迷走神经刺激术治疗儿童脑炎后药物难治性癫痫的疗效分析

摘要

目的 评价迷走神经刺激术对脑炎后药物难治性癫痫患儿的症状控制情况、术后认知、记忆功能及生活质量改善情况.方法 本研究采用单中心、回顾性研究方法,选择2008年1月至2016年12月在首都医科大学三博脑科医院行迷走神经刺激器植入术的脑炎后癫痫患儿.对术前,术后6个月、1年及以后每年的随诊复查进行评估,评估内容包括患儿的认知功能、社会功能及术后癫痫发作分级.结果 共有43例患儿完成了随访,其中男24例,女19例;年龄(9.37 ± 4.18)岁;随访时间(43.90 ± 33.04)个月.Engel分级:Ⅰ级3例(7.0%),Ⅱ级3例(7.0%),Ⅲ级14例(32.6%),Ⅳ级21例(48.8%).McHugh分级:Ⅰ级8例(18. 6%),Ⅱ级12例(28.0%),Ⅲ级11例(25.5%),Ⅳ级6例(14.0%),Ⅴ级4例(9.3%).患儿术后语言方面:显著改善3例(7.0%)、略有改善17例(39.6%);人际交往方面:显著提高7例(16.4%)、略有提高16例(37. 2%);学习/工作能力方面:显著提高6例(14.0%)、略有提高14例(32.6%).术后的言语智商较术前提高了(6.21 ± 5.02)分,操作智商较术前提高了(7.28 ± 6.10)分,总智商较术前提高(2.93 ± 3.74)分,记忆较术前提高了(4. 81 ± 2.98)分.结论 迷走神经刺激术可有效控制脑炎后药物难治性癫痫患儿临床发作,改善患儿的认知功能及远期预后,提高患儿的生活质量.%Objective To evaluate the effect of vagus nerve stimulation (VNS)on post－encephalitic intrac-table epilepsy and the improvement of postoperative cognitive function and quality of life.Methods The patients with post－encephalitic epilepsy in Sanbo Brain Hospital,Capital Medical University from January 2008 to December 2016 were selected.A single center and retrospective study method was used to evaluate the cognitive function,social function of preoperative and postoperative and postoperative seizure classification.The follow－up time points included preopera-tive,posto-perative in 6 months,1 year after operation and postoperative annual review.Results A total of 43 patients were followed up,including 19 females and 24 males,with an average age of (9.37 ± 4.18)years old.The time of fol-low－up was (43.90 ± 33.04)months.According to Engel classification:GradeⅠ3 cases (7.0%),gradeⅡ3 ca-ses (7. 0%),grade Ⅲ14 cases (32.6%),grade Ⅳ21 cases (48.8%).According to McHugh classification:GradeⅠ8 cases (18.6%),grade Ⅱ12 cases (28%),gradeⅢ11 cases (25.5%),gradeⅣ6 cases (14.0%),gradeⅤ4 cases (9.3%).Speech improvement of postoperative:significant improvement in 3 cases (7.0%),slightly improved in 17 cases (39.6%);interpersonal communication improvement of postoperative:significantly increased 7 cases (16. 4%), slightly improved 16 cases(37.2%);learning/working ability improvement of postoperative:significantly improved 6 cases (14. 0%),slightly increased 14 cases(32. 6%).The postoperative VIQ (6.21 ±5.02)scores,PIQ (7.28 ±6.10)scores,FIQ (2.93 ±3.74)scores and MQ were (4.81 ± 2.98)scores higher than preoperative.Conclusions VNS can effectively im-prove the seizures of post－encephalitic epilepsy as well as the children's quality of life,cognition and social function.