Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Epilepsy Behav. 2020 Oct;111:107253. doi: 10.1016/j.yebeh.2020.107253. Epub 2020 Jun 29.
For patients with generalized epilepsy who do not respond to antiseizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy-resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox-Gastaut Syndrome (LGS) and genetic generalized epilepsy (GGE).
We identified patients with a diagnosis of generalized epilepsy (including LGS and GGE), who underwent VNS implantation at the London Health Sciences Centre and Western University, London, Ontario, since this treatment became available in Canada in 1997 until July 2018. We assessed response to the treatment, including admissions to hospital and complications.
A total of 46 patients were included in this study with a history of therapy-resistant generalized epilepsy. The mean age at implantation was 24 years (interquartile range [IQR] = 17.8-31 years), significantly younger in the LGS group (p = 0.02) and 50% (n = 23) were female. The most common etiologies were GGE in 37% (n = 17) and LGS in 63% (n = 29). Median follow-up since VNS implantation was 63 months (IQR: 31-112.8 months). Of the LGS group 41.7% (n = 12) of patients had an overall seizure reduction of 50% or more, and 64.7% (n = 11) in the GGE group without statistical significance between the groups. The best response in seizure reduction was seen in generalized tonic-clonic seizures, with a significant reduction in the GGE group (p = 0.043). There was a reduction of seizure-related hospital admissions from 91.3% (N = 42) preimplantation, to 43.5% (N = 20) postimplantation (p < 0.05). The frequency of side effects due to the stimulation was almost equal in both groups (62.1% in LGS and 64.7% in GGE).
Vagus nerve stimulation should be considered as a treatment in patients with therapy-resistant generalized epilepsy, especially in cases with GGE.
对于对抗癫痫药物无反应的全身性癫痫患者，治疗选择有限。迷走神经刺激（Vagus nerve stimulation，VNS）主要用于治疗耐药性局灶性癫痫。关于 VNS 在全身性癫痫中的应用，包括 Lennox-Gastaut 综合征（LGS）和遗传性全面性癫痫（genetic generalized epilepsy，GGE），信息有限。
我们在伦敦健康科学中心和西安大略大学的伦敦分校确定了自 1997 年加拿大开始使用 VNS 治疗以来至 2018 年 7 月期间接受 VNS 植入术的诊断为全身性癫痫（包括 LGS 和 GGE）的患者。我们评估了治疗反应，包括住院和并发症。
本研究共纳入 46 例耐药性全身性癫痫患者。植入时的平均年龄为 24 岁（四分位距 [IQR] = 17.8-31 岁），LGS 组显著年轻（p = 0.02），50%（n = 23）为女性。最常见的病因是 GGE（37%，n = 17）和 LGS（63%，n = 29）。自 VNS 植入以来的中位随访时间为 63 个月（IQR：31-112.8 个月）。LGS 组中有 41.7%（n = 12）的患者总体癫痫发作减少 50%或更多，GGE 组为 64.7%（n = 11），两组之间无统计学意义。在全身性强直阵挛性癫痫中，最佳的癫痫发作缓解效果最显著，GGE 组的效果具有统计学意义（p = 0.043）。植入后，与癫痫相关的住院就诊率从植入前的 91.3%（n = 42）降至 43.5%（n = 20）（p < 0.05）。两组因刺激而产生副作用的频率几乎相等（LGS 组为 62.1%，GGE 组为 64.7%）。
对于抗癫痫药物耐药的全身性癫痫患者，应考虑将迷走神经刺激作为一种治疗方法，特别是在 GGE 患者中。
