural and functional characteristics of the locus coeruleus, a small brainstem nucleus involved in the antiseizure effects of VNS, as well as the structural attributes of thalamocortical tracts in patients with drug-resistant epilepsy who were implanted with a VNS device. Finally, an industrial part of this thesis aimed at developing a system, the Optical Communication Device (OCD), to communicate remotely (from the command room) with the fully MRI-compatible Synergia Medical optoelectronic neurostimulator in an MRI environment. The use of the OCD will ultimately help in the realization of functional MRI studies, aiming at better understanding the acute effects of VNS administration and optimizing this therapy by tuning the stimulation parameters to maximize the recruitment of structures involved in the antiseizure effects.
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Citations
Berger, A. (2024). Functional and structural biomarkers to optimize vagus nerve stimulation therapy in drug-resistant epilepsy. https://hdl.handle.net/2078.5/232812