Pichardo-Rojas Diego, Camarena-Rubio Karen Janely, Gómez-Oropeza Irene, Macias-López Jonathan Ulises, Valenzuela-Rangel Alder Fernando, Flores-Patiño Brandon, Castelo-Pablos María Fernanda, Bravo-Osorno Valeria Isabel, Quiñones Manuel Alejandro Del Río, Vanegas Laura Hernández, Mejía-Pérez Sonia Iliana, Paredes-Aragón Elma
Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Ciudad de México, Mexico.
Universidad Autónoma de Baja California, Mexicali, Baja California, Mexico.
Epileptic Disord. 2025 Jun 20. doi: 10.1002/epd2.70053.
Super Refractory Status Epilepticus (SRSE) is a neurological emergency characterized by a status epilepticus that persists or recurs despite 24 h of treatment with anesthetic therapy (A-T). Vagus Nerve Stimulation (VNS) is a well-established treatment for drug-resistant epilepsy (DRE). In this study, we explore the safety and efficacy of VNS for SRSE. A database search was conducted until August 14, 2024 to identify patients who were implanted with a VNS as a surgical neuromodulation therapy for SRSE. We report on the etiology of SRSE, previous DRE diagnosis, VNS parameters required for SRSE resolution, and long-term outcomes. Out of 257 screened studies, 24 met inclusion criteria, encompassing 30 published cases. Alongside 3 institutional cases, our study analyzed 33 patients. VNS was associated with SRSE resolution in 29/33 patients (87.87%). Median age at surgery was 15 years (range: neonate to 67 years). Seventeen had prior DRE diagnoses. Days on A-T before implantation ranged from 5 to 420 (median 25, IQR 12-42.5). Median VNS output for resolution was 1.375 milliamperes (mA) (IQR = 1-1.75), with 1 mA being the most common setting (11/30, 36.6%). Median time to reach therapeutic VNS parameters was 2 days (IQR = 1.25-7.75). SRSE resolved at a median of 7 days post-op 7 (IQR: 4.75-14). At follow-up of DRE patients, McHugh scores were as follows: 1 (8/15, 53.3%), 2 (4/15, 26.6%), 3 (1/15, 6.6%), and 5 (2/15, 13.3%). VNS was associated with SRSE resolution in 87.87% of cases. Based on available observational data, VNS may be considered for SRSE after 2 weeks of treatment nonresponse. Proposed titration strategies to reach ≥1 mA include immediate (within 20 min post-op), rapid (within 24-36 h), and accelerated (within 2 weeks). Titration should be individualized based on SRSE duration and patient tolerance. Further studies are needed to define the role of VNS in SRSE.
超难治性癫痫持续状态（SRSE）是一种神经系统急症，其特征为尽管接受了24小时的麻醉治疗（A-T），癫痫持续状态仍持续或复发。迷走神经刺激（VNS）是一种成熟的耐药性癫痫（DRE）治疗方法。在本研究中，我们探讨了VNS治疗SRSE的安全性和有效性。进行数据库检索至2024年8月14日，以确定接受VNS植入作为SRSE手术神经调节治疗的患者。我们报告了SRSE的病因、先前的DRE诊断、SRSE缓解所需的VNS参数以及长期预后。在257项筛选研究中，24项符合纳入标准，涵盖30例已发表病例。连同3例机构病例，我们的研究分析了33例患者。33例患者中有29例（87.87%）的SRSE通过VNS得到缓解。手术时的中位年龄为15岁（范围：新生儿至67岁）。17例患者先前有DRE诊断。植入前接受A-T治疗的天数为5至420天（中位值25天，四分位距12 - 42.5天）。缓解所需的中位VNS输出为1.375毫安（mA）（四分位距 = 1 - 1.75），1 mA是最常见的设置（30例中的11例，36.6%）。达到治疗性VNS参数的中位时间为2天（四分位距 = 1.25 - 7.75）。SRSE在术后中位7天（四分位距：4.75 - 14天）得到缓解。在对DRE患者的随访中，麦克休评分如下：1分（15例中的8例，53.3%）、2分（15例中的4例，26.6%）、3分（15例中的1例，6.6%）和5分（15例中的2例，13.3%）。87.87%的病例中VNS与SRSE缓解相关。基于现有观察数据，在治疗2周无反应后，可考虑对SRSE患者使用VNS。建议的达到≥1 mA的滴定策略包括立即（术后20分钟内）、快速（24 - 36小时内）和加速（2周内）。滴定应根据SRSE持续时间和患者耐受性进行个体化调整。需要进一步研究来确定VNS在SRSE中的作用。
