迷走神经刺激术对药物难治性癫痫病人胃肠道功能的影响

目的 探讨迷走神经刺激术（VNS）对药物难治性癫痫病人胃肠道功能的影响。方法 回顾性分析2014年3月至2017年11月VNS治疗的13例药物难治性癫痫的临床资料。术前及术后3、6、12个月以胃肠道症状评定量表（GSRS）评分评估胃肠道功能。结果 术后12个月，13 例发作频率平均减少50.9%，6例发作频率减少≥50%，7 例发作频率减少<50%。术后3、6、12个月，GSRS评分分别为（5.08±1.64）、（4.54±1.34）、（3.77±0.97），较术前[（5.85±1.92）]均显著改善（P<0.05）。GSRS评分与癫痫发作减少无显著相关性（r=0.02，P>0.05）。结论 VNS能够改善药物难治性癫痫病人的胃肠道症状，但与癫痫控制水平无相关性。     

国产迷走神经刺激器治疗药物难治性癫痫的疗效分析(附11例报告)

目的探讨国产迷走神经刺激器治疗药物难治性癫痫的疗效分析。方法对11例药物难治性癫痫患者进行国产迷走神经刺激手术治疗,术后2~4周开机,分次调试参数,脉冲发生器输出电流从0.2mA逐渐增加,刺激时间为30s,间歇5min,频率20~25Hz,脉宽250~500us。结果本组共计11例,随访1年,1例(9%)病人术后发作完全停止;3例(27%)病人术后发作频率减少75%;3例(27%)发作频率减少50%以上;3例(27%)发作频率减少25~50%;1例(9%)无改善;63.6%的难治性癫痫患者发作减少50%以上。结论迷走神经刺激是治疗药物难治性癫痫安全、有效的方法,治疗效果与刺激时间及参数调节有关。     

迷走神经刺激术治疗药物难治性癫痫的初步研究

目的 探讨迷走神经刺激术治疗药物难治性癫痫的方法及效果. 方法 回顾性分析上海交通大学医学院附属仁济医院神经外科自2007年1月至2011年1月收治的14例药物难治性、全身性癫痫患者临床资料,其中脑炎后继发癫痫6例,外伤后继发癫痫3例,原因不明5例,所有患者均行左侧迷走神经刺激术治疗.术后3周内开机,初始刺激参数为:刺激电流0.25 mA,频率30 Hz,刺激时间30 s,间歇时间5 min,脉宽500 μs.刺激电流强度以0.25 mA为一调整单位逐渐递增,并综合其他参数调控以到达满意疗效. 结果 随访3月以上,14例患者术后发作频率平均减少63.6％,其中3例发作频率减少＜50％,11例发作频率减少≥50％,6例发作频率减少＞80％,2例发作停止.5例患者使用磁铁后发作控制得到改善. 结论 迷走神经刺激术是一种治疗药物难治性癫痫有效、安全的方法,对全身性癫痫发作患者同样有效.     

神经调控技术在癫痫治疗方面的研究进展

神经调控技术作为治疗难治性癫痫的新方向,可有效的减少及减轻药物控制不理想或不适合切除性手术及术后控制不理想的难治性癫痫的发作频率及严重程度。目前应用及研究比较广泛的神经调控技术有迷走神经刺激、脑深部刺激及闭环刺激,三者均可有效控制一部分难治性癫痫发作,改善患者生活质量。     

迷走神经刺激术治疗难治性癫痫(附25例报告)

目的研究迷走神经刺激术治疗难治性癫痫的适应证选择、手术方法、术后程控及疗效。方法 2009年11月~2016年7月清华大学玉泉医院癫痫中心对25例难治性癫痫患者行迷走神经刺激术,术后给予程控管理控制癫痫发作;并通过随访回顾性分析术后疗效。结果术后随访患者4个月~7年,其中癫痫发作频率减少达McHughⅠ级6例、Ⅱ级12例、Ⅲ级4例、Ⅳ级1例、Ⅴ级2例。手术前后癫痫发作频率对比,差异有统计学意义(P0.05)。结论迷走神经刺激术作为一种安全有效的辅助治疗难治性癫痫的方法,其治疗效果可以随着参数的调整和时间延长而增强,并可以一定程度改善患者的认知行为和生活质量。     

