Vagus nerve stimulation-induced laryngeal motor evoked potentials for response prediction and intensity titration in drug-resistant epilepsy

Berger, Alexandre;Carapancea, Evelina;Vespa, Simone;Danthine, Venethia;El Tahry, Riëm;et.al.
(2023) Clinical Neurophysiology — Vol. 147, p. 99-107 (2023)

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Abstract
(en) OBJECTIVE: The objective of the study was to record Laryngeal Motor Evoked Potentials (LMEPs) in Vagus Nerve Stimulation (VNS)-implanted patients suffering from Drug-Resistant Epilepsy (DRE). Based on these recordings, LMEPs characteristics were evaluated and compared between responders (R) and non-responders (NR). Finally, possible under- or over-stimulation was assessed based on a physiological indicator of fiber engagement. METHODS: Mean dose-response curves were compared between R and NR. A Support Vector Machine (SVM) model was built based on both LMEP and dose-response curves features, to discriminate R from NR. For the exploration of possible under- or over-stimulation, a ratio between the clinically applied stimulation intensity and the intensity yielding to LMEP saturation was computed for each patient. RESULTS: A trend towards a greater excitability of the nerve was observed in R compared to NR. The SVM classifier discriminated R and NR with an accuracy of 80%. An ineffective attempt to overstimulate at current levels above what is usually necessary to obtain clinical benefits was suggested in NR. CONCLUSIONS: The SVM model built emphasizes a possible link between vagus nerve recruitment characteristics and treatment effectiveness. Most of the clinically responding patients receive VNS at a stimulation intensity 1-fold and 2-fold the intensity inducing LMEP saturation. SIGNIFICANCE: LMEP saturation could be a practical help in guiding the titration of the stimulation parameters using a physiological indicator of fiber engagement.
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Berger, A., Carapancea, E., Vespa, S., Danthine, V., Doguet, P., Delbeke, J., Nonclercq, A., & El Tahry, R. (2023). Vagus nerve stimulation-induced laryngeal motor evoked potentials for response prediction and intensity titration in drug-resistant epilepsy. Clinical Neurophysiology, 147, 99-107. https://doi.org/10.1016/j.clinph.2023.01.009 (Original work published 2023)