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Resting-state functional connectivity changes with microburst vagus nerve stimulation therapy.

Jane B Allendorfer1, Rodolphe Nenert1, Elhum Shamshiri2

  • 1Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Epilepsia Open
|May 28, 2025
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Summary

Microburst vagus nerve stimulation (μVNS) may reduce seizures in drug-resistant epilepsy (DRE). Baseline thalamic functional connectivity predicts long-term seizure reduction in focal DRE, suggesting a potential biomarker for treatment response.

Keywords:
drug‐resistant epilepsymicroburst vagus nerve stimulationneuromodulationresting‐state fMRIthalamus

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Area of Science:

  • Neuroscience
  • Epilepsy Research
  • Medical Technology

Background:

  • Drug-resistant epilepsy (DRE) poses significant challenges to patient quality of life.
  • Microburst vagus nerve stimulation (μVNS) is an emerging therapy targeting DRE.
  • Thalamic plasticity is a proposed mechanism for μVNS efficacy.

Purpose of the Study:

  • To investigate the role of thalamic resting-state functional connectivity (rsFC) in the therapeutic effects of μVNS.
  • To determine if baseline thalamic rsFC predicts long-term seizure frequency changes in DRE patients undergoing μVNS.
  • To compare rsFC patterns between focal and generalized DRE.

Main Methods:

  • Prospective study involving 28 DRE patients (18 focal, 10 generalized).
  • 3T resting-state fMRI was performed at baseline, 2 weeks, and 6 months post-μVNS implantation.
  • rsFC analysis used automated anatomical atlas (AAL) regions; correlations assessed baseline rsFC with 12-month seizure reduction.

Main Results:

  • Generalized DRE showed stronger baseline rsFC than focal DRE.
  • Significant longitudinal rsFC changes were observed in both groups, with distinct patterns involving the thalamus.
  • In focal DRE, baseline rsFC between the thalamus and specific cortical regions negatively correlated with long-term seizure reduction.

Conclusions:

  • Baseline thalamic rsFC is a significant predictor of μVNS treatment response in focal DRE.
  • rsFC may serve as a potential imaging biomarker to personalize μVNS therapy for focal epilepsy.
  • The relationship between thalamic rsFC and μVNS efficacy may differ between focal and generalized DRE subtypes.