Department of Neurology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
Epilepsy Res. 2024 Jul;203:107383. doi: 10.1016/j.eplepsyres.2024.107383. Epub 2024 May 21.
The aim of this single-centre, retrospective, observational study was to evaluate long-term effectiveness of vagus nerve stimulation (VNS) in drug-resistant epilepsy (DRE) by using retention rate as a surrogate measure for seizure reduction. We included all patients with DRE, treated at the adult neurology department of the University Hospitals Leuven and who started VNS therapy from January 1, 1994, until May 1, 2021, with follow-up data cutoff on January 1, 2023. Retention rate of VNS was defined as the percentage of patients who maintain VNS at established time points. We estimated cumulative retention rate and battery replacement rate and correlated these with seizure reduction, using Kaplan-Meier analysis. Statistical analysis of potential predictors of VNS outcome (age, sex and epilepsy duration at implantation) was performed using mono- and multivariate analyses. VNS was started in 110 patients with DRE, with a mean follow-up of 8.7 years (SD 6.5). VNS was discontinued in 55 patients (50%), with ineffectiveness as the main reason for discontinuation (98%). The battery was replaced at least once in 42 patients (38%). Estimated retention rates were 70%, 52%, 45% and 33% after 5, 10, 15 and 20 years, respectively. Estimated first battery replacement rates were 16%, 42% and 47% after 5, 10 and 15 years, respectively. Both estimates showed a statistically significant correlation with seizure reduction. No independent predictors of long-term outcome of VNS were found. This is the first long-term study using retention rate of VNS to assess effectiveness. VNS is a well-tolerated therapy, but retention rates decline with long follow-up.
这项单中心、回顾性、观察性研究的目的是通过保留率作为衡量减少癫痫发作的替代指标，评估迷走神经刺激（VNS）在耐药性癫痫（DRE）中的长期疗效。我们纳入了所有在鲁汶大学附属医院成人神经科接受治疗的 DRE 患者，并于 1994 年 1 月 1 日至 2021 年 5 月 1 日开始接受 VNS 治疗，随访数据截止到 2023 年 1 月 1 日。VNS 的保留率定义为在既定时间点保留 VNS 的患者比例。我们使用 Kaplan-Meier 分析来估计累积保留率和电池更换率，并将其与癫痫发作减少相关联。使用单变量和多变量分析来分析 VNS 结果（年龄、性别和植入时癫痫持续时间）的潜在预测因素。110 例 DRE 患者开始接受 VNS 治疗，平均随访 8.7 年（标准差 6.5 年）。55 例患者（50%）停止了 VNS 治疗，主要原因是无效（98%）。42 例患者（38%）至少更换过一次电池。分别估计 5、10、15 和 20 年后的保留率为 70%、52%、45%和 33%。估计首次更换电池的比例分别为 16%、42%和 47%，分别在 5、10 和 15 年后。这两个估计都与癫痫发作减少呈显著相关。未发现 VNS 长期疗效的独立预测因素。这是首次使用 VNS 的保留率来评估疗效的长期研究。VNS 是一种耐受良好的治疗方法，但随着随访时间的延长，保留率会下降。
