Wakai S, Kotagal P
Department of Neurology, The Cleveland Clinic Foundation, USA.
Pediatr Int. 2001 Feb;43(1):61-5. doi: 10.1046/j.1442-200x.2001.01326.x.
Vagus nerve stimulation (VNS) has been shown to be efficacious in the treatment of patients > 12 years of age with refractory partial epilepsies and it is suggested that VNS should be considered as one of the treatment options for these patients.
Four patients had partial epilepsies and one had symptomatic generalized epilepsy. After observation of the baseline seizure frequency and the average seizure frequency for 3 months, the VNS system was implanted. Thereafter, seizure frequency, average seizure frequency of each seizure type during the month just before the evaluation, seizure severity, side effects and quality of life were recorded.
In four of five patients, overall seizure frequency was reduced > 50% after VNS treatment. The seizure types that showed a > 50% reduction in frequency were auras, focal clonic, generalized tonic clonic seizures, astatic, versive, hypomotor, generalized tonic and generalized clonic seizures according to Lüders' classification. In two patients, as major convulsive seizures were reduced in number after VNS treatment, dialeptic seizures (non-convulsive seizure with lapse of consciousness) gradually appeared. In one patient without significant seizure reduction, quick recovery from postictal periods after generalized tonic seizure was seen after treatment. In one patient with generalized epilepsy, improvement of cognitive function was reported by his guardians. After VNS, the number of antiepileptic drugs was reduced from three to one in one patient. No significant adverse effects were noted in any patients.
Our results suggest that VNS is well tolerated in young patients with intractable epilepsies and it may be an important non-pharmacologic treatment option for children with severe epilepsies who cannot tolerate medical therapy and/or are not candidates for epilepsy surgery.
迷走神经刺激术（VNS）已被证明对治疗12岁以上难治性部分性癫痫患者有效，并且有人建议应将VNS视为这些患者的治疗选择之一。
4例患者患有部分性癫痫，1例患有症状性全身性癫痫。在观察基线癫痫发作频率和3个月的平均癫痫发作频率后，植入VNS系统。此后，记录癫痫发作频率、评估前一个月每种癫痫发作类型的平均癫痫发作频率、癫痫发作严重程度、副作用和生活质量。
5例患者中有4例在VNS治疗后总体癫痫发作频率降低超过50%。根据吕德斯分类，癫痫发作频率降低超过50%的发作类型有先兆、局灶性阵挛性、全身性强直阵挛性发作、无动性发作、旋转性发作、运动减少性发作、全身性强直发作和全身性阵挛性发作。2例患者在VNS治疗后主要惊厥性发作次数减少，逐渐出现失神发作（伴有意识丧失的非惊厥性发作）。1例癫痫发作无明显减少的患者在治疗后全身性强直发作后发作后期恢复较快。1例全身性癫痫患者的监护人报告其认知功能有所改善。VNS治疗后，1例患者的抗癫痫药物数量从3种减少到1种。所有患者均未观察到明显不良反应。
我们的结果表明，VNS在难治性癫痫的年轻患者中耐受性良好，对于无法耐受药物治疗和/或不适合癫痫手术的严重癫痫患儿，它可能是一种重要的非药物治疗选择。
