Hatano Keisuke, Fujimoto Ayataka, Yamamoto Takamichi, Enoki Hideo, Okanishi Tohru
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu 430-8558, Shizuoka, Japan.
Department of Neurosurgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu 430-8558, Shizuoka, Japan.
Brain Sci. 2021 Oct 23;11(11):1395. doi: 10.3390/brainsci11111395.
The effectiveness of vagus nerve stimulation (VNS) for residual seizures after corpus callosotomy (CC) has not yet been fully investigated. We hypothesized that seizure control would be improved by VNS after CC. The purpose of this study was to compare seizure frequency between patients with implantation of a VNS generator (post-VNS group) or without VNS (non-post-VNS group) following CC.
We retrospectively reviewed patients who underwent CC between January 2009 and May 2019 in our institution. We evaluated proportions of ≥50% reduction in seizure frequency (responders) and seizure reduction rate 1 and 2 years after VNS. To investigate factors related to responders, uni- and multivariate logistic regression analyses were performed regarding age, number of anti-seizure medications (ASMs), addition of novel ASMs (levetiracetam, lacosamide or perampanel), and post-VNS or non-post-VNS status.
Thirteen post-VNS patients and 24 non-post-VNS patients were analyzed in this study. Responder rate at 1 year after VNS differed significantly between the post-VNS group (53.9%) and non-post-VNS group (12.5%, = 0.017). Number of ASMs at the time of CC and post-VNS were significantly associated with responders in univariate analyses (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.13-0.88, = 0.025 and OR 8.2, 95%CI 1.6-41.6, = 0.011, respectively), whereas age, sex, seizure frequency, and addition of novel ASMs were not. In multivariate analysis, the presence of VNS procedures after CC was the only factor favorably associated with responder status (OR 82.2, 95%CI 1.55-4355.7, = 0.03).
VNS therapy after CC may increase the proportion of responders independent of the addition of novel ASMs.
胼胝体切开术（CC）后迷走神经刺激（VNS）对残留癫痫发作的有效性尚未得到充分研究。我们假设CC后VNS可改善癫痫控制。本研究的目的是比较CC后植入VNS发生器的患者（VNS植入后组）和未植入VNS的患者（非VNS植入后组）之间的癫痫发作频率。
我们回顾性研究了2009年1月至2019年5月在我院接受CC手术的患者。我们评估了VNS后1年和2年癫痫发作频率降低≥50%的患者比例（反应者）以及癫痫发作减少率。为了研究与反应者相关的因素，我们对年龄、抗癫痫药物（ASM）数量、新型ASM（左乙拉西坦、拉科酰胺或吡仑帕奈）的添加以及VNS植入后或非VNS植入后状态进行了单因素和多因素逻辑回归分析。
本研究分析了13例VNS植入后患者和24例非VNS植入后患者。VNS植入后组（53.9%）和非VNS植入后组（12.5%，P = 0.017）在VNS后1年的反应者率有显著差异。在单因素分析中，CC时和VNS植入后的ASM数量与反应者显著相关（优势比[OR]分别为0.34，95%置信区间[CI]为0.13 - 0.88，P = 0.025和OR 8.2，95%CI为1.6 - 41.6，P = 0.011），而年龄、性别癫痫发作频率和新型ASM的添加则无显著相关性。在多因素分析中，CC后进行VNS手术是与反应者状态唯一显著相关的因素（OR 82.2，95%CI为1.55 - 4355.7，P = 0.03）。
CC后VNS治疗可能会增加反应者的比例，且与新型ASM的添加无关。
