Iimura Yasushi, Suzuki Hiroharu, Mitsuhashi Takumi, Ueda Tetsuya, Nishioka Kazuki, Horikoshi Kou, Nomura Kazuki, Sugano Hidenori, Kondo Akihide
Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Epilepsy Center, Juntendo University Hospital, Tokyo, Japan.
Front Neurol. 2023 Sep 15;14:1258854. doi: 10.3389/fneur.2023.1258854. eCollection 2023.
Vagus nerve stimulation (VNS) is a palliative surgery for drug-resistant epilepsy. The two objectives of this study were to (1) determine the seizure type most responsive to VNS and (2) investigate the preventive effect on status epilepticus (SE) recurrence.
We retrospectively reviewed 136 patients with drug-resistant epilepsy who underwent VNS implantation. We examined seizure outcomes at 6, 12, and 24 months following implantation of VNS as well as at the last visit to the Juntendo Epilepsy Center. Univariate analysis and multivariate logistic regression models were used to estimate the prognostic factors.
125 patients were followed up for at least 1 year after VNS implantation. The percentage of patients with at least a 50% reduction in seizure frequency compared with prior to VNS implantation increased over time at 6, 12, and 24 months after VNS implantation: 28, 41, and 52%, respectively. Regarding overall seizure outcomes, 70 (56%) patients responded to VNS. Of the 40 patients with a history of SE prior to VNS implantation, 27 (67%) showed no recurrence of SE. The duration of epilepsy, history of SE prior to VNS implantation and seizure type were correlated with seizure outcomes after VNS implantation in univariate analysis ( = 0.05, < 0.01, and = 0.03, respectively). In multivariate logistic regression analysis, generalized seizure was associated with VNS response [odds ratio (OR): 4.18, 95% CI: 1.13-15.5, = 0.03]. A history of SE prior to VNS implantation was associated with VNS non-responders [(OR): 0.221, 95% CI: 0.097-0.503, < 0.01]. The duration of epilepsy, focal to bilateral tonic-clonic seizure and epileptic spasms were not significantly associated with VNS responders ( = 0.07, = 0.71, and = 0.11, respectively).
Following 125 patients with drug-resistant epilepsy for an average of 69 months, 56% showed at least 50% reduction in seizure frequency after VNS implantation. This study suggests that generalized seizure is the most responsive to VNS, and that VNS may reduce the risk of recurrence of SE. VNS was shown to be effective against generalized seizure and also may potentially influence the risk of further events of SE, two marker of disease treatment that can lead to improved quality of life.
迷走神经刺激术（VNS）是一种用于治疗药物难治性癫痫的姑息性手术。本研究的两个目的是：（1）确定对VNS反应最敏感的癫痫发作类型；（2）研究其对癫痫持续状态（SE）复发的预防作用。
我们回顾性分析了136例行VNS植入术的药物难治性癫痫患者。我们观察了VNS植入后6、12和24个月以及最后一次到顺天堂癫痫中心就诊时的癫痫发作情况。采用单因素分析和多因素逻辑回归模型评估预后因素。
125例患者在VNS植入后至少随访1年。与VNS植入前相比，癫痫发作频率至少降低50%的患者比例在VNS植入后6、12和24个月时随时间增加，分别为28%、41%和52%。关于总体癫痫发作结果，70例（56%）患者对VNS有反应。在VNS植入前有SE病史的40例患者中，27例（67%）未出现SE复发。在单因素分析中，癫痫病程、VNS植入前的SE病史和癫痫发作类型与VNS植入后的癫痫发作结果相关（分别为P = 0.05、P < 0.01和P = 0.03）。在多因素逻辑回归分析中，全身性发作与VNS反应相关[比值比（OR）：4.18，95%可信区间（CI）：1.13 - 15.5，P = 0.03]。VNS植入前有SE病史与VNS无反应者相关[（OR）：0.221，95%CI：0.097 - 0.503，P < 0.01]。癫痫病程、局灶性至双侧强直阵挛发作和癫痫痉挛与VNS反应者无显著相关性（分别为P = 0.07、P = 0.71和P = 0.11）。
对125例药物难治性癫痫患者平均随访69个月后，56%的患者在VNS植入后癫痫发作频率至少降低50%。本研究表明全身性发作对VNS反应最敏感，且VNS可能降低SE复发的风险。VNS被证明对全身性发作有效，还可能潜在影响SE进一步发作的风险，这两个疾病治疗指标可改善生活质量。
