Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Seizure. 2022 Jan;94:74-81. doi: 10.1016/j.seizure.2021.11.016. Epub 2021 Nov 29.
For epilepsy patients with drug-resistant, unresectable epilepsy, vagus nerve stimulation (VNS) is an option for seizure control. Approximately 40-70% of patients will achieve ≥50% seizure reduction with VNS. New closed loop VNS models detect ictal tachycardia and responsively stimulate the vagus nerve. The effectiveness of closed loop VNS compared to traditional VNS for pediatric epilepsy is unknown.
An 11-year retrospective electronic medical record review at Children's Hospital of Pittsburgh was performed. Patients with drug-resistant epilepsy who underwent VNS implantation were included. Patients were divided into groups based on VNS model: traditional versus closed loop. Those who transitioned from traditional to closed loop VNS were excluded. Given potential for selection bias, propensity scores matching was utilized to compare traditional to closed loop VNS patients. Patients with focal versus generalized epilepsy were also separately analyzed. The primary outcome was "VNS response", defined as at least 50% seizure frequency reduction from baseline.
A total of 320 patients were included in this sample. The percentage of matched patients (total n = 220: n = 179 traditional VNS, n = 41 closed loop VNS) who responded to VNS after one year of therapy was 43% for traditional VNS and 39% for closed loop VNS (p = 0.64). After two years of therapy, a higher proportion of closed loop VNS patients than traditional VNS patients responded to VNS among all subgroups, though no differences were statistically significant (p>0.05). Notably, for those with generalized epilepsy, 73% of closed loop patients responded to VNS compared to only 46% of traditional patients (p = 0.10). After two years of VNS therapy, patients were taking approximately the same quantity of antiseizure medications as baseline (change of +0.074 +/- 0.90 ) with no difference between VNS models (p = 0.87).
Among pediatric patients with drug-resistant epilepsy, closed loop VNS trends towards a higher rate of VNS response after two years of treatment, especially among generalized epilepsy patients. Neither model of VNS allows patients to reduce antiseizure medication quantity after two years.
对于耐药性、无法切除的癫痫患者，迷走神经刺激（VNS）是控制癫痫发作的一种选择。大约 40-70%的患者通过 VNS 治疗可达到≥50%的癫痫发作减少。新型闭环 VNS 模型可检测到癫痫性心动过速，并对迷走神经进行响应性刺激。闭环 VNS 与儿科癫痫的传统 VNS 相比的有效性尚不清楚。
匹兹堡儿童医院进行了一项为期 11 年的回顾性电子病历研究。纳入接受 VNS 植入的耐药性癫痫患者。根据 VNS 模型将患者分为两组：传统组与闭环组。排除从传统 VNS 转为闭环 VNS 的患者。鉴于潜在的选择偏倚，采用倾向评分匹配来比较传统 VNS 与闭环 VNS 患者。还分别分析了局灶性与全面性癫痫患者。主要结局为“VNS 反应”，定义为基线时癫痫发作频率至少减少 50%。
共有 320 名患者纳入本样本。在接受一年治疗后，对 VNS 有反应的匹配患者（总数 n=220：n=179 例传统 VNS，n=41 例闭环 VNS）的百分比为传统 VNS 为 43%，闭环 VNS 为 39%（p=0.64）。在两年的治疗后，所有亚组中，闭环 VNS 患者比传统 VNS 患者对 VNS 有反应的比例更高，但差异无统计学意义（p>0.05）。值得注意的是，对于全面性癫痫患者，闭环 VNS 患者中有 73%对 VNS 有反应，而传统患者仅有 46%（p=0.10）。在 VNS 治疗两年后，患者服用的抗癫痫药物数量与基线时大致相同（变化为+0.074 +/- 0.90），两种 VNS 模型之间无差异（p=0.87）。
在耐药性癫痫的儿科患者中，闭环 VNS 在两年的治疗后，VNS 反应的趋势更高，尤其是在全面性癫痫患者中。两种 VNS 模型都不能使患者在两年后减少抗癫痫药物的使用量。
