Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium.
Dev Med Child Neurol. 2011 Dec;53(12):1143-9. doi: 10.1111/j.1469-8749.2011.04103.x. Epub 2011 Aug 31.
Vagus nerve stimulation (VNS) is a therapeutic option for individuals with refractory epilepsy. Individuals with refractory epilepsy are prone to dysfunction of the autonomic nervous system. Reduced heart rate variability is a marker of dysfunction of the autonomic nervous system. Our goal was to study heart rate variability in children with refractory epilepsy and the influence of VNS on this parameter.
In 17 children (13 male; four female; mean age 7 y 6 mo; age range 3-16 y) with refractory epilepsy, electroencephalographic and electrocardiographic data were obtained before and after implantation of VNS during stage 2 and slow-wave sleep. Time and frequency domain parameters were calculated and the results were compared with an age- and sex-matched group of individuals without refractory epilepsy.
Our results show that autonomic cardiac control is affected in individuals with refractory epilepsy. There is a striking reduction in vagal tone during slow-wave sleep and modulation capacity is smaller than in individuals without refractory epilepsy. Implantation of VNS induces a shift in sympathovagal balance towards sympathetic predominance and an improvement in autonomic modulation.
Heart rate variability is affected in children with refractory epilepsy, and changes after implantation of VNS. The observed changes could be of importance in the cardiac complications of individuals with epilepsy and should be explored in more detail.
迷走神经刺激（VNS）是治疗耐药性癫痫患者的一种选择。耐药性癫痫患者易出现自主神经系统功能障碍。心率变异性降低是自主神经系统功能障碍的标志物。我们的目标是研究耐药性癫痫儿童的心率变异性以及 VNS 对该参数的影响。
在 17 名耐药性癫痫儿童（男 13 名，女 4 名；平均年龄 7 岁 6 个月；年龄范围 3-16 岁）中，在 VNS 植入的第 2 阶段和慢波睡眠期间，获得脑电图和心电图数据。计算时域和频域参数，并将结果与无耐药性癫痫的年龄和性别匹配组进行比较。
我们的结果表明，耐药性癫痫患者的自主心脏控制受到影响。在慢波睡眠期间，迷走神经张力明显降低，调制能力小于无耐药性癫痫患者。VNS 的植入诱导交感神经优势的交感神经-迷走神经平衡转移，并改善自主神经调制。
耐药性癫痫儿童的心率变异性受到影响，并且在 VNS 植入后发生变化。观察到的变化在癫痫患者的心脏并发症中可能很重要，应进一步详细研究。
