Arya Ravindra, Greiner Hansel M, Horn Paul S, Turner Michele, Holland Katherine D, Mangano Francesco T
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Neurol. 2014 Dec;51(6):800-5. doi: 10.1016/j.pediatrneurol.2014.09.008. Epub 2014 Sep 18.
Corpus callosotomy and vagus nerve stimulation are common palliative options for people with drug-resistant epilepsy when resective epilepsy surgery is not feasible. Because most of the published corpus callosotomy experience comes from a period before vagus nerve stimulation was approved and widely used, there is a paucity of data about efficacy of corpus callosotomy in patients with inadequate response to vagus nerve stimulation.
We report seven patients who had complete corpus callosotomy after an inadequate response to vagus nerve stimulation. At the time of surgery, these patients had failed a median of six antiseizure medications, three patients also had failed a trial of ketogenic diet, and all the patients had a vagus nerve stimulation implanted for a mean duration of 2.5 years with maximal tolerated settings.
There was a decrease in total daily seizure frequency of 34.7% (± 94.7; median, 71.4%; interquartile range, 55.3) after corpus callosotomy at a mean follow-up of 2.6 years (± 1.4). One patient achieved complete seizure freedom and five patients had ≥ 50% reduction in seizure frequency. Six patients continued to have partial-onset seizures though the frequency was decreased. Drop attacks and tonic seizures stopped in all the patients.
Seizure outcomes after corpus callosotomy in our series are most likely a result of complex dynamic interaction between the natural history of epilepsy, the effect of the surgery, ongoing vagus nerve stimulation modulation, and modification in antiseizure drugs. Our study supports the clinical decision to try corpus callosotomy in patients having nonlateralizing drug-resistant epilepsy with inadequate response to vagus nerve stimulation.
当切除性癫痫手术不可行时，胼胝体切开术和迷走神经刺激术是耐药性癫痫患者常用的姑息治疗选择。由于大多数已发表的胼胝体切开术经验来自迷走神经刺激术获批并广泛应用之前的时期，因此关于胼胝体切开术对迷走神经刺激术反应不佳患者的疗效数据较少。
我们报告了7例对迷走神经刺激术反应不佳后接受完全胼胝体切开术的患者。手术时，这些患者平均有6种抗癫痫药物治疗失败，3例患者生酮饮食试验也失败，所有患者均植入迷走神经刺激器，平均持续时间为2.5年，采用最大耐受设置。
平均随访2.6年（±1.4）后，胼胝体切开术后每日癫痫发作总频率降低了34.7%（±94.7；中位数，71.4%；四分位间距，55.3）。1例患者实现了癫痫完全缓解，5例患者癫痫发作频率降低≥50%。6例患者尽管癫痫发作频率降低，但仍有部分性发作。所有患者的跌倒发作和强直发作均停止。
我们系列研究中胼胝体切开术后的癫痫发作结果很可能是癫痫自然病史、手术效果、持续的迷走神经刺激调节以及抗癫痫药物调整之间复杂动态相互作用的结果。我们的研究支持了对非定位性耐药性癫痫且对迷走神经刺激术反应不佳的患者尝试进行胼胝体切开术的临床决策。
