摘要：
目的 评价植入式迷走神经刺激治疗难治性癫痫的安全性和有效性.方法 于2012-2015年选取符合标准的难治性癫痫患者,完善术前评估和基线信息采集,在首都医科大学宣武医院功能神经外科行植入式迷走神经刺激术,由神经内科医师进行随访及刺激参数调整.在术后1个月、3个月、6个月、1年、2年及3年时进行随访,内容包括发作情况(发作表现、发作频率、发作持续时间、先兆、诱因等)、脑电图结果、药物及刺激参数的调整情况.评价指标为平均发作减少率、治疗有效率、癫痫样放电数量的减少率等,记录不良反应.结果 本研究共纳入患者33例,平均年龄17.79岁.随访期间,患者的平均发作减少率为33％.在术后1个月、3个月、6个月、1年、2年及3年时,平均发作减少率分别为11.9％、17.3％、35.5％、38.1％、45.4％及50.0％,治疗有效率分别为18.2％(6/33)、27.3％(9/33)、41.4％(12/29)、38.5％(10/26)、7/18及10/17.脑电图上癫痫样放电数量的平均减少率在术后6个月为0.4％,术后1年为13.0％,其中癫痫样放电数量减少率大于50％的患者比例从术后6个月的15.3％增加至术后1年的23.1％.结论 植入式迷走神经刺激治疗难治性癫痫具有安全性和有效性,随着治疗时间的推移,治疗有效率及平均发作减少率逐渐增加,脑电图上癫痫样放电数量逐渐减少,其疗效有时间累积效应.%Objective To identify the efficacy and safety of implant vagus nerve stimulation (IVNS) for intractable epilepsy.Methods Eligible patients with intractable epilepsy during 2012-2015 were enrolled,and the information of preoperative evaluation was collected as baseline.During IVNS therapy,the process of seizures,the epileptic discharges of electroencephalogram (EEG),the complications and the changes of antiepileptic drugs or device parameters were recorded.The responder rate,the mean seizure reduction and the change of epileptic discharges were chosen as the indictors.Results Efficacy analyses were done in 33 patients,and the average age of these patients was 17.79 years.Seizure control improved over time with mean seizure reduction of 11.9％,17.3％,35.5％,38.1％,45.4％ and 50.0％,and responder rates of 18.2％(6/33),27.3％(9/33),41.4％(12/29),38.5％(10/26),7/18,and 10/17 at 1,3,6,12,24,36 months of IVNS therapy,respectively.In addition,the mean epileptic discharge reduction in EEG was 0.4％ and 13.0％,while the rate of patients who had epileptic discharge reduction of ≥50％ was 15.3％ and 23.1％ at 6,12 months of IVNS therapy,respectively.Conclusions IVNS is effective and safe.Furthermore,the efficacy of IVNS is time-dependent.
