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Correlation between GABA(A) receptor density and vagus nerve stimulation in individuals with drug-resistant partial epilepsy.

Abstract
Vagus nerve stimulation (VNS) is an important option for the treatment of drug-resistant epilepsy. Through delivery of a battery-supplied intermittent current, VNS protects against seizure development in a manner that correlates experimentally with electrophysiological modifications. However, the mechanism by which VNS inhibits seizures in humans remains unclear. The impairment of gamma-aminobutyric acid (GABA)-mediated neuronal inhibition associated with epilepsy has suggested that GABA(A) receptors might contribute to the therapeutic efficacy of VNS. We have now applied single photon emission computed tomography (SPECT) with the benzodiazepine receptor inverse agonist [123I]iomazenil to examine cortical GABA(A) receptor density (GRD) before and 1 year after implantation of a VNS device in 10 subjects with drug-resistant partial epilepsy. VNS therapeutic responses resulted significantly correlated with the normalization of GRD. Moreover, a comparable control group, scheduled for a possible VNS implant, failed to show significant GRD variations after 1 year of a stable anti-epileptic treatment. These results suggest that VNS may modulate the cortical excitability of brain areas associated with epileptogenesis and that GABA(A) receptor plasticity contributes to this effect.
AuthorsFrancesco Marrosu, Alessandra Serra, Alberto Maleci, Monica Puligheddu, Giovanni Biggio, Mario Piga
JournalEpilepsy research (Epilepsy Res) 2003 Jun-Jul Vol. 55 Issue 1-2 Pg. 59-70 ISSN: 0920-1211 [Print] Netherlands
PMID12948617 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Anticonvulsants
  • Receptors, GABA-A
Topics
  • Adult
  • Anticonvulsants (therapeutic use)
  • Drug Resistance
  • Electric Stimulation Therapy (methods)
  • Epilepsies, Partial (diagnostic imaging, metabolism, therapy)
  • Female
  • Humans
  • Male
  • Receptors, GABA-A (biosynthesis)
  • Tomography, Emission-Computed, Single-Photon (methods)
  • Up-Regulation (physiology)
  • Vagus Nerve (physiology)

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