Amar A P, Heck C N, Levy M L, Smith T, DeGiorgio C M, Oviedo S, Apuzzo M L
Department of Neurological Surgery, University of Southern California, Los Angeles 90033, USA.
Neurosurgery. 1998 Dec;43(6):1265-76; discussion 1276-80. doi: 10.1097/00006123-199812000-00001.
Intermittent stimulation of the left cervical vagus nerve trunk is emerging as a novel adjunct in the treatment of medically refractory seizures. We sought to evaluate theoretical and practical issues attendant to this concept. We review the anatomic and physiological background arguing for clinical application of vagus nerve stimulation, discuss salient aspects of patient selection and the nuances of surgical technique, and present our observations of and results from application of the method.
Each of 18 patients with medically refractory epilepsy and at least six complex partial or secondarily generalized seizures per month underwent placement of a NeuroCybernetic Prosthesis pulse generator (Cyberonics, Webster, TX) in the chest, connected to helical platinum leads applied to the left cervical vagus nerve trunk. The patients were then randomized in a double-blinded fashion to receive either high (presumably therapeutic) or low (presumably less therapeutic) levels of vagus nerve stimulation. Reduction in seizure frequency, global assessments of quality of life, physiological measurements, and adverse events were recorded during a 3-month period. Patients in the low group were then crossed over to high-stimulation paradigms during a 15-month extension trial.
All operations were successful, uneventful, and without adverse postoperative sequelae. One patient was excluded from analysis because of inadequate seizure calendars. Of the seven patients initially assigned to high stimulation, the mean reduction in seizure frequency was 71% at 3 months and 81% at 18 months. Five (72%) of these patients had a greater than 75% reduction in seizure frequency, and one (14%) remained seizure-free after more than 1.5 years of follow-up. The mean reduction in seizure frequency among the low-stimulation group was only 6% at 3 months. No serious complications, device failures, or physiological perturbations occurred.
In our experience, vagus nerve stimulation has proven to be a safe, feasible, and potentially effective method of reducing seizures in select patient populations. However, the elements of strict definition for the application of the method require further study.
间歇性刺激左侧颈迷走神经干正逐渐成为治疗药物难治性癫痫的一种新型辅助方法。我们试图评估这一概念所涉及的理论和实际问题。我们回顾了支持迷走神经刺激临床应用的解剖学和生理学背景，讨论了患者选择的显著方面和手术技术的细微差别，并介绍了我们对该方法应用的观察结果和结果。
18例药物难治性癫痫患者，每月至少有6次复杂部分性发作或继发性全身性发作，均在胸部植入神经控制假体脉冲发生器（Cyberonics，韦伯斯特，德克萨斯州），并连接到应用于左侧颈迷走神经干的螺旋铂电极。然后，患者以双盲方式随机接受高（可能具有治疗作用）或低（可能治疗作用较小）水平的迷走神经刺激。在3个月期间记录癫痫发作频率的降低、生活质量的总体评估、生理测量和不良事件。低刺激组的患者在为期15个月的延长试验中转换为高刺激模式。
所有手术均成功、顺利，术后无不良后遗症。1例患者因癫痫发作记录不充分而被排除在分析之外。最初分配到高刺激组的7例患者中，癫痫发作频率在3个月时平均降低71%，在18个月时平均降低81%。其中5例（72%）患者的癫痫发作频率降低超过75%，1例（14%）在随访超过1.5年后无癫痫发作。低刺激组在3个月时癫痫发作频率的平均降低仅为6%。未发生严重并发症、设备故障或生理紊乱。
根据我们的经验，迷走神经刺激已被证明是一种安全、可行且可能有效的方法，可减少特定患者群体的癫痫发作。然而，该方法应用的严格定义要素需要进一步研究。
