Galbarriatu L, Pomposo I, Aurrecoechea J, Marinas A, Agúndez M, Gómez J C, Acera M A, Martínez M J, Valle E, Maestro I, Mateos B, Cabrera A, Fernández J, Iturri F, Garamendi I
Department of Neurosurgery, Cruces University Hospital, Barakaldo, Spain.
Department of Neurosurgery, Cruces University Hospital, Barakaldo, Spain.
Clin Neurol Neurosurg. 2015 Oct;137:89-93. doi: 10.1016/j.clineuro.2015.06.023. Epub 2015 Jul 2.
Treatment-resistant epilepsy (TRE) occurs in 20-30% of patients. The goal of this study is to assess the efficacy and safety of vagus nerve stimulation (VNS) in this group of patients, including adult and pediatric populations and several off-label indications.
This is a retrospective review of 59 consecutive patients in whom 60 VNS devices were implanted at a single institution during a 15-year period. Patients were evaluated in the Multidisciplinary Epilepsy Committee and complete presurgical workup was performed. The series included indications not approved by the FDA, such as children under 12 years of age, pregnancy and right-sided VNS. Performing the procedure on an out-patient basis was recently adopted, minimizing hospital length of stay.
There were 42 adults and 17 children (14 under 12 years of age) and the mean age at implantation was 26 years. Duration of VNS therapy ranged from 6 months to 9 years. For the entire cohort, the mean percentage seizure reduction was 31.37%. Twenty patients (34.48%) were considered responders (seizure reduction ≥50%); 7 patients (12.06%) had seizure reduction of ≥75% and 2 patients had seizure control of ≥90% (3.4%). The patient in whom right-sided VNS was implanted achieved the same reduction in seizure burden and the patient who became pregnant could reduce antiepileptic drugs dosage, without complications. Side-effects were mild and there were no permanent nerve injuries. One patient died in the follow-up due to psychiatric disorders previously known.
VNS is a safe and effective palliative treatment for TRE patients. There are an increasing number of indications and further randomized trials would potentially expand the number of patients who may benefit from it. A multidisciplinary team is crucial for a complete preoperative evaluation and selection of the optimal candidates for the treatment.
20%-30%的患者会出现药物难治性癫痫（TRE）。本研究的目的是评估迷走神经刺激（VNS）在该组患者中的疗效和安全性，包括成人和儿童群体以及几种非适应证。
这是一项对59例连续患者的回顾性研究，在15年期间，同一机构为这些患者植入了60台VNS设备。患者在多学科癫痫委员会接受评估，并进行了完整的术前检查。该系列包括未获美国食品药品监督管理局（FDA）批准的适应证，如12岁以下儿童、妊娠和右侧VNS。最近采用门诊手术，尽量缩短住院时间。
有42名成人和17名儿童（14名12岁以下），植入时的平均年龄为26岁。VNS治疗时间为6个月至9年。对于整个队列，平均癫痫发作减少百分比为31.37%。20例患者（34.48%）被视为反应者（癫痫发作减少≥50%）；7例患者（12.06%）癫痫发作减少≥75%，2例患者癫痫发作控制≥90%（3.4%）。植入右侧VNS的患者癫痫发作负担减轻程度相同，怀孕的患者可以减少抗癫痫药物剂量，且无并发症。副作用轻微，无永久性神经损伤。1例患者在随访中因先前已知的精神疾病死亡。
VNS是TRE患者一种安全有效的姑息治疗方法。适应证越来越多，进一步的随机试验可能会扩大受益患者的数量。多学科团队对于完整的术前评估和选择最佳治疗候选者至关重要。