迷走神经刺激术对药物难治性癫痫患者认知功能的影响及其相关因素分析

目的探讨迷走神经刺激术对药物难治性癫痫患者认知功能的影响及其相关因素。方法 2014年1月至2015年4月收治符合标准药物难治性癫痫40例,均经MRI、视频脑电图、PET或SPECT等检查与评估后行迷走神经刺激术治疗。采用蒙特利尔认知功能量表进行认知功能评定,根据中国修订版韦氏成人智力量表、中国修订版韦氏记忆测验量表等评估言语智商、操作智商。结果术后3、6、12个月蒙特利尔认知功能量表评分分别为(22.3±4.6)分、(23.5±3.1)分、(25.2±2.9)分,均显著高于术前[(18.9±3.5)分;P0.05]。单因素分析和多元线性回归分析显示年龄、抗癫痫药物服用种类显著影响患者言语智商(P0.05),致病灶位置、全面强直阵挛发作、癫痫发作频率显著影响患者操作智商(P0.05)。结论迷走神经刺激术能有效改善药物难治性癫痫患者认知功能,但治疗前需对患者认知功能进行评估,减少或去除相关影响因素,选取对患者认知功能影响较小的药物、手术进行干预治疗,最大程度控制癫痫发作,减轻癫痫对患者认知功能造成的损害。     

迷走神经刺激治疗药物难治性癫痫的随访研究（附62例分析）

目的研究迷走神经刺激治疗药物难治性癫痫的疗效。方法回顾性分析62例接受迷走神经刺激（vNs）治疗的药物难治性癫痫患者的临床资料。通过患者来院或电话对患者的发作频率、持续时间和生活质量等进行随访。结果62例患者,失访5例,1例患者刺激时间小于2个月未纳入统计范围,对接受迷走神经刺激治疗3～40个月的56例患者进行统计分析,McHughⅠ级22例（39．3％）,Ⅱ级16例（28．6％）,Ⅲ级13例（23．2％）,Ⅳ级＋Ⅴ级5例（8．9％）。其中3例（5．4％）术后无发作,38例（67．9％）发作减少50％以上。结论迷走神经刺激是治疗药物难治性癫痫安全、有效的方法。VNS刺激时间和刺激参数可能是影响其对药物难治性癫痫疗效的重要因素,随刺激时间延长疗效增加。     

儿童难治性癫痫手术前后对认知功能的影响

目的探讨难治性癫痫患儿外科手术治疗前后认知功能的变化。方法 27例儿童难治性癫痫患儿通过结构功能影像学、头皮长程视频脑电图(VEEG),需要时行侵入性脑电图(iEEG)等全面评估后个体化选择癫痫外科手术,于术前7天、术后3个月、6个月及12个月分别采用韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测试患儿认知功能,评价手术前后认知功能,术后采用Engel分级评价手术治疗效果。结果 27例难治性癫痫儿童,术后随访12～36个月(平均随访22个月),17例患儿术后完全无癫痫发作,5例患儿术后发作极少,1年中仅1次,发作频率减少超过90%有3例,2例癫痫发作控制改善不明显,发作频率及症状未见明显改善。27例患儿配合完成了韦氏儿童智力量表第四版中文版(WISC-Ⅳ)测验,癫痫外科手术治疗后12个月患儿智商相比术前增加2.00～12.00(6.70±2.45)分(P0.001),认知功能改善有统计学意义,且开颅手术与迷走神经刺激术对患者认知功能影响的差异之间无统计学意义(P0.05)。结论癫痫外科手术对于难治性癫痫儿童安全且有效,可控制或减少术后发作频率,难治性癫痫儿童术后认知功能有不同程度提高。     

迷走神经刺激治疗难治性癫痫(附11例报告)

