Pires do Prado Henrique Jannuzzelli, Pinto Lécio Figueira, Bezerra Daniela Fontes, de Paola Luciano, Arruda Francisco, de Oliveira Andrea Julião, Romão Tayla Taynan, Lessa Vanessa Cristina Colares, Silva Jonadab Dos Santos, D'Andrea-Meira Isabella
Department of Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
Postgraduate Program in Neurology/Neurosciences, Universidade Federal Fluminense, Niterói, Brazil.
Front Neurosci. 2023 Jul 27;17:1210221. doi: 10.3389/fnins.2023.1210221. eCollection 2023.
Vagus nerve stimulation (VNS) therapy is an established treatment for patients with drug-resistant epilepsy that reduces seizure frequency by at least 50% in approximately half of patients; however, the characteristics of the patients with the best response have not yet been identified. Thus, it is important to identify the profile of patients who would have the best response to guide early indications and better patient selection.
This retrospective study evaluated vagus nerve stimulation (VNS) as an adjuvant therapy for patients with drug-resistant epilepsy from six epilepsy centers in Brazil. Data from 192 patients aged 2-66 years were analyzed, and all patients received at least 6 months of therapy to be included.
Included patients were aged 2-66 years (25.6 ± 14.3), 105 (54.7%) males and 87 (45.8%) females. Median follow-up interval was 5 years (range, 2005-2018). Overall, the response rate (≥50% seizure reduction) after VNS implantation was 65.6% (126/192 patients). Most patients had 50-90% seizure reduction (60.9%) and nine patients became seizure-free. There were no serious complications associated with VNS implantation. The rate of a ≥ 50% seizure reduction response was significantly higher in patients with no history of neurosurgery. The presence of focal without generalized seizures and focal discharges on interictal EEG was associated with better response. Overall, etiological predictors of a better VNS response profile were tumors while a worse response to VNS was related to the presence of vascular malformations and Lennox-Gastaut Syndrome.
We observed an association between a better response to VNS therapy no history of neurosurgery, focal interictal epileptiform activity, and focal seizure pattern. Additionally, it is important to highlight that age was not a determinant factor of the response, as children and adults had similar response rates. Thus, VNS therapy should be considered in both adults and children with DRE.
迷走神经刺激（VNS）疗法是治疗耐药性癫痫患者的一种既定疗法，约半数患者的癫痫发作频率可降低至少50%；然而，尚未确定反应最佳患者的特征。因此，确定对VNS反应最佳的患者特征对于指导早期适应症和更好地选择患者很重要。
这项回顾性研究评估了迷走神经刺激（VNS）作为巴西六个癫痫中心耐药性癫痫患者辅助治疗的效果。分析了192例年龄在2至66岁之间患者的数据，所有患者均接受了至少6个月的治疗才被纳入研究。
纳入患者年龄在2至66岁之间（25.6±14.3），男性105例（54.7%），女性87例（45.8%）。中位随访时间为5年（范围：2005年至2018年）。总体而言，VNS植入后的反应率（癫痫发作减少≥50%）为65.6%（192例患者中的126例）。大多数患者癫痫发作减少50%至90%（60.9%），9例患者癫痫发作停止。VNS植入未出现严重并发症。无神经外科手术史的患者癫痫发作减少≥50%的反应率显著更高。发作间期脑电图显示局灶性而非全身性发作以及局灶性放电与更好的反应相关。总体而言，VNS反应较好的病因预测因素是肿瘤，而对VNS反应较差与血管畸形和Lennox-Gastaut综合征的存在有关。
我们观察到对VNS治疗反应较好与无神经外科手术史、发作间期局灶性癫痫样活动和局灶性发作模式之间存在关联。此外，重要的是要强调年龄不是反应的决定因素，因为儿童和成人的反应率相似。因此，对于耐药性癫痫的成人和儿童患者均应考虑VNS治疗。
