Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Pediatr Neonatol. 2020 Dec;61(6):606-612. doi: 10.1016/j.pedneo.2020.07.010. Epub 2020 Jul 22.
Vagus nerve stimulation (VNS) is used as an add-on treatment for epilepsy. This study aimed to use Taiwanese nationwide registry data to analyze the therapeutic effects of VNS in children with refractory epilepsy (RE) and try to explore predictive factors of VNS treatment effectiveness.
This retrospective study collected data from December 2007 to December 2014. Patient variables included gender, age, VNS implantation date, epilepsy duration, seizure frequency, seizure type, etiology, and antiepileptic drug (AED) history. We divided patients into three groups: Group I as seizure frequency >80 times per month, Group II as seizure frequency 24-80 times per month, and Group III as seizure frequency <24 times per month. Multivariate regression analysis was performed to determine predictors of seizure frequency reduction after VNS treatment.
A total of 80 patients were included in this study. Three or more AED types were prescribed for 61 (77.1%) patients. Seizure frequency decreased significantly at 12 and 24 months after VNS treatment. The mean seizure reduction rates were 44.6% and 50.1% at 12 and 24 months after VNS treatment, with the difference between them reaching statistical significance (p = 0.001). In multivariate linear regression, high seizure frequency (Group I) was a positive predictor of seizure frequency reduction (p < 0.001). The most common complication was coughing (eight patients, 10%) and no patient had early withdrawal or premature termination of VNS use due to complications.
VNS is an effective palliative treatment for children with RE for different seizure types. Seizure reduction rate at 24 months after VNS was better than at 12 months after VNS. High seizure frequency can be regarded as a positive predictor for seizure frequency reduction in children with RE treated with VNS.
迷走神经刺激术（VNS）被用作癫痫的附加治疗方法。本研究旨在使用台湾全国性登记数据来分析 VNS 治疗耐药性癫痫（RE）儿童的疗效，并尝试探讨 VNS 治疗效果的预测因素。
本回顾性研究收集了 2007 年 12 月至 2014 年 12 月的数据。患者变量包括性别、年龄、VNS 植入日期、癫痫持续时间、发作频率、发作类型、病因和抗癫痫药物（AED）史。我们将患者分为三组：组 I 为每月发作频率>80 次，组 II 为每月发作频率 24-80 次，组 III 为每月发作频率<24 次。进行多变量回归分析以确定 VNS 治疗后发作频率降低的预测因素。
本研究共纳入 80 例患者。61 例（77.1%）患者处方了三种或更多种 AED 类型。VNS 治疗后 12 个月和 24 个月时，发作频率显著降低。VNS 治疗后 12 个月和 24 个月时的平均发作减少率分别为 44.6%和 50.1%，差异具有统计学意义（p=0.001）。在多变量线性回归中，高发作频率（组 I）是发作频率降低的阳性预测因子（p<0.001）。最常见的并发症是咳嗽（8 例，10%），没有患者因并发症而提前终止或提前终止 VNS 治疗。
VNS 是治疗 RE 儿童不同发作类型的有效姑息治疗方法。VNS 治疗后 24 个月的发作减少率优于治疗后 12 个月。高发作频率可作为 VNS 治疗 RE 儿童发作频率降低的阳性预测因子。
