Effect of Vagus Nerve Stimulation on Electroencephalogram Synchronization: A Longitudinal Study Using a...

No reliable biomarkers exist for predicting and assessing vagus nerve stimulation (VNS) response. While VNS induces acute electroencephalography (EEG) desynchronization after implantation, longitudinal evaluations of EEG synchronization changes are lacking. This study constitutes the first prospective investigation evaluating EEG synchronization before and after VNS device implantation and correlating it with the clinical response to VNS.

High-density EEG recordings were obtained from 12 adults with drug-resistant epilepsy before and after VNS device implantation (one, three, and six months). EEG resting state (180 seconds), with eyes open and eyes closed (EC), was recorded in VNS ON and OFF conditions. The global weighted phase lag index (wPLI) was computed as an EEG phase-synchronization measure and correlated with the VNS response using various assessment methods, including binary classification (>50% or <50% seizure frequency reduction), percentage of seizure reduction, and the newly developed Clinical-Research Response Scale (CRRS).

We observed a progressive decrease of wPLI in the delta band during the EC VNS OFF condition, which correlated with the VNS response over time, particularly when assessed using the new CRRS compared with other assessment methods. Additionally, a higher preimplant global wPLI predicted a better outcome of VNS, as did an early magnet response.

Overall, VNS may positively influence specific brain states, with a time-dependent evolution of EEG synchronization reflecting therapeutic efficacy. Preimplantation EEG synchronization and an early magnet response may predict VNS response. Moreover, the CRRS could constitute a more sensitive method for characterizing VNS response compared with traditional assessment methods.