Neurology Department, Hospital Clínic, Barcelona, Spain.
Eur J Neurol. 2012 Sep;19(9):1219-23. doi: 10.1111/j.1468-1331.2012.03707.x. Epub 2012 Mar 26.
Vagus nerve stimulation (VNS) has been reported to be a safe and effective treatment for drug-resistant epilepsy. The aim of this study is to describe the effect of VNS in patients with a history of repeated episodes of status epilepticus (SE) before implantation.
From a total of 83 adult patients with drug-resistant epilepsy who had VNS implanted in four tertiary centers in Spain between 2000 and 2010, eight had a previous history of repeated episodes of SE. We performed a retrospective observational study analyzing the outcome of seizures and episodes of SE after implantation. Stimulation was started at the usual settings, and intensity increased according to clinical response and tolerability.
Regarding the eight patients with a history of SE, the mean age at time of VNS implantation was 25.1 [14-40] years. Duration of epilepsy until the implantation was 21.7 [7-39.5] years, and they had been treated with a mean of 12 antiepileptic drugs [10-16]. Mean follow-up since implantation was 4.15 [2-7.5] years. Average seizure frequency decreased from 46 to 8.2 per month. Interestingly, four of the eight patients remained free of new episodes of SE after implantation, and in two additional patients, the frequency decreased by >75%. Adverse effects were mild or moderate in intensity and included mainly coughing and dysphonia.
In those patients with refractory epilepsy and history of SE who are not surgical candidates, VNS is a safe and effective method to reduce seizure frequency and episodes of SE.
迷走神经刺激（VNS）已被报道为治疗耐药性癫痫的安全有效方法。本研究旨在描述 VNS 在植入前有反复癫痫持续状态（SE）发作史的患者中的作用。
在西班牙的四个三级中心，从 2000 年至 2010 年间植入 VNS 的 83 例成年耐药性癫痫患者中，有 8 例有反复发作 SE 的病史。我们进行了一项回顾性观察研究，分析了植入后癫痫发作和 SE 发作的结果。刺激以通常的设置开始，并根据临床反应和耐受性增加强度。
对于 8 例有 SE 病史的患者，VNS 植入时的平均年龄为 25.1 [14-40] 岁。癫痫发作持续时间至植入时间为 21.7 [7-39.5] 年，他们接受了平均 12 种抗癫痫药物的治疗[10-16]。自植入以来的平均随访时间为 4.15 [2-7.5] 年。平均每月癫痫发作频率从 46 次减少到 8.2 次。有趣的是，在 8 例患者中有 4 例在植入后仍然没有新的 SE 发作，另外 2 例患者的发作频率减少了>75%。不良反应强度为轻度或中度，主要包括咳嗽和声音嘶哑。
对于那些无法手术的耐药性癫痫和 SE 病史的患者，VNS 是一种安全有效的方法，可以减少癫痫发作频率和 SE 发作。
