Pintea Bogdan, Hampel Kevin, Boström Jan, Surges Rainer, Vatter Hartmut, Lendvai Ilana S, Kinfe Thomas M
Department of Neurosurgery, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
Department of Epileptology, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
Neuromodulation. 2017 Jun;20(4):375-382. doi: 10.1111/ner.12540. Epub 2016 Nov 22.
Invasive vagal nerve stimulation (iVNS) is an established treatment option for drug-resistant focal seizures and has been assumed to diminish frequent co-incidental daily headache/migraine. However, long-term effects on cognitive/affective head pain perception, headache intensity/frequency are lacking. We therefore investigated potential iVNS-induced effects in patients with drug-resistant focal seizure and daily headache/migraine.
A clinical database was used to select 325 patients with drug-resistant epilepsy treated by either iVNS plus best medical treatment (BMT) or BMT alone, compared to a healthy control group (HC). We assessed headache intensity (VAS), headache frequency, affective/cognitive pain perception (PASS; FSVA), migraine disability scores (MIDAS), sleep architecture (PSQI), depressive symptoms (BDI), and body weight (BMI).
Nineteen patients with daily headache/migraine composed the clinical groups (10 iVNS and 9 BMT; iVNS mean age 49 years, range 36-61 years; BMT mean age 45 years, range 23-63 years; equally distributed gender). Cervical iVNS was applied from 5-13 years (mean 8 years) with following stimulation patterns: 1.3 mA (0.5-2 mA), 20 Hz, 250 μsec, 30 sec on/1.9 min off (0.5-5 min). The iVNS group had significantly lower VAS scores (iVNS 5.4; BMT 7.8; p = 0.03) and PASS cognitive/anxiety subscores (iVNS 21; BMT 16; p = 0.02) compared to BMT and HC. Global PASS (p = 0.07), FSVA, PSQI, BDI, and BMI scores did not differ significantly between groups.
iVNS appears to have positive modulatory long-term effects on headache and affective/cognitive head pain perception in patients with drug-resistant focal epilepsy, thus deserving further attention.
侵入性迷走神经刺激（iVNS）是耐药性局灶性癫痫的一种既定治疗选择，并且一直被认为可以减轻频繁并发的日常头痛/偏头痛。然而，目前缺乏关于其对认知/情感性头痛感知、头痛强度/频率的长期影响的研究。因此，我们调查了iVNS对耐药性局灶性癫痫且伴有日常头痛/偏头痛患者的潜在影响。
利用一个临床数据库，选取325例接受iVNS加最佳药物治疗（BMT）或仅接受BMT治疗的耐药性癫痫患者，并与一个健康对照组（HC）进行比较。我们评估了头痛强度（视觉模拟评分法，VAS）、头痛频率、情感/认知性疼痛感知（疼痛和症状严重程度量表，PASS；恐惧性社交焦虑视觉模拟量表，FSVA）、偏头痛残疾评分（MIDAS）、睡眠结构（匹兹堡睡眠质量指数，PSQI）、抑郁症状（贝克抑郁量表，BDI）和体重指数（BMI）。
19例伴有日常头痛/偏头痛的患者构成了临床研究组（10例接受iVNS治疗，9例接受BMT治疗；iVNS组平均年龄49岁，范围36 - 61岁；BMT组平均年龄45岁，范围23 - 63岁；性别分布均衡）。颈段iVNS治疗时间为5 - 13年（平均8年），采用以下刺激模式：电流1.3毫安（0.5 - 2毫安），频率20赫兹，脉宽250微秒，开启30秒/关闭1.9分钟（0.5 - 5分钟）。与BMT组和HC组相比，iVNS组的VAS评分显著更低（iVNS组为5.4；BMT组为7.8；p = 0.03），PASS认知/焦虑子量表评分也更低（iVNS组为21；BMT组为16；p = 0.02）。各组之间的总体PASS评分（p = 0.07）、FSVA、PSQI、BDI和BMI评分无显著差异。
iVNS似乎对耐药性局灶性癫痫患者的头痛以及情感/认知性头痛感知具有积极的长期调节作用，因此值得进一步关注。
