Guo Mengyi, Wang Jing, Xiong Zhonghua, Deng Jiahui, Zhang Jing, Tang Chongyang, Kong Xiangru, Wang Xiongfei, Guan Yuguang, Zhou Jian, Zhai Feng, Luan Guoming, Li Tianfu
Beijing Key Laboratory of Epilepsy Research, Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2023 Jan 6;13:1074997. doi: 10.3389/fneur.2022.1074997. eCollection 2022.
Vagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy. Encephalomalacia is one of the most common MRI findings in the preoperative evaluation of patients with pharmacoresistant epilepsy. This is the first study that aimed to determine the effectiveness of VNS for pharmacoresistant epilepsy secondary to encephalomalacia and evaluate the potential predictors of VNS effectiveness.
We retrospectively analyzed the seizure outcomes of VNS with at least 1 year of follow-up in all patients with pharmacoresistant epilepsy secondary to encephalomalacia. Based on the effectiveness of VNS (≥50% or <50% reduction in seizure frequency), patients were divided into two subgroups: responders and non-responders. Preoperative data were analyzed to screen for potential predictors of VNS effectiveness.
A total of 93 patients with epilepsy secondary to encephalomalacia who underwent VNS therapy were recruited. Responders were found in 64.5% of patients, and 16.1% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 36.6, 50.5, 64.5, and 65.4% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, seizure onset in adults (>18 years old) (OR: 0.236, 95%CI: 0.059-0.949) was found to be a positive predictor, and the bilateral interictal epileptic discharges (IEDs) (OR: 3.397, 95%CI: 1.148-10.054) and the bilateral encephalomalacia on MRI (OR: 3.193, 95%CI: 1.217-8.381) were found to be negative predictors of VNS effectiveness.
The results demonstrated the effectiveness and safety of VNS therapy in patients with pharmacoresistant epilepsy secondary to encephalomalacia. Patients with seizure onset in adults (>18 years old), unilateral IEDs, or unilateral encephalomalacia on MRI were found to have better seizure outcomes after VNS therapy.
迷走神经刺激术（VNS）是药物难治性癫痫的一种辅助治疗方法。脑软化是药物难治性癫痫患者术前评估中最常见的MRI表现之一。这是第一项旨在确定VNS治疗继发于脑软化的药物难治性癫痫的有效性并评估VNS有效性潜在预测因素的研究。
我们回顾性分析了所有继发于脑软化的药物难治性癫痫患者接受VNS治疗且随访至少1年的癫痫发作结果。根据VNS的有效性（癫痫发作频率降低≥50%或<50%），将患者分为两个亚组：反应者和无反应者。分析术前数据以筛选VNS有效性的潜在预测因素。
共招募了93例接受VNS治疗的继发于脑软化的癫痫患者。64.5%的患者为反应者，16.1%的患者在最后一次随访时实现无癫痫发作。此外，反应率随时间增加，在3个月、6个月、12个月和24个月随访时分别为36.6%、50.5%、64.5%和65.4%。多因素分析后发现，成人（>18岁）癫痫发作（OR：0.236，95%CI：0.059 - 0.949）是一个阳性预测因素，而双侧发作间期癫痫样放电（IEDs）（OR：3.397，95%CI：1.148 - 10.054）和MRI上的双侧脑软化（OR：3.193，95%CI：1.217 - 8.381）是VNS有效性的阴性预测因素。
结果证明了VNS治疗继发于脑软化的药物难治性癫痫患者的有效性和安全性。发现成人（>18岁）癫痫发作、单侧IEDs或MRI上单侧脑软化的患者在VNS治疗后癫痫发作结果更好。
