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Hall Plan

Hallenplan Biomedica 2017

Day 2 // Opening Session, Blauwe Zaal

Keynote 3

Prof. Dr. Kristl Vonck

09:30 - Neuro stimulation

Prof. Dr. Kristl Vonck

UZ Gent, BE

Assistant Professor of Neurology

Curriculum vitae

Kristl Vonck is Assistant Professor of Neurology at Ghent University Hospital, Ghent, Belgium. Her medical training was carried out at Ghent University and her PhD thesis was entitled ‘Neurostimulation for refractory epilepsy, clinical efficacy and mechanism of action’. She has held international training positions at Guy’s Hospital, London, UK; Yale University School of Medicine, New Haven, Connecticut, USA and the University of Stellenbosch, South Africa.

Her research interests include neurostimulation and neurophysiological homemonitoring of neurological disorders. In the translational research setting of the Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3) her team investigates the mechanism of action, efficacy and side effects of several neurostimulation modalities. Both in animals and patients, crucial questions are investigated for the application of neurostimulation as a valuable treatment option for neurological disorders: stimulation parameters, open and closed loop neurostimulation applications, seizure detection and prediction algorithms, invasive versus non-invasive neurostimulation. Proof-of-concept and early innovative techniques for neurological monitoring@home are validated at the excellence Center for Neurofysiological Monitoring (CNM) of Ghent University Hospital before being investigated in a home environment. Kristl Vonck has published widely in international peer-reviewed journals (>150 abstracts and >120 papers), has authored seven book chapters and has given 125 international presentations.

Abstract

Neurostimulation is an emerging treatment for neuropsychiatric disorders. Excitability-reducing neurostimulation is pursued as an alternative therapeutic strategy for refractory epilepsy when drugs and surgery fail or are not indicated.

Various neurostimulation modalities for epilepsy have been developed or are currently being investigated for efficacy and safety. Electrical stimulation of the tenth cranial nerve or vagus nerve stimulation (VNS) is an invasive but extracranial type of stimulation that was developed in the eighties and is currently routinely available in epilepsy centers worldwide. Through an implanted device and electrode, electrical pulses are administered to the afferent fibers of the left vagus nerve at the cervical level. Apart from the vagus nerve, the trigeminal nerve is another cranial nerve that is being targeted to treat refractory seizures. Long-term results with trigeminal nerve stimulation (TNS) from an open pilot trial have become available.  Non-invasive forms of both VNS and TNS have in the meantime been developed and are available for treatment of patients.

Transcranial magnetic stimulation (TMS) is an extracranial and non-invasive neurostimulation technique. In TMS a coil that transmits magnetic fields is held over the scalp and allows a non-invasive evaluation of excitatory and inhibitory functions of the cerebral cortex. In addition, repetitive TMS (rTMS) can modulate the excitability of cortical networks. This therapeutic form of TMS is currently being investigated as a treatment option for refractory epilepsy with varying results. Transcranial direct current stimulation (tDCS) tDCS uses sponge electrodes attached to the patient’s head to deliver electrical currents over longer periods of time (minutes) to achieve changes in cortical excitability that persist even after stimulation has ceased, hence with therapeutic potential in diseases characterised by a disturbed cortical excitability.

For intracranial neurostimulation, stimulation electrodes are inserted into intracerebral targets in ‘deep brain stimulation’ (DBS) or placed over the cortical convexity for ‘cortical stimulation’ (CS) to administer electrical pulses to central nervous system structures. These modalities of neurostimulation are not entirely new for neurological indications. Some have been extensively applied in movement disorders and pain. Several new indications such as obsessive compulsive behaviour and cluster headache are being investigated with promising results. In the past DBS and CS of different brain structures such as the cerebellum, the locus coeruleus and the thalamus were performed mainly in patients with spasticity or psychiatric disorders who had epilepsy as a comorbidity. The vast progress in biotechnology along with the experience in other neurological diseases in the past ten years has led to a renewed interest in intracerebral stimulation for epilepsy. Several epilepsy centers around the world have recently reinitiated trials with DBS in different intracerebral structures such as the thalamus, the subthalamic nucleus, the caudate nucleus and medial temporal lobe structures. Also CS has been investigated in a multicenter trial and incorporated in a so called closed-loop system (the Responsive neurostimulator system, RNS). Especially CS of eloquent cortex may be developed into a valuable alternative for resective surgery to treat refractory partial focal motor seizures.

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