Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.
Department of Neurology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.
Childs Nerv Syst. 2021 Apr;37(4):1237-1241. doi: 10.1007/s00381-020-04962-3. Epub 2020 Nov 10.
The recent VNS models (AspireSR® Model 106, SenTiva™ Model 1000 (VNS Therapy®, LivaNova)) include a new function of cardiac-based seizure detection (CBSD) automatic stimulation, known as 'AutoStim'. This algorithm uses tachycardia as a proxy to a seizure, and the battery delivers a closed-loop electrical current in addition to its programmed stimulation. This function leads to further seizure reduction in adults, but this advantage has not been reported in the paediatric population. This study aims to investigate whether battery change with AutoStim leads to further seizure reduction in children.
This observational study included the first 10 cases of VNS battery change from non-AutoStim to AutoStim function. During the battery change operation, the new VNS was switched on, with the same normal and magnet mode settings as the previous VNS. The AutoStim mode was activated at the same time. Data on seizure burden were collected at 3 time points: (1) before the first VNS insertion, (2) before battery replacement (post-1st VNS) and (3) 12 months post-battery change (post-AutoStim). The net effect of AutoStim, the only changed parameter, was evaluated by comparing the seizure burden prior to and 12 months following battery change in each child.
The seizure reduction improved significantly from 60 to 83% following battery change with AutoStim. Categorising the outcome according the McHugh classification, children achieving class I and II outcome (≥ 50% seizure reduction) improved from 70 to 90%.
This is the first study to demonstrate the additional efficacy of AutoStim in children treated with VNS.
最近的 VNS 模型（AspireSR® Model 106、SenTiva™ Model 1000（VNS Therapy®，LivaNova））包括一种新的心脏相关癫痫发作检测（CBSD）自动刺激功能，称为“AutoStim”。该算法使用心动过速作为癫痫发作的替代指标，除了其程控刺激外，电池还会输送闭环电流。该功能可进一步减少成人的癫痫发作，但尚未在儿科人群中报道这一优势。本研究旨在探讨 AutoStim 下的电池更换是否可进一步减少儿童的癫痫发作。
本观察性研究纳入了前 10 例从非 AutoStim 功能切换至 AutoStim 功能的 VNS 电池更换病例。在电池更换手术过程中，新的 VNS 设备开机，与之前的 VNS 设备具有相同的正常和磁铁模式设置。同时激活 AutoStim 模式。收集了 3 个时间点的癫痫发作负担数据：（1）第一次 VNS 插入之前，（2）更换电池前（第一 VNS 后）和（3）更换电池后 12 个月（AutoStim 后）。通过比较每个孩子在更换电池前后 12 个月的癫痫发作负担，评估 AutoStim（唯一改变的参数）的净效应。
AutoStim 下的电池更换使癫痫发作减少率从 60%显著提高至 83%。根据 McHugh 分类法对结果进行分类，癫痫发作减少≥50%（达到 I 类和 II 类结果）的儿童比例从 70%提高至 90%。
这是第一项证明 AutoStim 在接受 VNS 治疗的儿童中具有额外疗效的研究。
