Investigation of mechanisms of vagus nerve stimulation for seizure using finite element modeling

Epilepsy Research
Jeffrey E ArleLongzhi Mei

Abstract

While the efficacy of vagus nerve stimulation (VNS) to reduce seizures in pharmaco-resistant patients is clinically proven, its efficacy and side effects mechanisms are not fully understood. Our goals were 1) to use a finite element model (FEM) and axon models to examine different fiber activation and blocking thresholds and 2) examine fiber activation and blocking in three fiber groups likely to be responsible for efficacy and side effects. Using FEM, we examined the field potential along axons within a vagus nerve model with fascicles. These data were input to a computational fiber model to estimate numbers of axons activated across all diameters. We estimated numbers of activated and blocked fibers by diameter. 1) At the low end of VNS amplitudes, little efficacy for seizure control is appreciated while large Aβ fibers associated with the recurrent laryngeal nerve are recruited. As amplitudes are increased, Aβ fibers can produce hoarseness, and next recruited are fast B fibers associated with the aortic fascicle. We hypothesize these B fibers are the source of efficacy in treating seizure. As amplitudes are further increased, coughing may occur, possibly due to recruitment of smaller and deeper pulmonary fibers. 2) Clinical ...Continue Reading

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Feb 17, 2017·Neurology·Jeremy K Cutsforth-Gregory, Eduardo E Benarroch
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