迷走神经刺激治疗儿童难治性癫痫的初步疗效分析

摘要

Objective Implant vagus nerve stimulation is considered as an adjunctive treatment for intractable epilepsy where patients are not suitable for resective surgery.This research is designed to identify the safety and efficacy of vagus nerve stimulation in children intractable epilepsy,and analyze the effects on different epilepsy syndromes.Methods Eligible children with intractable epilepsy were recruited in the research,and we collected data from pre-operative assessments as the baseline.During the follow-up time,we recorded the process of seizures (frequency,duration,and seizure type),the changes of drugs or parameters,the complications and so on.In the research we had chosen the mean reduction rate of seizures,response rate,and McHugh scale as the indictors.Results A total of 32 patients were implanted with vagus nerve stimulators,and the average age was 6.6 years.In the follow-up time of post-operative 1 month,3 months,6 months,9 months and 12 months,the average reduction rate was 8.79％,50.85％,40.67％,56.54％,and 66.62％,while the response rate was 21.87％,62.50％,57.14％,69.23％ and 77.78％.In addition,IVNS had different effects on epilepsy syndromes,the reduction rate of WEST syndmme was increased from 37.64％ (post-operative 1 m) to 83.33％ (post-operative 12 m),and the Lennox-Gastuat syndrome'reduction rate was improved from 27.42％ to 55.10％ in 6 months.Conclusion Vagus nerve stimulation is safe and effective in children intractable epilepsy,and the seizure reduction occurs in a time-dependent manner.Moreover,WEST syndrome and LG syndrome may get the most benefits from IVNS.%目的 植入式迷走神经刺激(IVNS)是治疗难治性癫痫的重要辅助治疗手段之一,其有效性和安全性已经得到广泛认可.但目前国内外关于IVNS治疗儿童难治性癫痫(尤其是低龄儿童)的疗效分析相对少见,本研究旨在明确IVNS治疗儿童难治性癫痫是否安全有效,并分析探讨IVNS对不同癫痫综合征的具体疗效.方法 选取符合入组条件的患儿为研究对象,搜集基线信息,记录IVNS术前术后的发作情况(发作频率、发作持续时间、发作后状态、发作类型等)、药物和刺激参数的调整、不良事件等,以平均发作减少率、有效率及McHugh分级为评价指标,评估IVNS的疗效.结果 研究中共纳入2015年3月至2016年6月在我院连续接受IVNS治疗的难治性癫痫患儿32名,术后1个月、3个月、6个月、9个月及12个月时的平均发作减少率分别为8.79％、50.85％、40.67％、56.54％及66.62％,有效率分别为21.87％、62.50％、57.14％、69.23％、77.78％.对不同癫痫综合征,IVNS也有不同的疗效,其中WEST综合征的平均发作减少率从术后1个月的37.64％逐渐增加至术后12个月的83.3％,Lennox-Gatuat (LG)综合征的平均发作减少率从术后1个月的27.42％逐渐增加至术后6个月的55.10％.结论 迷走神经刺激治疗儿童难治性癫痫具有安全和有效性,且有时间累积效应.此外,WEST综合征和LG综合症对IVNS治疗的反应较好.