Cukiert Arthur, Cukiert Cristine Mella, Burattini Jose Augusto, Guimaraes Rafael Basilio
Department of Neurosurgery, São Paulo Epilepsy Clinic, São Paulo, São Paulo, Brazil.
Department of Neurosurgery, São Paulo Epilepsy Clinic, São Paulo, São Paulo, Brazil.
Neuromodulation. 2023 Dec;26(8):1742-1746. doi: 10.1016/j.neurom.2022.08.449. Epub 2022 Sep 13.
This article describes our findings while treating patients with refractory generalized epilepsy with combined vagus nerve stimulation (VNS) and centro-median deep brain stimulation (CMDBS).
A total of 11 consecutive patients with refractory generalized epilepsy (ten with Lennox-Gastaut syndrome) previously submitted to VNS and who subsequently underwent CMDBS were retrospectively studied. The VNS final parameters were 2 to 2.5 mA, 30 Hz, and 500 μs, cycling mode, 30 seconds "on" and 5 minutes "off" for all patients. The CMDBS final parameters were 4 to 5 V, 130 Hz, and 300 μs, bipolar, continuous stimulation in all patients.
There were eight male participants, ranging in age from eight to 49 years (mean 19 years). Follow-up time after VNS ranged from 18 to 132 months (mean 52 months) and from an additional 18 to 164 months (mean 42 months) during combined VNS-CMDBS. All patients had daily seizures. Atypical absences were noted in eight patients, tonic seizures in seven, bilateral tonic-clonic seizures in four, atonic seizures in three, and myoclonic seizures in two patients. Four patients were initially considered responders to VNS. All these patients also had an additional >50% seizure frequency reduction during combined VNS-CMDBS. Seven patients were not responders to VNS, and of those, four had an additional >50% seizure frequency reduction during combined VNS-CMDBS. Eight patients had an additional >50% reduction in seizure frequency when moved from VNS alone to VNS-CMDBS therapy. There were two nonresponders during combined VNS-CMDBS therapy, and both were nonresponders to VNS alone. Nine patients were considered responders during VNS-CMDBS combined therapy compared with baseline.
This study showed that combined VNS-CMDBS therapy was able to double the number of responders compared with VNS alone in a cohort of patients with refractory generalized epilepsy. We believe these data represent the first evidence that combined neuromodulation may be useful in this quite homogeneous patient population.
本文介绍了我们在使用迷走神经刺激（VNS）和中央中脑深部脑刺激（CMDBS）联合治疗难治性全身性癫痫患者时的发现。
对11例先前接受过VNS治疗且随后接受CMDBS治疗的难治性全身性癫痫连续患者（10例患有Lennox-Gastaut综合征）进行回顾性研究。所有患者的VNS最终参数为2至2.5毫安、30赫兹和500微秒，采用循环模式，“开启”30秒、“关闭”5分钟。所有患者的CMDBS最终参数为4至5伏、130赫兹和300微秒，采用双极连续刺激。
有8名男性参与者，年龄在8至49岁之间（平均19岁）。VNS后的随访时间为18至132个月（平均52个月），在VNS-CMDBS联合治疗期间为额外的18至164个月（平均42个月）。所有患者每天都有癫痫发作。8例患者出现非典型失神发作，7例出现强直发作，4例出现双侧强直阵挛发作，3例出现失张力发作，2例出现肌阵挛发作。4例患者最初被认为对VNS有反应。所有这些患者在VNS-CMDBS联合治疗期间癫痫发作频率也额外降低了>50%。7例患者对VNS无反应，其中4例在VNS-CMDBS联合治疗期间癫痫发作频率额外降低了>50%。8例患者从单独的VNS治疗转为VNS-CMDBS治疗时，癫痫发作频率额外降低了>50%。在VNS-CMDBS联合治疗期间有2例无反应者，且这2例单独使用VNS时也无反应。与基线相比，9例患者在VNS-CMDBS联合治疗期间被认为有反应。
本研究表明，在难治性全身性癫痫患者队列中，与单独使用VNS相比，VNS-CMDBS联合治疗能够使有反应者的数量增加一倍。我们认为这些数据代表了首个证据，即联合神经调节在这个相当同质的患者群体中可能是有用的。
