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Perfusion SPECT Changes After Acute and Chronic Vagus Nerve Stimulation in Relation to Prestimulus Condition and Long-Term Clinical Efficacy

Koenraad Van Laere, MD, PhD, ScD1, Kristl Vonck, MD2, Paul Boon, MD, PhD2, Jan Versijpt, MD1 and Rudi Dierckx, MD, PhD1

1 Division of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
2 Epilepsy Monitoring Unit, Department of Neurology, Ghent University Hospital, Ghent, Belgium



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  		FIGURE 1. Diagram overview of study design. Maximally, 4 SPECT scans were acquired: 2 at initial VNS onset and 2 during chronic follow-up. Effect of acute stimulation was investigated in initial situation (A) and in chronic situation (B). Chronic changes were evaluated between baseline, prestimulus SPECT scan and chronic situation (C). This pre-VNS study was also compared with studies of age- and sex-matched healthy individuals (D). Below timeline, t, stimulus intensity, I, is schematically shown for different conditions.

 


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  		FIGURE 2. Relationship between 99mTc-ECD uptake in right amygdala at initial, acute VNS stimulation and long-term seizure reduction in group of 10 patients for whom long-term perfusion measurements were assessed.

 


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  		FIGURE 3. 99mTc-ECD uptake difference caused by acute, initial VNS in thalamus (right [{square}] and left [{blacktriangleup}]) in relation to prestimulus z score and to age- and sex-matched template of 20 healthy volunteers.

 


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  		FIGURE 4. Chronic 99mTc-ECD uptake changes in thalamus and mesial temporal cortex (95% confidence interval for mean). Significant decreases are indicated with asterisk. LAM = left amygdala; LHI = left hippocampus; LPH = left gyrus parahippocampus (+ fusiform gyrus); LTH = left thalamus; RAM = right amygdala; RHI = right hippocampus; RPH = right gyrus parahippocampus (+ fusiform gyrus); RTH = right thalamus.

 




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