Englot Dario J, Rolston John D, Wright Clinton W, Hassnain Kevin H, Chang Edward F
*UCSF Comprehensive Epilepsy Center, University of California, San Francisco, California; ‡Department of Neurological Surgery, University of California, San Francisco, California; §Cyberonics, Inc., Houston, Texas.
Neurosurgery. 2016 Sep;79(3):345-53. doi: 10.1227/NEU.0000000000001165.
Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.
To elucidate rates and predictors of seizure freedom with VNS.
We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.
Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.
Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.
AED, antiepileptic drugVNS, vagus nerve stimulation.
基于神经调节的治疗方法在癫痫治疗中变得越来越重要。大多数接受神经调节治疗的癫痫患者并未实现完全无癫痫发作，因此，先前关于迷走神经刺激（VNS）疗法的研究转而将癫痫发作频率的降低作为治疗反应的一项衡量指标。
阐明VNS实现无癫痫发作的比率及预测因素。
我们研究了VNS治疗患者结局登记处的5554例患者，并对包括78项研究中的2869例患者的文献进行了系统综述。
登记处数据显示，VNS治疗后无癫痫发作的情况随时间逐渐增加。总体而言，49%的患者在植入后0至4个月对VNS治疗有反应（癫痫发作频率降低≥50%），5.1%的患者实现无癫痫发作，而63%的患者在24至48个月时有反应，8.2%实现无癫痫发作。多变量分析显示，癫痫发作起始年龄>12岁（比值比[OR]，1.89；95%置信区间[CI]，1.38 - 2.58）以及主要为全身性癫痫发作类型（OR，1.36；95%CI，1.01 - 1.82）可预测无癫痫发作，而无病变性癫痫可预测对VNS的总体反应（OR，1.38；95%CI，1.06 - 1.81）。系统文献综述结果与登记处分析一致：在0至4个月时，40.0%的患者对VNS有反应，2.6%实现无癫痫发作，而在最后一次随访时，60.1%的个体有反应，8.0%实现无癫痫发作。
VNS治疗的反应率和无癫痫发作率随时间增加，尽管只有一小部分患者实现了完全无癫痫发作。
AED，抗癫痫药物；VNS，迷走神经刺激
