Pediatric Neurology Department, Ospedali Riuniti, Ancona, Italy.
Seizure. 2011 Jul;20(6):468-74. doi: 10.1016/j.seizure.2011.02.011. Epub 2011 Mar 10.
The effectiveness of VNS was evaluated in thirty-nine encephalopatic patients with drug-resistant epilepsy characterized by multiple seizures and drop attacks. Twenty-five patients were affected by severe epilepsy with multiple independent spike foci (SE-MISF) and fourteen patients by Lennox-Gastaut syndrome (LGS).
Changes in seizure frequency, cognition, adaptive behaviour and quality of life were assessed before and after VNS implant until three years. Outcome assessment for all seizure types included the number of seizures/month and the reduction in seizure frequency rate at each follow-up. Moreover, the effect of VNS on frequency, duration and intensity of drop attacks was separately addressed by a modification of McHugh scale.
VNS produced a mean seizure rate reduction of 41% at six months, 50% at twelve months, and 54% at thirty-six months. After one year of stimulation, thirteen patients with SE-MISF (52%) and three patients with LGS (21%) showed a reduction above 50% in all seizures' frequency rate. As for drop attacks, eight patients (20%) gained a reduction above 50%, while seven patients (17%) showed a reduction only in intensity and duration. Cognitive level and adaptive behaviour were unchanged, while a better quality of life was reported in half out of the patients.
VNS had a greater effect in reducing seizures frequency and drop attacks' intensity and duration in SE-MISF patients than LGS patients. An improved quality of life was observed also in those patients who only reduced the intensity and duration of drop attacks.
评估迷走神经刺激术（VNS）在 39 例药物难治性癫痫脑病患者中的有效性，这些患者的特征是多种发作和猝倒发作。25 例患者受严重癫痫伴多灶性棘波（SE-MISF）影响，14 例患者受 Lennox-Gastaut 综合征（LGS）影响。
在 VNS 植入前和植入后至 3 年期间，评估了发作频率、认知、适应行为和生活质量的变化。所有发作类型的结果评估包括每月发作次数和每次随访时的发作频率降低率。此外，通过修改 McHugh 量表，分别评估了 VNS 对猝倒发作频率、持续时间和强度的影响。
VNS 在 6 个月时产生了平均 41%的发作率降低，在 12 个月时为 50%，在 36 个月时为 54%。在刺激一年后，13 例 SE-MISF 患者（52%）和 3 例 LGS 患者（21%）的所有发作频率降低率均超过 50%。至于猝倒发作，8 例患者（20%）的降低率超过 50%，而 7 例患者（17%）仅在强度和持续时间上有所降低。认知水平和适应行为没有变化，而一半以上的患者报告生活质量得到改善。
在 SE-MISF 患者中，VNS 对降低发作频率和猝倒发作强度和持续时间的效果大于 LGS 患者。在那些仅降低猝倒发作强度和持续时间的患者中，也观察到了生活质量的改善。
