Systems and methods for stimulating and/or monitoring loci in the brain to treat inflammation and to enhance vagus nerve stimulation
Described herein are methods and systems for using EEG recordings to improve vagus nerve stimulation (VNS) therapy. In particular, described herein are methods and systems for using EEG recordings to detect P300 and/or activation of the nucleus basalis and/or the locus coeruleus to determine the efficacy of VNS. The EEG recordings can be used to provide feedback control to help optimize stimulation parameters and to screen for patients that respond well to VNS therapy.
1. A method of titrating a vagus nerve stimulation dosage of an implanted vagus nerve stimulator for inducing long term potentiation of the inflammatory reflex in a patient, the method comprising:
stimulating the vagus nerve of the patient according to a dosage of stimulation parameters to stimulate an anti-inflammatory pathway;
recording an electroencephalogram (EEG) while stimulating the vagus nerve;
analyzing the recorded EEG to detect activation of at least one of the nucleus basalis and the locus coeruleus indicating stimulation of the anti-inflammatory pathway;
adjusting the dose of the implanted vagus nerve stimulator, wherein adjusting comprises decreasing one or more of an amplitude, a pulse width, a pulse frequency and a duration of the stimulation parameters if the recorded EEG indicates activation of at least one of the nucleus basalis and the locus coeruleus, further wherein adjusting comprises increasing one or more of the amplitude, the pulse width, the pulse frequency and the duration of the stimulation parameters if the recorded EEG does not indicate activation of at least one of the nucleus basalis and the locus coeruleus; and
repeating the steps of stimulating, recording, analyzing and adjusting until the dose of the implanted vagus nerve stimulator is at a minimum level necessary to modulate the inflammatory reflex.
2. The method of claim 1 , wherein adjusting the dose comprises increasing a current amplitude if the recorded EEG indicates activation.
3. The method of claim 1 , further comprising recording a baseline EEG.
4. The method of claim 3 , wherein analyzing the recorded EEG to detect activation of at least one of the nucleus basalis and the locus coeruleus by the vagus nerve stimulation comprises comparing the recorded EEG with the baseline EEG.
5. The method of claim 1 , wherein adjusting the dose comprises decreasing a time between stimulations if the recorded EEG indicates activation of at least one of the nucleus basalis and the locus coeruleus.
6. The method of claim 1 , wherein adjusting the dose comprises increasing a time between stimulations and decreasing a current intensity if the recorded EEG does not indicate activation of at least one of the nucleus basalis and the locus coeruleus.
7. The method of claim 1 , wherein analyzing the recorded EEG to detect activation of one or more of the nucleus basalis and the locus coeruleus comprises detecting a P300 signal.
8. The method of claim 1 , wherein analyzing the recorded EEG to detect activation of one or more of the nucleus basalis and the locus coeruleus comprises detecting activation of both of the nucleus basalis and the locus coeruleus.
9. A method of titrating a vagus nerve stimulation dosage of an implanted vagus nerve stimulator for inducing long term potentiation of the inflammatory reflex in a patient, the method comprising:
recording a baseline electroencephalogram (EEG) before stimulating the vagus nerve to stimulate an anti-inflammatory pathway;
recording a second EEG while stimulating the vagus nerve with a dose of vagus nerve stimulation;
determining from the baseline EEG and the second EEG if at least one of the nucleus basalis and the locus coeruleus has been activated indicating that the anti-inflammatory pathway has been stimulated by the vagus nerve stimulation; and
adjusting the dose of the implanted vagus nerve stimulator, wherein adjusting comprises decreasing one or more of an amplitude, pulse width, pulse frequency and duration of stimulation parameters if at least one of the nucleus basalis and the locus coeruleus has been activated, wherein adjusting comprises increasing one or more of the amplitude, pulse width, pulse frequency and duration of the stimulation parameters if at least one of the nucleus basalis and the locus coeruleus has not been activated; and
repeating the steps of recording the second EEG, determining and adjusting until the dosage of the implanted vagus nerve stimulator is at a minimum level necessary to modulate the inflammatory reflex.
10. The method of claim 9 , wherein the stimulation parameters are adjusted between an amplitude of between 0.1 and 3 mA, a frequency of between 1 Hz and 30 Hz, a pulse width of between 100 microseconds and 500 microseconds, and a duration of between about 0.5 second to 10 minutes.
11. The method of claim 9 , further comprising waiting an off time between the stimulation and re-stimulation of greater than two hours when repeating the steps of recording the second EEG, determining and adjusting.
12. The method of claim 9 , wherein the stimulation is sufficient to modulate cytokine release when at least one of the nucleus basalis and the locus coeruleus have been activated.
13. The method of claim 9 , wherein determining from the baseline EEG and the second EEG if at least one of the nucleus basalis and the locus coeruleus has been activated comprises detecting a P300 signal.
14. The method of claim 9 , wherein determining from the baseline EEG and the second EEG if at least one of the nucleus basalis and the locus coeruleus has been activated comprises determining from the baseline EEG and the second EEG that both of the nucleus basalis and the locus coeruleus have been activated.