Moro-De Faes G, Serrano-Moyano B, Cantarin-Extremera V, Moreno-Vinues B, Garcia-Fernandez M, Perez-Jimenez M A, Rivero-Martin M B, Garcia-Ezquiaga J, Duat-Rodriguez A, Ruiz-Falco Rojas M L
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
Rev Neurol. 2018 Nov 16;67(10):382-386.
Fifty million people are affected by epilepsy. Up to 30% are not controlled with the aid of antiepileptic drugs. The vagus nerve stimulator (VNS) is a therapeutic alternative that must be taken into account.
To determine the effect of the VNS in a cohort of paediatric patients with refractory epilepsy.
A retrospective study of children with a VNS implanted between 2008 and 2017 in a tertiary hospital. Epidemiological, aetiological, clinical and electrophysiological data, along with VNS parameters were analysed.
The study included 35 patients, with a mean age when the VNS was implanted of 12.84 years (range: 3.1-18.7 years) and a mean time between onset of epilepsy and implantation of 7.2 years (range: 1.3-17.7 years). The causation was structural in 62.9% of cases. The most frequent epileptic conditions were: Lennox-Gastaut syndrome and focal epilepsy, with a predominance of tonic seizures (57.1%). The video electroencephalogram showed multifocal anomalies (54%) and a pattern of epileptic encephalopathies (34.3%). Intellectual disability was associated in 94% of the cases. The mean of previous antiepileptic drugs was 9.6 ± 3 (range: 4-16). 43% responded to treatment (>= 50% reduction in number of seizures), with a mean reduction of 67.3%, which improved with higher ages of onset of epilepsy. Three patients were seizure-free (8.5%). The number of seizures decreased by 33% at six months and by 47.4% at 24 months. There was also a notable degree of cognitive (57%) and behavioural improvement (53%). In 28% of cases there were some side effects, but in general they were mild.
The VNS is a valid option in refractory epilepsy, with improvements not only in terms of seizures but also regarding cognitive-behavioural aspects, this being very important for the paediatric population.
五千万人受癫痫影响。高达30%的患者无法通过抗癫痫药物得到控制。迷走神经刺激器（VNS）是一种必须考虑的治疗选择。
确定VNS对一组难治性癫痫儿科患者的疗效。
对2008年至2017年在一家三级医院植入VNS的儿童进行回顾性研究。分析了流行病学、病因学、临床和电生理数据以及VNS参数。
该研究纳入35例患者，VNS植入时的平均年龄为12.84岁（范围：3.1 - 18.7岁），癫痫发作与植入之间的平均时间为7.2年（范围：1.3 - 17.7年）。62.9%的病例病因是结构性的。最常见的癫痫病症为：Lennox - Gastaut综合征和局灶性癫痫，强直发作占主导（57.1%）。视频脑电图显示多灶性异常（54%）和癫痫性脑病模式（34.3%）。94%的病例伴有智力残疾。之前使用的抗癫痫药物平均数量为9.6 ± 3（范围：4 - 16）。43%的患者对治疗有反应（癫痫发作次数减少>= 50%），平均减少67.3%，癫痫发病年龄越大改善越明显。3例患者无癫痫发作（8.5%）。癫痫发作次数在6个月时减少33%，在24个月时减少47.4%。认知（57%）和行为（53%）也有显著改善。28%的病例出现一些副作用，但总体较轻。
VNS是难治性癫痫的一种有效选择，不仅在癫痫发作方面有改善，在认知 - 行为方面也有改善，这对儿科人群非常重要。
