Liu Tinghong, Li Zheng, Xu Jinshan, Wang Lijuan, Chen Chunhong, Zhai Feng, Ji Jian, Wang Yangshuo, Chen Feng, Yu Bowen, Wang Quan, Liang Shuli
Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China.
Pediatric Intensive Care Unit, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Neurotherapeutics. 2025 Apr;22(3):e00551. doi: 10.1016/j.neurot.2025.e00551. Epub 2025 Feb 25.
In the acute phase of Febrile infection-related epilepsy syndrome (FIRES), super-refractory status epilepticus (SE) is a common clinical symptom. This research aimed to study effectiveness of vagus nerve stimulation (VNS) and explore a rapid parameter programming protocol suitable for VNS in patients with the acute phase of FIRES-related super-refractory SE. The children with acute phase of FIRES-related prolonged super-refractory SE in ICU were enrolled and divided into VNS and control group based on whether the patient underwent VNS. A standardized rapid programming protocol of stimulation parameters was used in patients with VNS. The patients' demographic data, treatments method, time of SE termination, percentage of seizure freedom, mortality, activities of daily living, and Glasgow Outcome Scale (GOS) were collected and analyzed. Sixty patients were enrolled, and 30 in VNS group underwent VNS with rapid parameter programming protocol. A significant difference was found in their duration of SE after enrollment between groups. VNS was the exclusive influence factor for post-enrollment mortality of all patients and seizure freedom in surviving patients. Patients without VNS presented a significantly higher probability of death (HR = 3.46) and recurrent seizures (HR = 7.75) compared to those with VNS. A significant difference was also observed in the percentage of patients with ADL scores >60 between the two groups at follow-up. No obvious complication was reported for the surgery of VNS and during the electrical stimulation process. VNS with rapid parameters programming protocol was a safe approach for treating super-refractory SE in the acute phase of FIRES. It can significantly reduced the duration of SE, mortality, and recurrent seizure.
在发热感染相关癫痫综合征（FIRES）的急性期，超难治性癫痫持续状态（SE）是一种常见的临床症状。本研究旨在探讨迷走神经刺激（VNS）的有效性，并探索一种适用于FIRES相关超难治性SE急性期患者的VNS快速参数编程方案。纳入重症监护病房（ICU）中处于FIRES相关长时间超难治性SE急性期的儿童，并根据患者是否接受VNS分为VNS组和对照组。对接受VNS的患者采用标准化的刺激参数快速编程方案。收集并分析患者的人口统计学数据、治疗方法、SE终止时间、无癫痫发作百分比、死亡率、日常生活活动能力以及格拉斯哥预后量表（GOS）。共纳入60例患者，其中30例VNS组患者采用快速参数编程方案进行VNS治疗。两组患者入组后SE持续时间存在显著差异。VNS是所有患者入组后死亡率和存活患者无癫痫发作的唯一影响因素。与接受VNS的患者相比，未接受VNS的患者死亡概率（HR = 3.46）和癫痫复发概率（HR = 7.75）显著更高。随访时两组间日常生活活动能力（ADL）评分>60分的患者百分比也存在显著差异。VNS手术及电刺激过程中未报告明显并发症。采用快速参数编程方案的VNS是治疗FIRES急性期超难治性SE的一种安全方法。它可显著缩短SE持续时间、降低死亡率和癫痫复发率。
