Neuroimaging and electroencephalographic changes after VNS

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Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy.

Source: Journal of the Formosan Medical Association (2014) 113, 258e263
Authors: Pi-Chuan Fan, Steven Shinn-Forng Peng, Ruoh-Fang Yen, Jeng-Yi Shieh, Meng-Fai Kuo.

Aim:

case study of vagal nerve stimulation (VNS) in a 4-year-old boy with intractable myoclonic astatic epilepsy (MAE).

Methods:

Before and after VNS implantation various tests were performed: electroencephalography (EEG), brain diffuse-tensor imaging (DTI) and 18F-fluorodeoxyglucose positron emission tomography (PET).

Results: Before VNS the boy had 10-40 drop attacks per day with global regression in motor, speech, cognition and behaviour; 6 months after implantation the boy was seizure free and became more communicable with social smiles. EEG before VNS showed frequents bursts of symmetric generalized polyspike waves; 6 months after implantation EEG showed diffuse beta and gamma fast activities without epileptiform discharges. DTI before VNS showed decreased fraction anisotropy in the right fimbria-fornix; 10 months after VNS showed improvement in this area. PET before VNS showed extensive hypometabolism in the bilateral frontal parietal and temporal cortex; after VNS this showed global improvement.

http://www.ncbi.nlm.nih.gov/pubmed/23643463

Comments reviewer, prof Van Nieuwenhuizen:

first of all the clinical effects of VNS in this type of epilepsy syndrome is amazing. With regards to the results of EEG, DTI and PET, a hypothesis is put forward containing that the anticonvulsive effects of VNS in MAE are related to improved glucose metabolism and white matter diffusion in the fornix, which connects hippocampus and thalamus. The thalamus may mediate cortical desynchronization accounting for anticonvulsive effect and cognitive improvement.

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