Xie Han, Ma Jiayi, Ji Taoyun, Liu Qingzhu, Cai Lixin, Wu Ye
Department of Pediatrics, Peking University First Hospital, Beijing, China; Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.
Epilepsy Behav. 2023 Mar;140:109107. doi: 10.1016/j.yebeh.2023.109107. Epub 2023 Feb 7.
Vagus nerve stimulation (VNS) is one of the treatment options for drug-resistant epilepsy (DRE). To analyze the efficacy of VNS in children of DRE with structural etiology, we conducted a cohort study including 95 patients of DRE with structural etiology who underwent VNS treatment. Patients were followed up every 3 months at the outpatient department or via a remote programming platform. The median follow-up period was 2.6 years (range 1.0-4.6 years). The respective responder rates at 6, 12, 18, and 24 months of follow-up were 40.0% (38/95), 52.6% (50/95), 56.0% (47/84), and 59.7% (37/62). The respective seizure-free rates at 12, 18, and 24 months of follow-up were 8.4% (8/95), 9.5% (8/84), and 9.7% (6/62). The patients were divided into four groups based on etiologies: malformations of cortical development (n = 26), post-encephalitic lesions (n = 36), perinatal brain injury lesions (n = 31), and hippocampal sclerosis (n = 2). The respective responder rates at 12 months of follow-up in these groups were 53.8% (14/26), 52.8% (19/36), 51.6% (16/31), and 50.0% (1/2). There were no significant differences in gender, age at onset, age at stimulator implantation, epilepsy duration prior to VNS implantation, number of anti-seizure medications ever tried before VNS treatment, pulse amplitude of VNS, specific structural etiologies, lobe distribution or hemispheric side of structural lesions between responders and non-responders. Of the 95 patients, 8 (8.4%) underwent lesion surgery or hemispherectomy before VNS implantation, and 6/8 (75%) of these patients had a >50% reduction in seizure frequency. One patient who had a corpus callosotomy before VNS implantation had no response to VNS treatment. In conclusion, VNS is an effective treatment in children of DRE with structural etiology. There was no significant difference in VNS efficacy in patients with different structural etiologies. Vagus nerve stimulation treatment may also control seizures well in some patients with poor outcomes after lesion resection or hemispherectomy before VNS implantation.
迷走神经刺激术（VNS）是耐药性癫痫（DRE）的治疗选择之一。为分析VNS对有结构性病因的DRE患儿的疗效，我们进行了一项队列研究，纳入95例有结构性病因且接受VNS治疗的DRE患儿。患者每3个月在门诊或通过远程程控平台进行随访。中位随访期为2.6年（范围1.0 - 4.6年）。随访6、12、18和24个月时的有效率分别为40.0%（38/95）、52.6%（50/95）、56.0%（47/84）和59.7%（37/62）。随访12、18和24个月时的无癫痫发作率分别为8.4%（8/95）、9.5%（8/84）和9.7%（6/62）。根据病因将患者分为四组：皮质发育畸形（n = 26）、脑炎后病变（n = 36）、围生期脑损伤病变（n = 31）和海马硬化（n = 2）。这些组在随访12个月时的有效率分别为53.8%（14/26）、52.8%（
19/36）、51.6%（16/31）和50.0%（1/2）。应答者和非应答者在性别、起病年龄、刺激器植入年龄、VNS植入前癫痫病程、VNS治疗前尝试过的抗癫痫药物数量、VNS的脉冲幅度、具体结构性病因、结构性病变的叶分布或半球侧别方面均无显著差异。95例患者中，8例（8.4%）在VNS植入前接受了病变手术或大脑半球切除术，其中6/8（75%）的患者癫痫发作频率降低>50%。1例在VNS植入前接受胼胝体切开术的患者对VNS治疗无反应。总之，VNS对有结构性病因的DRE患儿是一种有效的治疗方法。不同结构性病因患者的VNS疗效无显著差异。对于一些在VNS植入前病变切除或大脑半球切除术后预后不佳的患者，迷走神经刺激治疗也可能很好地控制癫痫发作。
