Samanta Debopam
Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
Children (Basel). 2024 Jul 27;11(8):905. doi: 10.3390/children11080905.
Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, and abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) is a widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different seizure types, non-seizure outcomes, and adverse events in this population have not been comprehensively reviewed. To conduct a scoping review on the use of VNS in LGS, a literature search was performed in PubMed, OVID, Web of Science, and Embase from inception to 9 June 2024, using relevant keywords and without restrictions on study design. The search yielded forty eligible studies (twenty-four retrospective cohorts, fourteen prospective cohorts, and two registry analyses) comprising 1400 LGS patients treated with VNS. No randomized controlled trials were identified. Across studies, the median seizure reduction ranged from 20.6% to 65%, with 0% to 100% of patients achieving a ≥50% seizure reduction. No consistent preoperative biomarker of VNS responsiveness was identified in LGS. Although inconsistent among different studies, tonic, atonic, and tonic-clonic seizures responded best, while focal seizures responded worst. Improvements in seizure severity, alertness, and quality of life were reported in some studies, but cognitive and adaptive functioning generally remained unchanged. Adverse events were mostly mild and transient, including hoarseness, cough, and paresthesia. Device-related complications and infections were uncommon. In conclusion, further research is needed to better understand VNS's position in the evolving LGS treatment landscape and its cost effectiveness.
伦诺克斯 - 加斯托综合征（LGS）是一种严重的发育性和癫痫性脑病，其特征为药物难治性癫痫发作、认知障碍和异常脑电图模式。迷走神经刺激（VNS）是一种广泛用于LGS的神经调节疗法，但它对该人群癫痫发作结局、不同癫痫发作类型、非癫痫发作结局及不良事件的影响尚未得到全面综述。为了对VNS在LGS中的应用进行范围综述，我们于2024年6月9日前在PubMed、OVID、科学网和Embase中进行了文献检索，使用相关关键词且对研究设计无限制。检索得到40项符合条件的研究（24项回顾性队列研究、14项前瞻性队列研究和2项注册分析），共纳入1400例接受VNS治疗的LGS患者。未识别到随机对照试验。在各项研究中，癫痫发作减少的中位数范围为20.6%至65%，0%至100%的患者癫痫发作减少≥50%。在LGS中未识别出一致的VNS反应性术前生物标志物。尽管不同研究结果不一致，但强直性、失张力性和强直 - 阵挛性发作反应最佳，而局灶性发作反应最差。一些研究报告了癫痫发作严重程度、警觉性和生活质量有所改善，但认知和适应性功能总体保持不变。不良事件大多轻微且短暂，包括声音嘶哑、咳嗽和感觉异常。与设备相关的并发症和感染并不常见。总之，需要进一步研究以更好地了解VNS在不断发展的LGS治疗格局中的地位及其成本效益。
