Dai Yihai, Jean Stéphane, Tagu Panashe Tevin, Qian Zhe, Liu Weihong, Xu Yuming, Wang Tangfei, Lin Zewei, Chen Weitao, Song Shiwei
Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Pediatric Epilepsy Center, Fujian Medical University Fuzhou Children's Hospital, Fuzhou 350001, China.
Epilepsy Behav. 2025 Oct;171:110591. doi: 10.1016/j.yebeh.2025.110591. Epub 2025 Jul 15.
The aim of this study was to prospectively investigate the efficacy of transcutaneous vagus nerve stimulation (t-VNS) in drug-resistant epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS) pediatric patients.
We prospectively reviewed 11 drug-resistant epilepsy pediatric patients who underwent a 3-month t-VNS. We used a weighted phase lag index (wPLI) measure to assess the change in connectivity measures that quantify electroencephalogram (EEG) synchronization before and after stimulation. We measured the change in non-rapid eye movement (NREM) and seizure frequency following t-VNS, and cognitive functions were assessed before and after stimulation using the Chinese Wechsler Intelligence Scale for Children (C-WISC) and the Chinese Wechsler Preschool and Primary Scale of Intelligence (C-WPPSI).
Our results show that 63.63% of EE-SWAS patients were responders to the 3- month t-VNS, with 4 being seizure-free, and resulted in a reduction of NREM, seizure frequency, and coupling strength. More specifically, there was a significant decrease in coupling strength in the frontal-occipital and central-occipital regions in the theta band; frontal-parietal, central-parietal, parietal, parietal-occipital, parietal-temporal, occipital-temporal, and temporal regions in the alpha band; and lastly, frontal-occipital, central-parietal, parietal-occipital, and occipital-temporal regions in the beta band. There were no statistically significant changes in total intelligence before and after t-VNS.
This study presents evidence that t-VNS is a safe and effective non-invasive treatment for refractory EE-SWAS. Despite the relatively short stimulation period, t-VNS resulted in a decrease in NREM, seizure frequency, and in an alteration in brain functional connectivity strength. Future studies with a larger cohort and longer stimulation duration may be necessary to substantiate our findings.
本研究旨在前瞻性地调查经皮迷走神经刺激（t-VNS）对睡眠期棘波激活型耐药性癫痫性脑病（EE-SWAS）儿科患者的疗效。
我们前瞻性地回顾了11例接受了3个月t-VNS治疗的耐药性癫痫儿科患者。我们使用加权相位滞后指数（wPLI）测量来评估刺激前后量化脑电图（EEG）同步性的连接性测量指标的变化。我们测量了t-VNS后非快速眼动（NREM）和癫痫发作频率的变化，并使用中国韦氏儿童智力量表（C-WISC）和中国韦氏学前及初小儿童智力量表（C-WPPSI）在刺激前后评估认知功能。
我们的结果表明，63.63%的EE-SWAS患者对3个月的t-VNS治疗有反应，其中4例无癫痫发作，并且导致NREM、癫痫发作频率和耦合强度降低。更具体地说，θ频段的额枕和中央枕区、α频段的额顶、中央顶、顶叶、顶枕、顶颞、枕颞和颞区以及β频段的额枕、中央顶、顶枕和枕颞区的耦合强度显著降低。t-VNS前后总智力无统计学显著变化。
本研究提供了证据表明t-VNS是一种安全有效的难治性EE-SWAS非侵入性治疗方法。尽管刺激期相对较短，但t-VNS导致NREM、癫痫发作频率降低以及脑功能连接强度改变。未来可能需要进行更大样本量和更长刺激持续时间的研究来证实我们的发现。
