Chrastina J, Horák O, Ryzí M, Brázdil M, Novák Z, Zeman T, Danhofer P
Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic.
Department of Pediatric Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic.
Childs Nerv Syst. 2023 Nov;39(11):3215-3224. doi: 10.1007/s00381-023-05992-3. Epub 2023 May 23.
A retrospective study, based on a prospectively built database, presents the results of long-term follow-up care of pediatric vagus nerve stimulation (VNS) patients in terms of seizure outcome, surgical aspects, the potential impact of maturation, and medication changes.
From a prospectively built database, 16 VNS patients (median age 12.0 years, range 6.0 to 16.0 years; median seizure duration 6.5 years, range 2.0 to 15.5 years) followed for at least 10 years were graded as non-responder - NR (seizure frequency reduction < 50%), responder - R (reduction ≥ 50% and < 80%), and 80% responder - 80R (reduction ≥ 80%). Data about surgical aspects (battery replacement, system complications), seizure dynamics, and medication changes were taken from the database.
The early percentages of good results (80R + R) were 43.8% (year 1), 50.0% (year 2), and 43.8% (year 3). These percentages remained stable between years 10 and 12 (50% year 10; 46.7% year 11; 50% year 12) and increased in years 16 (60%) and 17 (75%). Depleted batteries were replaced in ten patients, six of whom were either R or 80R. In the four NR, the indication for replacement was improved quality of life. Three patients had VNS explanted or switched off-one had repeated asystolia and two were NR. The effect of hormonal changes in menarche on seizure was not proven. During the study, antiseizure medication was changed in all patients.
The study proved the efficacy and safety of VNS in pediatric patients over an exceptionally long follow-up period. The demand for battery replacements indicates a positive treatment effect.
一项基于前瞻性建立数据库的回顾性研究，展示了小儿迷走神经刺激（VNS）患者在癫痫发作结局、手术方面、成熟度的潜在影响以及药物变化方面的长期随访结果。
从前瞻性建立的数据库中，选取16例接受VNS治疗且随访至少10年的患者（中位年龄12.0岁，范围6.0至16.0岁；中位癫痫发作时长6.5年，范围2.0至15.5年），将其分为无反应者-NR（癫痫发作频率降低<50%）、反应者-R（降低≥50%且<80%）和80%反应者-80R（降低≥80%）。手术方面（电池更换、系统并发症）、癫痫发作动态及药物变化的数据均取自该数据库。
早期良好结果（80R+R）的百分比在第1年为43.8%，第2年为50.0%，第3年为43.8%。这些百分比在第10年至第12年保持稳定（第10年为50%；第11年为46.7%；第12年为50%），并在第16年（60%）和第17年（75%）有所增加。10例患者更换了耗尽的电池，其中6例为R或80R。在4例NR患者中，更换电池的指征是生活质量改善。3例患者的VNS被取出或关闭，1例出现反复心脏停搏，2例为NR。月经初潮时激素变化对癫痫发作的影响未得到证实。在研究期间，所有患者的抗癫痫药物均有改变。
该研究证明了VNS在小儿患者超长随访期内的有效性和安全性。电池更换需求表明治疗效果良好。
