Gill Sonia, Devlin Kathryn N, Yuan Hsiangkuo, Mintzer Scott, Skidmore Christopher, Wu Chengyuan, Sperling Michael R, Nei Maromi
Jefferson Comprehensive Epilepsy Center (SG, SM, CS, MRS, MN), Department of Neurology, Thomas Jefferson University Hospital; Department of Psychological and Brain Sciences (KND), Drexel University; Jefferson Headache Center (HY), Department of Neurology, Thomas Jefferson University Hospital; Department of Neurosurgery (CW), Thomas Jefferson University Hospital, Philadelphia, PA; and Inova Medical Group - Neurology (SG), Fairfax, VA.
Neurol Clin Pract. 2024 Dec;14(6):e200358. doi: 10.1212/CPJ.0000000000200358. Epub 2024 Aug 16.
To compare long-term seizure control in patients with long-term VNS (vagal nerve stimulator) stimulation (VNS-on) with those who discontinued VNS after >3 years (VNS-off).
Patients with refractory epilepsy with VNS therapy for >3 years (and follow-up for >2 years after VNS discontinuation for VNS-off patients) were included. Patients with brain surgery <3 years after VNS were excluded. We compared the percentage of patients with ≥50% seizure reduction (50% responder rate) and change in seizure frequency within and between groups in follow-up.
Thirty-three VNS-on and 16 VNS-off patients were evaluated. VNS-on patients underwent stimulation for 9.7 years (mean). VNS-off patients had VNS treatment for 6.5 years (mean), discontinued treatment, then had additional 8.0 years (mean) follow-up. 50% responder rates were similar between groups (VNS-on: 54.5% vs VNS-off at last-on: 37.5%, = 0.26; vs VNS-off at the last follow-up: 62.5%, = 0.60). VNS-on patients had a significant reduction in seizure frequency at the last follow-up compared with baseline (median [Mdn] = -4.5 seizures/month, interquartile range [IQR] = 14.0, 56% reduction, = 0.013). VNS-off patients also showed significant seizure reduction while still continuing VNS therapy (Mdn = -1.0 seizures/month, IQR = 13.0, 35% reduction, = 0.020) and, after discontinuing therapy, at the last follow-up compared with baseline (Mdn = -3.2, IQR = 11.0, 52% reduction, = 0.020). The 2 groups were comparable in seizure frequency change both at the last-on visit (absolute change, = 0.62; relative change, = 0.50) at the last follow-up (absolute change, = 0.67; relative change, = 0.76).
Patients who discontinued VNS therapy and those who continued therapy had similar response during active treatment and similar long-term outcomes, suggesting that factors such as the natural disease course and/or medication treatment strongly affect long-term outcomes.
比较长期接受迷走神经刺激器（VNS）刺激（VNS开启）的患者与VNS治疗超过3年后停用VNS（VNS关闭）的患者的长期癫痫控制情况。
纳入接受VNS治疗超过3年（VNS关闭的患者在VNS停用后随访超过2年）的难治性癫痫患者。排除VNS治疗后3年内接受脑部手术的患者。我们比较了随访期间两组内及两组间癫痫发作减少≥50%（50%缓解率）的患者百分比以及癫痫发作频率的变化。
评估了33例VNS开启患者和16例VNS关闭患者。VNS开启患者平均接受刺激9.7年。VNS关闭患者平均接受VNS治疗6.5年，然后停止治疗，随后平均随访8.0年。两组的50%缓解率相似（VNS开启组：54.5%，最后一次开启时VNS关闭组：37.5%，P = 0.26；最后一次随访时VNS关闭组：62.5%，P = 0.60）。与基线相比，VNS开启患者在最后一次随访时癫痫发作频率显著降低（中位数[Mdn]= -4.5次/月，四分位数间距[IQR]= 14.0，降低56%，P = 0.013）。VNS关闭患者在仍继续VNS治疗时癫痫发作也显著减少（Mdn = -1.0次/月，IQR = 13.0，降低35%，P = 0.020），并且在停止治疗后，与基线相比在最后一次随访时（Mdn = -3.2，IQR = 11.0，降低52%，P = 0.020）。两组在最后一次开启就诊时（绝对变化，P = 0.62；相对变化，P = 0.50）以及最后一次随访时（绝对变化，P = 0.67；相对变化，P = 0.76）的癫痫发作频率变化具有可比性。
停用VNS治疗的患者和继续治疗的患者在积极治疗期间反应相似，长期预后也相似，这表明自然病程和/或药物治疗等因素对长期预后有强烈影响。
