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Electroencephalogram and heart rate variability features as predictors of responsiveness to vagus nerve stimulation in patients with epilepsy: a systematic review

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Abstract

Introduction

Vagus nerve stimulation (VNS) is a mainstay treatment in people with medically refractive epilepsy with a growing interest to identify biomarkers that are predictive of VNS efficacy. In this review, we looked at electroencephalography (EEG) and heart rate variability (HRV) parameters as potential biomarkers.

Methodology

A comprehensive search of several databases limited to the English language and excluding animal studies was conducted. Data was collected from studies that specifically reviewed preoperative EEG and HRV characteristics as predictive factors of VNS outcomes.

Results

Ten out of 1078 collected studies were included in this review, of which EEG characteristics were reported in seven studies; HRV parameters were reported in two studies, and one study reported both. For EEG, studies reported a lower global rate of synchronization in alpha, delta, and gamma waves as predictors of the VNS response. The P300 wave, an evoked response on EEG, had conflicting results. Two studies reported high P300 wave amplitudes in nonresponders and low amplitudes in responders, whereas another study reported high P300 wave amplitudes in responders. For HRV, one study reported high-frequency power as the only parameter to be significantly lower in responders. In contrast, two studies from the same authors showed that HRV parameters were not different between responders and nonresponders.

Conclusion

HRV parameters and EEG characteristics including focal seizures and P300 wave have been reported as potential biomarkers for VNS outcomes in people with medically refractive epilepsy. However, the contradictory findings imply a need for validation through clinical trials.

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Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Jorge Arturo Larco

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Mehdi Abbasi

  3. Global Institute of Future Technologies, Shanghai Jiao Tong University, Shanghai, China

    Yang Liu

  4. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA

    Evan Nicolai

  5. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Gregory Worrell

  6. Department of Neurological Surgery, University of California, San Francisco, San Francisco, USA

    Sarosh Irfan Madhani & Luis Savastano

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  1. Sarosh Irfan Madhani
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  2. Mehdi Abbasi
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  3. Yang Liu
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  4. Jorge Arturo Larco
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Correspondence to Sarosh Irfan Madhani.

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Madhani, S., Abbasi, M., Liu, Y. et al. Electroencephalogram and heart rate variability features as predictors of responsiveness to vagus nerve stimulation in patients with epilepsy: a systematic review. Childs Nerv Syst 38, 2083–2090 (2022). https://doi.org/10.1007/s00381-022-05653-x

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