Bodin Emilie, Le Moing Anne-Gaëlle, Bourel-Ponchel Emilie, Querne Laurent, Toussaint Patrick, Berquin Patrick
Service de Neurologie Pédiatrique, CHU d'Amiens, Amiens, France.
Service de Neurologie Pédiatrique, CHU d'Amiens, Amiens, France.
Eur J Paediatr Neurol. 2016 May;20(3):346-51. doi: 10.1016/j.ejpn.2016.01.011. Epub 2016 Feb 8.
BACKGROUND/PURPOSE: Vagus nerve stimulation (VNS) has been demonstrated to be safe and effective for adults and children with drug-resistant epilepsy and is able to improve most types of epilepsy. The aim of this study, in a paediatric population, was to assess the overall efficacy of vagus nerve stimulation on seizures, to assess tolerability and quality of life.
This single-centre, retrospective study reviewed the files of 29 children in whom a vagus nerve stimulator was implanted between 1995 and 2012. The response rate (greater than 50% reduction of the seizure frequency), antiepileptic efficacy according to the type of epilepsy or age at implantation or age at onset of epilepsy, the time-course of seizures, adverse effects, overall quality of life and number of hospitalisations were studied.
In our population, vagus nerve stimulation achieved a significant reduction in the seizure frequency throughout follow-up (p = 0.015). Response rates were 59% at 3 months, and 66% at 6 months, and the response rate then remained stable at about 70%. Stimulation tended to be more effective in patients with non-idiopathic partial epilepsy than in patients with non-idiopathic and idiopathic generalised epilepsy (0.01 < p < 0.11). No other predictive factors of efficacy were identified. Patients, parents, caregivers reported improvement in overall quality of life in 38% of patients during clinical interviews. A significant reduction in the number of hospitalisations due to a reduction of seizure frequency was observed after implantation (p = 0.03). VNS was stopped because of complications or insufficient efficacy in 9 cases.
Vagus nerve stimulation is a safe and effective treatment option in children with drug-resistant epilepsy who are not candidates for surgery.
背景/目的：迷走神经刺激术（VNS）已被证明对耐药性癫痫的成人和儿童安全有效，并且能够改善大多数类型的癫痫。本研究在儿科人群中的目的是评估迷走神经刺激术对癫痫发作的总体疗效、耐受性和生活质量。
这项单中心回顾性研究查阅了1995年至2012年间植入迷走神经刺激器的29名儿童的病历。研究了缓解率（癫痫发作频率降低超过50%）、根据癫痫类型、植入时年龄或癫痫发作起始年龄的抗癫痫疗效、癫痫发作的时间进程、不良反应、总体生活质量和住院次数。
在我们的研究人群中，迷走神经刺激术在整个随访期间使癫痫发作频率显著降低（p = 0.015）。3个月时缓解率为59%，6个月时为66%，之后缓解率稳定在约70%。非特发性部分性癫痫患者的刺激效果往往比非特发性和特发性全身性癫痫患者更有效（0.01 < p < 0.11）。未发现其他疗效预测因素。在临床访谈中，38%的患者的患者、父母、护理人员报告总体生活质量有所改善。植入后观察到由于癫痫发作频率降低，住院次数显著减少（p = 0.03）。9例患者因并发症或疗效不佳而停止VNS治疗。
迷走神经刺激术是不适合手术的耐药性癫痫儿童的一种安全有效的治疗选择。
