Galli Renato, Limbruno Ugo, Pizzanelli Chiara, Giorgi Filippo Sean, Lutzemberger Ludovico, Strata Giancarlo, Pataleo Luca, Mariani Mario, Iudice Alfonso, Murri Luigi
Section of Neurology, Department of Neurosciences, University of Pisa, via Roma, 67, 56126, Pisa, Italy.
Auton Neurosci. 2003 Aug 29;107(1):52-9. doi: 10.1016/s1566-0702(03)00081-x.
Vagus nerve stimulation (VNS) has been suggested as an adjunctive treatment for drug-resistant epilepsy when surgery is inadvisable. The overall safety profile of VNS seems to be favorable as only minor adverse effects have been described. The purpose of this study was to determine if cardiac vagal tone is eventually modified by short- and long-term VNS. The effects of short- and long-term VNS were evaluated in seven subjects with intractable epilepsy. Autonomic cardiac function has been carried out by means of a 24-h analysis of RR variability at baseline (t(0)), 1 month (t(1), short-term VNS) and 36 months after VNS initiation (t(2), long-term VNS). Frequency- and time-domain parameters were calculated. Periodic cardiological and neurological evaluations were performed.Clinically relevant cardiac effects were not observed throughout the study. Despite the limited number of patients and the variety of data among them, for all the patients, a common trend towards a nocturnal decrease in the high-frequency (HF) component of the spectrum was observed after long-term VNS (mean+/-S.D.: 40+/-18 normalized units (nu) at t(0), 38+/-17 nu at t(1), 18+/-10 nu at t(2); p<0.05 of t(2) vs. either t(0) or t(1)). The day-to-night changes in the power of low-frequency (LF) and HF components were significantly blunted after long-term VNS (LF day-to-night change: +16+/-13 nu at t(0) and +15+/-8 nu at t(1) vs. +3+/-13 nu at t(2), p<0.02; HF day-to-night change: -18+/-13 nu at t(0) and -13+/-11 nu at t(1) vs. +3+/-12 nu at t(2), p<0.003). No significant changes were observed with regard to the time-domain parameters of the heart rate variability. Throughout the neurological follow-up, one subject became seizure-free, three experienced a seizure reduction of >50%, two patients of <50% and one had no changes in his seizure frequency. Our findings suggest that long-term VNS might slightly affect cardiac autonomic function with a reduction of the HF component of the spectrum during night and a flattening of sympathovagal circadian changes, not inducing, however, clinically relevant cardiac side effects.
当手术不可行时，迷走神经刺激（VNS）已被建议作为耐药性癫痫的辅助治疗方法。VNS的总体安全性似乎良好，因为仅描述了轻微的不良反应。本研究的目的是确定短期和长期VNS是否最终会改变心脏迷走神经张力。对7名顽固性癫痫患者评估了短期和长期VNS的效果。通过在基线（t(0)）、1个月（t(1)，短期VNS）和VNS开始后36个月（t(2)，长期VNS）对RR变异性进行24小时分析来评估自主心脏功能。计算了频域和时域参数。进行了定期的心脏和神经学评估。在整个研究过程中未观察到临床相关的心脏效应。尽管患者数量有限且他们之间的数据存在差异，但对于所有患者，长期VNS后均观察到频谱高频（HF）成分夜间下降的共同趋势（平均值±标准差：t(0)时为40±18归一化单位（nu），t(1)时为38±17 nu，t(2)时为18±10 nu；t(2)与t(0)或t(1)相比，p<0.05）。长期VNS后，低频（LF）和HF成分功率的昼夜变化明显减弱（LF昼夜变化：t(0)时为+16±13 nu，t(1)时为+15±8 nu，t(2)时为+3±13 nu，p<0.02；HF昼夜变化：t(0)时为-18±13 nu，t(1)时为-13±11 nu，t(2)时为+3±12 nu，p<0.003）。心率变异性的时域参数未观察到显著变化。在整个神经学随访过程中，1名受试者无癫痫发作，3名受试者癫痫发作减少>50%，2名受试者减少<50%，1名受试者癫痫发作频率无变化。我们的研究结果表明，长期VNS可能会轻微影响心脏自主神经功能，夜间频谱HF成分降低，交感迷走昼夜变化变平，但不会诱发临床相关的心脏副作用。
