Knorr Corine, Greuter Ladina, Constantini Shlomi, Fried Itzhak, Kremer Uri, Datta Alexandre N, Guzman Raphael, Soleman Jehuda
Department of Neurosurgery and Division of Pediatric Neurosurgery, Children's University Hospital of Basel (UKBB), Basel, Switzerland.
Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center and Dana Children's Hospital, Tel Aviv University, Tel Aviv, Israel.
Childs Nerv Syst. 2021 Jan;37(1):243-252. doi: 10.1007/s00381-020-04628-0. Epub 2020 May 2.
Vagal nerve stimulator (VNS) implantation at an early age seems to lead to improved quality of life and cognitive outcome. The aim of this analysis is to evaluate whether specific patient or seizure characteristics might lead to better seizure control, cognitive outcome, and higher quality of life in children undergoing VNS implantation.
Primary outcome measure was reduction in seizure frequency. Secondary outcome measures were epilepsy outcome assessed by McHugh and Engel classifications, reduction in antiepileptic drugs (AED), developmental and cognitive outcome, as well as quality of life assessed through the pediatric quality of life (PEDSQL™) questionnaire and care giver impression (CGI) scale. Forty-five consecutive children undergoing VNS implantation were analyzed for the following subgroups: age (categorized to 1-2 years old, 3-5 years old, 6-12 years old, and 13-18 years old), sex, underlying cause (categorized to idiopathic, encephalitis, stroke, syndromic), duration of preoperative seizures (dichotomized to under or above 89 months, corresponding to the median of the whole cohort), and preoperative seizure frequency (dichotomized to under and above 360 seizures per month).
Encephalitis as the underlying cause for seizures was the only variable significantly associated with higher reduction rate of seizure frequency. Patients with VNS implantation at the age of ≤ 2 years showed a strong association with better developmental and cognitive outcome, as well as quality of life. Shorter duration of preoperative seizures and higher preoperative seizure frequency showed a strong association with better developmental outcome, as well as quality of life. Engel outcome scores were significantly better in patients with epilepsy due to encephalitis (100% Engel I-III). However, patients with epilepsy due to encephalitis showed significantly higher complication rates (71.4%, p = 0.045).
Children suffering from epilepsy due to encephalitis show higher seizure reduction rates after VNS implantation when compared with children suffering from epilepsy due to other causes. Developmental and cognitive outcomes as well as quality of life of children undergoing VNS implantation is strongly associated with shorter duration of preoperative seizures and implantation at a young age.
早年植入迷走神经刺激器（VNS）似乎能改善生活质量和认知结果。本分析的目的是评估特定的患者或癫痫特征是否可能使接受VNS植入的儿童获得更好的癫痫控制、认知结果和更高的生活质量。
主要结局指标是癫痫发作频率的降低。次要结局指标包括通过麦克休和恩格尔分类法评估的癫痫结局、抗癫痫药物（AED）的减少、发育和认知结局，以及通过儿童生活质量（PEDSQL™）问卷和照顾者印象（CGI）量表评估的生活质量。对连续45例接受VNS植入的儿童进行分析，分为以下亚组：年龄（分为1 - 2岁、3 - 5岁、6 - 12岁和13 - 18岁）、性别、潜在病因（分为特发性、脑炎、中风、综合征性）、术前癫痫发作持续时间（二分法分为低于或高于89个月，对应整个队列的中位数）和术前癫痫发作频率（二分法分为每月低于和高于360次发作）。
脑炎作为癫痫的潜在病因是唯一与癫痫发作频率更高降低率显著相关的变量。≤2岁时植入VNS的患者与更好的发育和认知结局以及生活质量密切相关。术前癫痫发作持续时间较短和术前癫痫发作频率较高与更好的发育结局以及生活质量密切相关。脑炎所致癫痫患者的恩格尔结局评分明显更好（100%为恩格尔I - III级）。然而，脑炎所致癫痫患者的并发症发生率明显更高（71.4%，p = 0.045）。
与其他病因所致癫痫的儿童相比，脑炎所致癫痫的儿童在植入VNS后癫痫发作减少率更高。接受VNS植入的儿童的发育和认知结局以及生活质量与术前癫痫发作持续时间较短和年轻时植入密切相关。
