Identifying responders to vagus nerve stimulation based on microstructural features of thalamocortical tracts in drug-resistant epilepsy

IF 8.3 2区 材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2024-09-01 DOI:10.1016/j.neurot.2024.e00422
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Abstract

The mechanisms of action of Vagus Nerve Stimulation (VNS) and the biological prerequisites to respond to the treatment are currently under investigation. It is hypothesized that thalamocortical tracts play a central role in the antiseizure effects of VNS by disrupting the genesis of pathological activity in the brain. This pilot study explored whether in vivo microstructural features of thalamocortical tracts may differentiate Drug-Resistant Epilepsy (DRE) patients responding and not responding to VNS treatment. Eighteen patients with DRE (37.11 ​± ​10.13 years, 10 females), including 11 responders or partial responders and 7 non-responders to VNS, were recruited for this high-gradient multi-shell diffusion Magnetic Resonance Imaging (MRI) study. Using Diffusion Tensor Imaging (DTI) and multi-compartment models - Neurite Orientation Dispersion and Density Imaging (NODDI) and Microstructure Fingerprinting (MF), we extracted microstructural features in 12 subsegments of thalamocortical tracts. These characteristics were compared between responders/partial responders and non-responders. Subsequently, a Support Vector Machine (SVM) classifier was built, incorporating microstructural features and 12 clinical covariates (including age, sex, duration of VNS therapy, number of antiseizure medications, benzodiazepine intake, epilepsy duration, epilepsy onset age, epilepsy type - focal or generalized, presence of an epileptic syndrome - no syndrome or Lennox-Gastaut syndrome, etiology of epilepsy - structural, genetic, viral, or unknown, history of brain surgery, and presence of a brain lesion detected on structural MRI images). Multiple diffusion metrics consistently demonstrated significantly higher white matter fiber integrity in patients with a better response to VNS (pFDR < 0.05) in different subsegments of thalamocortical tracts. The SVM model achieved a classification accuracy of 94.12%. The inclusion of clinical covariates did not improve the classification performance. The results suggest that the structural integrity of thalamocortical tracts may be linked to therapeutic effectiveness of VNS. This study reveals the great potential of diffusion MRI in improving our understanding of the biological factors associated with the response to VNS therapy.
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根据耐药性癫痫丘脑皮质束的微观结构特征识别迷走神经刺激的应答者。
迷走神经刺激(VNS)的作用机制和对治疗产生反应的生物学先决条件目前正在研究之中。据推测,丘脑皮质束在 VNS 的抗癫痫作用中起着核心作用,它能扰乱大脑中病理活动的起源。这项试验性研究探讨了丘脑皮质束的体内微结构特征是否能区分对 VNS 治疗有反应和无反应的耐药性癫痫(DRE)患者。这项高梯度多壳弥散磁共振成像(MRI)研究招募了18名DRE患者(37.11 ± 10.13岁,10名女性),包括11名对VNS治疗有反应或部分反应者和7名无反应者。利用弥散张量成像(DTI)和多区室模型--神经元定向弥散和密度成像(NODDI)和微结构指纹(MF),我们提取了丘脑皮质束 12 个亚段的微结构特征。这些特征在应答者/部分应答者和非应答者之间进行了比较。癫痫类型--局灶性或全身性;是否存在癫痫综合征--无综合征或 Lennox-Gastaut 综合征;癫痫的病因--结构性、遗传性、病毒性或未知;脑部手术史;以及是否存在在结构性 MRI 图像上检测到的脑部病变)。在丘脑皮质束的不同亚段,多种弥散指标一致显示,对 VNS 反应较好的患者白质纤维完整性明显更高(pFDR < 0.05)。SVM 模型的分类准确率达到 94.12%。加入临床协变量并未提高分类性能。结果表明,丘脑皮质束的结构完整性可能与 VNS 的治疗效果有关。这项研究揭示了弥散核磁共振成像在提高我们对与 VNS 治疗反应相关的生物学因素的认识方面的巨大潜力。
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来源期刊
ACS Applied Materials & Interfaces
ACS Applied Materials & Interfaces 工程技术-材料科学:综合
CiteScore
16.00
自引率
6.30%
发文量
4978
审稿时长
1.8 months
期刊介绍: ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.
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