Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Epilepsy Behav. 2024 Oct;159:109948. doi: 10.1016/j.yebeh.2024.109948. Epub 2024 Aug 2.
Drug-resistant epilepsy (DRE) affects one-third of patients with focal epilepsy. A large portion of patients are not candidates for epilepsy surgery, thus alternative options, such as vagus nerve stimulation (VNS), are proposed. Our objective is to study the effect of vagus nerve stimulation on lesional versus non-lesional epilepsies.
This is a retrospective cohort study in a single center in London, Ontario, which includes patients with DRE implanted with VNS, implanted between 1997-2018 and the date of analysis is December 2023.
Patients implanted with VNS were classified by lesional (VNS-L) and non-lesional (VNS-NL) based on their MRI head findings. We further subdivided the VNS groups into patients with VNS alone versus those who also had additional epilepsy surgeries.
A total of 29 patients were enrolled in the VNS-L, compared to 29 in the VNS-NL. The median age of the patients in the study was 31.8 years, 29.31 % were men (N = 17). 41.4 % (n = 12) of the patients were VNS responders (≥50 % seizure reduction) in the VNS-L group compared to 62.0 % (n = 18) in the VNS-NL group (p = 0.03). When other epilepsy surgeries were combined with VNS in the VNS-L group, the median rate of seizure reduction was greater (72.4 (IQR 97.17-45.88) than the VNS-NL group 53.9 (IQR 92.22-27.92); p = 0.27).
VNS is a therapeutic option for patients with lesional epilepsy, with slightly inferior results compared to patients with non-lesional epilepsy. Patients implanted with VNS showed higher seizure reduction rates if they had previous epilepsy surgeries. This study demonstrates that VNS in lesional epilepsies can be an effective treatment.
耐药性癫痫（DRE）影响三分之一的局灶性癫痫患者。很大一部分患者不适合癫痫手术，因此提出了替代方案，如迷走神经刺激（VNS）。我们的目的是研究迷走神经刺激对病变性和非病变性癫痫的影响。
这是一项在安大略省伦敦的单中心回顾性队列研究，包括 1997 年至 2018 年植入 VNS 的 DRE 患者和分析日期为 2023 年 12 月的患者。
根据 MRI 头部发现，将植入 VNS 的患者分为病变性（VNS-L）和非病变性（VNS-NL）。我们进一步将 VNS 组细分为仅接受 VNS 治疗的患者和还接受其他癫痫手术的患者。
共纳入 29 例 VNS-L 患者和 29 例 VNS-NL 患者。研究患者的中位年龄为 31.8 岁，29.31%为男性（N=17）。VNS-L 组中 41.4%（n=12）的患者为 VNS 应答者（癫痫发作减少≥50%），而 VNS-NL 组中 62.0%（n=18）的患者为 VNS 应答者（p=0.03）。当在 VNS-L 组中结合其他癫痫手术时，中位癫痫发作减少率更高（72.4（IQR 97.17-45.88）比 VNS-NL 组的 53.9（IQR 92.22-27.92）；p=0.27）。
VNS 是病变性癫痫患者的一种治疗选择，其结果略逊于非病变性癫痫患者。植入 VNS 的患者如果之前进行过癫痫手术，其癫痫发作减少率更高。本研究表明，VNS 在病变性癫痫中的应用是一种有效的治疗方法。
