Zeiler F A, Zeiler K J, Teitelbaum J, Gillman L M, West M
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada; Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada.
Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada.
Epilepsy Res. 2015 May;112:100-13. doi: 10.1016/j.eplepsyres.2015.02.014. Epub 2015 Mar 9.
Our goal was to perform a systematic review of the literature on the insertion of vagal nerve stimulators (VNS) for refractory status epilepticus (RSE) and its impact on the control of RSE.
All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to June 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers (FZ and MW).
Overall, 17 studies were identified, with 7 manuscripts and 10 meeting abstracts. A total of 28 patients were treated. In those with generalized RSE, 76% displayed cessation of RSE with VNS insertion. In cases of focal RSE, 25% responded to VNS insertion. Few adverse effects related to VNS insertion were described.
We currently cannot recommend the use of VNS for RSE. Oxford level 4, GRADE D evidence exists to suggest improvement in seizure control with the use of urgent VNS in generalized RSE. No comments can be made on the utility of VNS in focal RSE. Further prospective study is warranted.
我们的目标是对迷走神经刺激器（VNS）植入治疗难治性癫痫持续状态（RSE）及其对RSE控制效果的相关文献进行系统综述。
检索了MEDLINE、BIOSIS、EMBASE、Global Health、HealthStar、Scopus、Cochrane图书馆、国际临床试验注册平台、clinicaltrials.gov（从起始到2014年6月）的所有文章，以及相关文章的参考文献列表和灰色文献。由两名独立评审员（FZ和MW）使用牛津方法和GRADE方法判定证据强度。
共识别出17项研究，包括7篇手稿和10篇会议摘要。共治疗了28例患者。在全身性RSE患者中，76%在植入VNS后癫痫发作停止。在局灶性RSE病例中，25%对VNS植入有反应。很少有与VNS植入相关的不良反应报道。
我们目前不推荐将VNS用于RSE。牛津4级、GRADE D级证据表明，在全身性RSE中紧急使用VNS可改善癫痫控制。对于VNS在局灶性RSE中的效用无法做出评价。有必要进行进一步的前瞻性研究。
