[迷走神经刺激术（VNS）治疗耐药性癫痫。VNS治疗效果的4年随访评估]

[Vagus nerve stimulation (VNS) in the treatment of drug-resistant epilepsy. A 4-year follow-up evaluation of VNS treatment efficacy].

作者信息

Koszewski Waldemar, Bacia Tadeusz, Rysz Andrzej

机构信息

Klinicznego Oddziału Neurochirurgii Kliniki Neurologii II Wydziału lekarskiego A.M w Warszawie.

出版信息

Neurol Neurochir Pol. 2003 May-Jun;37(3):573-86.

DOI:

PMID:14593753

Abstract

OBJECTIVES

Vagus nerve stimulation (VNS) is an alternative non-destructive surgical treatment for patients with medically intractable epilepsy. Neither the rationale nor proper indications for this treatment modality have been fully established yet.

AIM OF THE STUDY

To assess the long-term efficacy of chronic VNS.

MATERIAL

A series of 6 patients with drug-resistant epilepsy, subjected to VNS therapy. (4 females, 2 males, mean age 35.5 years, 3 patients with focal epilepsy, 3 with non-focal epilepsy, mean history of seizures 10 years, seizures frequency 10-400/per month).

METHOD

An open-label prospective study with a 4-year follow-up.

RESULTS

At a 4-year follow-up one patient (with non-focal epilepsy) was seizure-free, with only rare episodes of aura (Engel Ia), while in another one (with bitemporal epilepsy) seizures frequency remained unchanged with VNS (Engel IVb). In the remaining 4 cases (one with bitemporal, one with parietal, and two with non-focal epilepsy) the mean overall reduction in seizures frequency as compared to the baseline was 60% (Engel IIIa). VNS resulted in a reduction of seizures by 90% in a patient with a history of an unsuccessful anterior callosotomy.

CONCLUSIONS

VNS was found to reduce both the frequency of seizures (an overall 60% reduction in seizures frequency) and the duration of post-seizure consciousness disturbances in focal and non-focal epilepsies, but seizures-free state could be obtained in only one out of six patients. 2. A previous unsuccessful callosotomy did not prevent a good anticonvulsant effect in one patient. 3. The anticonvulsant effect of VNS was cumulative over time during the first 3 years postoperatively, then it tended to reach a plateau. 4. The best clinical outcome was positively correlated with the currents 1.5-2.0 mA. No significant correlation was noted for the current adjustments at the level of 2.0-3.5 mA. 5. Since no difference between the two stimulation patterns tested (30 s stimulation + 5 min break vs. 14 s + 3 min) was found as regards the anticonvulsant action of VNS, the latter pattern was subsequently used as the one more sparing the battery.

摘要

目的

迷走神经刺激术（VNS）是一种针对药物治疗难治性癫痫患者的非破坏性手术替代疗法。然而，这种治疗方式的原理和恰当适应症尚未完全明确。

研究目的

评估慢性VNS的长期疗效。

材料

选取6例耐药性癫痫患者接受VNS治疗。（4例女性，2例男性，平均年龄35.5岁，3例局灶性癫痫患者，3例非局灶性癫痫患者，平均癫痫发作史10年，发作频率为每月10 - 400次）。

方法

一项开放标签的前瞻性研究，随访4年。

结果

在4年随访时，1例患者（非局灶性癫痫）无癫痫发作，仅偶有先兆发作（Engel Ia级），而另1例患者（双侧颞叶癫痫）VNS治疗后发作频率未变（Engel IVb级）。其余4例患者（1例双侧颞叶癫痫、1例顶叶癫痫、2例非局灶性癫痫）与基线相比，发作频率平均总体降低60%（Engel IIIa级）。VNS使1例曾行胼胝体前部切开术但效果不佳的患者发作减少90%。

结论

发现VNS可降低局灶性和非局灶性癫痫的发作频率（发作频率总体降低60%）以及发作后意识障碍持续时间，但6例患者中仅1例达到无癫痫发作状态。2. 既往胼胝体切开术失败并未妨碍1例患者获得良好的抗惊厥效果。3. VNS的抗惊厥作用在术后前3年随时间累积，之后趋于平稳。4. 最佳临床结局与1.5 - 2.0 mA的电流呈正相关。在2.0 - 3.5 mA水平的电流调整未发现显著相关性。5. 由于在测试的两种刺激模式（30秒刺激 + 5分钟间歇与14秒 + 3分钟）的VNS抗惊厥作用方面未发现差异，后一种模式随后被用作更节省电池的模式。