Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,
Stereotact Funct Neurosurg. 2020;98(1):21-29. doi: 10.1159/000504859. Epub 2020 Feb 19.
Patients with medically refractory temporal lobe epilepsy (TLE) are candidates for neuromodulation procedures. While vagus nerve stimulation (VNS) was historically the procedure of choice for this condition, the responsive neurostimulation system (RNS) has come into favor for its more targeted approach. While both VNS and RNS have been reported as efficacious treatments for TLE, the outcomes of these 2 procedures have not been directly compared. This study aims to compare outcomes following VNS versus RNS for TLE.
We retrospectively reviewed the records of all patients with TLE who underwent VNS or RNS placement at our institution from 2003 to 2018. The primary outcome was change in seizure frequency. Other outcomes included Engel score, change in anti-epileptic medications, and complications.
Twenty-three patients met inclusion criteria; 11 underwent VNS and 12 underwent RNS. At baseline, the 2 groups were statistically similar regarding age at surgery, epilepsy duration, and preoperative seizure frequency. At last follow-up, both groups displayed reduced seizure frequency (mean reduction of 46.3% for the VNS group and 58.1% for the RNS group, p = 0.49). Responder rate, Engel score, and change in medications were statistically similar between groups. Compared to 0.0% of the VNS group, 13.3% of the RNS group experienced infection requiring re-operation.
Despite their different mechanisms, VNS and RNS resulted in similar response rates for patients with TLE. We suggest that VNS should not be excluded as a treatment for patients with medically refractory TLE who are not candidates for resective or ablative procedures.
对于药物难治性颞叶癫痫（TLE）患者，神经调节程序是一种治疗选择。虽然迷走神经刺激（VNS）在历史上是这种情况的首选程序，但反应性神经刺激系统（RNS）因其更具针对性的方法而受到青睐。虽然 VNS 和 RNS 均被报道为 TLE 的有效治疗方法，但这两种程序的结果尚未直接比较。本研究旨在比较 VNS 与 RNS 治疗 TLE 的结果。
我们回顾性地审查了 2003 年至 2018 年在我们机构接受 VNS 或 RNS 治疗的所有 TLE 患者的记录。主要结果是癫痫发作频率的变化。其他结果包括 Engel 评分、抗癫痫药物的变化和并发症。
23 名患者符合纳入标准；11 名接受了 VNS，12 名接受了 RNS。在基线时，两组在手术时的年龄、癫痫持续时间和术前癫痫发作频率方面具有统计学相似性。在最后一次随访时，两组的癫痫发作频率均降低（VNS 组的平均降低 46.3%，RNS 组的平均降低 58.1%，p = 0.49）。两组之间的应答率、Engel 评分和药物变化均具有统计学相似性。与 VNS 组的 0.0%相比，RNS 组有 13.3%的患者发生感染需要再次手术。
尽管 VNS 和 RNS 的机制不同，但它们对 TLE 患者的反应率相似。我们建议，对于不能进行切除或消融手术的药物难治性 TLE 患者，不应排除 VNS 作为一种治疗方法。
