Boluk Cem, Ozkara Cigdem, Isler Cihan, Uzan Mustafa
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey.
Turk Neurosurg. 2022;32(1):97-102. doi: 10.5137/1019-5149.JTN.33775-21.2.
To investigate and compare the efficacy and safety of vagus nerve stimulation (VNS) therapy in different types of epilepsy.
Patients, who were implanted with VNS between the years 2005 and 2020, were retrospectively included in the study. Age, gender, age at seizure onset, epilepsy types, VNS implantation year, replacement year, pre and post-VNS seizure frequency, number of responders, number of antiseizure medication and adverse events were recorded.
In total, 41 patients were included in the study. The number of patients with focal epilepsy was 21 (51.2%). 10 patients (24.4%) had generalized epilepsy and 10 patients (24.4%) had ?combined generalized and focal epilepsy? (Lennox-Gastaut, Dravet syndrome). The Pre-VNS median seizure frequency was 1.5/day in the focal group, 0.6/day in the generalized group and 6/day in the combined group. Seizure frequencies dropped to 0.3/day in the focal group, 0.2/day in the generalized group and 3.0/day in the combined group at the 12th month after VNS (p < 0.001, p=0.004, p < 0.001). The response rate was found to be 68.3% at the 12th month after VNS. The number of antiseizure medications was decreased from 3.6/day to 3.1/day at the 12th months after VNS (p < 0.001). Two patients? (4.9%) VNS therapy was discontinued due to adverse events.
The study indicates that VNS therapy is safe and effective in focal, generalized and combined epilepsy types. Despite having a low seizure freedom rate, VNS is a good alternative treatment option for patients who for any reason are not candidates for resective surgery.
研究并比较迷走神经刺激（VNS）疗法在不同类型癫痫中的疗效和安全性。
回顾性纳入2005年至2020年间接受VNS植入的患者。记录年龄、性别、癫痫发作起始年龄、癫痫类型、VNS植入年份、更换年份、VNS治疗前后的癫痫发作频率、反应者数量、抗癫痫药物数量及不良事件。
本研究共纳入41例患者。局灶性癫痫患者21例（51.2%）。10例患者（24.4%）患有全身性癫痫，10例患者（24.4%）患有“全身性和局灶性癫痫合并症”（Lennox-Gastaut综合征、Dravet综合征）。VNS治疗前，局灶性癫痫组的癫痫发作中位数频率为1.5次/天，全身性癫痫组为0.6次/天，合并症组为6次/天。VNS治疗12个月后，局灶性癫痫组的癫痫发作频率降至0.3次/天，全身性癫痫组降至0.2次/天，合并症组降至3.0次/天（p<0.001，p=0.004，p<0.001）。VNS治疗12个月时的反应率为68.3%。VNS治疗12个月后，抗癫痫药物的数量从3.6次/天降至3.1次/天（p<0.001）。2例患者（4.9%）因不良事件停止VNS治疗。
该研究表明，VNS疗法在局灶性、全身性及合并性癫痫类型中均安全有效。尽管癫痫发作完全缓解率较低，但对于因任何原因不适合进行切除性手术的患者，VNS是一种良好的替代治疗选择。
