Department of Neurology, University of Toledo College of Medicine, Toledo, OH 43614, USA.
Epilepsy Behav. 2010 Jul;18(3):299-302. doi: 10.1016/j.yebeh.2010.04.008. Epub 2010 May 23.
The objective of the study was to evaluate the efficacy of vagus nerve stimulator (VNS) therapy and identify factors associated with reduction of seizures. The VNS is an accepted therapeutic option for patients with refractory partial epilepsy. There are, however, limited data regarding efficacy in any specific group of patients with epilepsy.
This is a retrospective review of patients with epilepsy on VNS therapy initiated between January 2000 and December 2007 at a university medical center. Information collected included demographics, epilepsy type and duration, antiepileptic drug usage, stimulation parameters, and seizure frequency at baseline, 3months, 6months, 1year, 2years, and 3years after VNS therapy initiation. Seizure frequency at different follow-up intervals was compared with baseline frequency. Patients were stratified into three subsets based on VNS response. Relationships between VNS response and factors including demographics, location of seizure focus, type or duration of epilepsy, and VNS settings were examined as a whole as well as in subsets.
Fifty-four patients were implanted with VNSs over a period of 7years. Four patients were excluded. A total of 50 patients (31 men, 19 women) with mean age 39years and on VNS therapy were included in this study. Average duration of VNS therapy was 4.5years. Baseline average frequency was 10 seizures per month. Significant decreases in median seizure frequency were noted at 3months (P<0.001), 6months (P<0.001), 1year (P=0.004), 2years (P<0.001), and 3years (P<0.0001). Seventy-two percent of the patients reported a decrease in seizure frequency within the first 3months, which increased to 80% by the end of 3years. Overall, the percentage reduction in seizure frequency was 64% at 3months and increased to 86% at the end of 3years. In the subset of patients who responded to VNSs, reduction in seizure frequency improved from 80 to 89% by the end of 3years. There were no correlations between seizure frequency and specific VNS settings, epileptic focus, or duration or type of epilepsy, in the group as a whole or in its subsets. Data suggest a favorable VNS response in patients with higher baseline seizure frequency.
Significant reductions in seizure frequency were noted with VNS therapy over a 3-year follow-up period with a possible cumulative effect. Lateralization or localization of epileptic focus or epilepsy subtype did not correlate with response to VNSs.
本研究的目的是评估迷走神经刺激器（VNS）疗法的疗效，并确定与癫痫发作减少相关的因素。VNS是难治性部分性癫痫患者公认的治疗选择。然而，关于任何特定癫痫患者群体疗效的数据有限。
这是一项对2000年1月至2007年12月在一所大学医学中心开始接受VNS治疗的癫痫患者的回顾性研究。收集的信息包括人口统计学资料、癫痫类型和病程、抗癫痫药物使用情况、刺激参数以及VNS治疗开始后基线、3个月、6个月、1年、2年和3年时的癫痫发作频率。将不同随访间隔的癫痫发作频率与基线频率进行比较。根据VNS反应将患者分为三个亚组。研究了VNS反应与包括人口统计学资料、癫痫发作灶位置、癫痫类型或病程以及VNS设置等因素之间的整体关系以及亚组关系。
在7年期间，有54例患者植入了VNS。4例患者被排除。本研究共纳入50例接受VNS治疗的患者（31例男性，19例女性），平均年龄39岁。VNS治疗的平均持续时间为4.5年。基线平均发作频率为每月10次。在3个月（P<0.001）、6个月（P<0.001）、1年（P=0.004）、2年（P<0.001）和3年（P<0.0001）时，癫痫发作频率中位数显著降低。72%的患者报告在最初3个月内癫痫发作频率下降，到3年结束时这一比例增至80%。总体而言，3个月时癫痫发作频率降低的百分比为64%，到3年结束时增至86%。在对VNS有反应的患者亚组中，到3年结束时癫痫发作频率降低从80%提高到89%。在整个组或其亚组中，癫痫发作频率与特定的VNS设置、癫痫病灶、癫痫病程或类型之间均无相关性。数据表明，基线癫痫发作频率较高的患者对VNS反应良好。
在3年的随访期内，VNS治疗使癫痫发作频率显著降低，可能存在累积效应。癫痫病灶的侧化或定位以及癫痫亚型与对VNS的反应无关。
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