Buoni Sabrina, Mariottini Aldo, Pieri Sergio, Zalaffi Alessandro, Farnetani Maria Angela, Strambi Mirella, Palma Lucio, Fois Alberto
Department of Pediatrics, Obstetric and Reproductive Medicine, Section of Pediatrics, Policlinico Le Scotte, Viale Bracci, 53100, University of Siena, Siena, Italy.
Brain Dev. 2004 Apr;26(3):158-63. doi: 10.1016/S0387-7604(03)00120-7.
We present our experience with the use of intermittent vagal nerve stimulation in 13 patients with medically intractable epilepsy. A surgical approach, with the exception of callosotomy, was impossible. The age range was 6-28 years (median 17 years). In all patients the epilepsy was severe and in six of them was symptomatic. Seven patients had Lennox-Gastaut syndrome, one epilepsy with myoclonic-astatic seizures, four localization-related and one symptomatic generalized epilepsy. The length of the follow-up averaged 22 months (range 8 months-3 years). Of the 13 patients, five (38.4%) had a 50% or more reduction in the number of seizures compared with preimplantation. Of these patients, one with a localization-related epilepsy had a 90% reduction as well as a significant improvement in alertness. Three patients showed no improvement with regard to the number of seizures but there was an improvement in alertness and, in one case in hyperactivity. Some seizure types responded better than others did: complex partial seizures with secondary generalization and atonic seizures. All our responsive patients improved in the first 2 months of VNS activation and only one case with further improvement was observed after this period. Considering the severity of the epilepsy the results can be considered satisfactory. We think that this treatment appears to be a safe adjunctive therapy for children and adults with medically and surgically intractable epilepsy.
我们介绍了对13例药物治疗难治性癫痫患者使用间歇性迷走神经刺激的经验。除胼胝体切开术外，无法采用手术方法。年龄范围为6至28岁（中位数17岁）。所有患者的癫痫病情都很严重，其中6例为症状性癫痫。7例患者患有Lennox-Gastaut综合征，1例为伴有肌阵挛-失张力发作的癫痫，4例为局灶性相关癫痫，1例为症状性全身性癫痫。随访时间平均为22个月（范围8个月至3年）。13例患者中，5例（38.4%）与植入前相比癫痫发作次数减少了50%或更多。在这些患者中，1例局灶性相关癫痫患者发作次数减少了90%，警觉性也有显著改善。3例患者癫痫发作次数没有改善，但警觉性有所提高，其中1例多动症状有所改善。某些癫痫发作类型的反应比其他类型更好：伴有继发性全身性发作的复杂部分性发作和失张力发作。所有有反应的患者在迷走神经刺激激活的前2个月内病情改善，在此之后仅观察到1例病情进一步改善。考虑到癫痫的严重程度，结果可被认为是令人满意的。我们认为这种治疗方法对于药物和手术治疗均难治的儿童和成人癫痫患者似乎是一种安全的辅助治疗方法。