目的 探讨迷走神经刺激术治疗顽固性癫痫的治疗效果和机制.方法 2004年4月～2006年12月,11例顽固性癫痫进行了迷走神经刺激治疗,其中3例为脑炎后部分性继发全身发作,3例为Lenonx-Castaut Syndrome(LGS),另外5例为原因不明的全身强直阵挛性发作.手术在全麻下进行,在甲状软骨水平左侧胸锁乳突肌前缘作3cm皮肤切口,分离肌肉并显示左侧迷走神经干约3cm,将螺旋型迷走神经刺激电极缠绕于迷走神经干上,在左腋前线作一皮肤切口,将刺激器置入皮下并与刺激电极相连接及固定.术后2周开机,调试参数,刺激电流从0.25mA逐渐调至1.5mA,刺激模式为:刺激时间为30秒,间歇5分钟,脉宽为500～1000μs,频率为30Hz.结果 术后3个月～2年随访,癫痫发作频率平均减少60%,发作程度减轻,全身强直阵挛性发作明显减少,精神状态明显改善.结论 迷走神经刺激手术创伤小,副作用少,术后能减少病人发作的频率,提高病人生活质量,对不适合开颅手术的难治性癫痫是一种有效的治疗方法.     

迷走神经刺激治疗癫痫新进展

癫痫是神经系统最常见的病症之一,严重影响患者、家庭和社会。约1/3的患者为药物难治性癫痫,其中只有一部分适合行手术治疗,其余患者可考虑行迷走神经刺激术(VNS)治疗。迷走神经刺激术是许多癫痫发作类型和癫痫综合征的有效治疗方法,是治疗药物难治性癫痫最常用的神经调控技术。迷走神经刺激术治疗难治性癫痫已有30 a历史,本文对近年来在儿童、青年、成年难治性癫痫中的有效性、不良反应、生活质量及花费问题,以及该疗法的一些仍需探讨的问题做一综述。     

Long-term outcome of vagus nerve stimulation for refractory partial epilepsy

We assessed 1- and 2-year outcomes of specific seizure types, quality of life, depression, and anxiety among patients treated with vagus nerve stimulation (VNS) for refractory partial epilepsy. Patients completed a seizure questionnaire, the Quality of Life in Epilepsy-89 (QOLIE-89) questionnaire, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and 1 year, and 2 years after activation of VNS. VNS was associated with >or=50% reduction in total seizure frequency in 54% of patients at 1 year and 61% of patients 2 years post-VNS activation compared with baseline. No statistically significant changes from baseline to 12 or 24 months were found in mean quality of life, depression, or anxiety measures in the overall study population. Patients with at least 50% reduction in seizures had significant improvement in anxiety at 12 and 24 months compared with patients who did not have the same degree of seizure reduction.     

Quality-of-Life Assessment in Patients Treated with Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) is a novel therapy used in patients with medically intractable epilepsy. We administered a Quality of Life in Epilepsy-10 (QOLIE-10) questionnaire consisting of questions designed to assess the patients' rating of their memory, level of physical and mental well-being, energy, depression, worries about seizures and work, social limitations, and overall quality of life on VNS treatment. The questionnaire was administered before and at 1-3 weeks, 5-7 weeks, 3 months, 6 months, and 9-12 months after the initiation of VNS in 17 patients. QOLIE-10 scores were significantly better after the initiation of the therapy as compared with baseline (P < 0.01). There was no correlation between the improvement in QOLIE-10 scores and the reduction in seizure frequency, decreased severity of seizures, or increased level of energy/alertness. We conclude that VNS therapy is associated with a significant improvement in subjective quality of life.     

Effect of vagus nerve stimulation on adults with pharmacoresistant generalized epilepsy syndromes.

INTRODUCTION: Although vagus nerve stimulation (VNS) therapy is approved for the treatment of partial onset seizures, its efficacy for generalized seizures has not been fully evaluated. This Investigational Device Exemption assessed the outcome of VNS therapy among patients with generalized epilepsy syndromes. METHODS: Sixteen patients with pharmacoresistant generalized epilepsy syndromes and stable antiepileptic drug (AED) regimens were implanted with the VNS therapy device and were evaluated for changes in seizure frequency and type between baseline and follow-up of 12-21 months. RESULTS: The patients experienced a statistically significant overall median seizure frequency reduction of 43.3% (P = 0.002, Wilcoxon signed rank test) after 12-21 months of VNS therapy. Types of seizures that may involve a fall or collapse decreased with reductions in the frequency of myoclonic (60% reduction, n = 9; P = 0.016, Wilcoxon signed rank test), tonic (75% reduction, n = 8, NS), atonic (98.6%, n = 3, NS), and clonic seizures (86.7%, n = 1, NS). Conclusion: The benefits of reduced seizure frequency and reduced risk of injury merit consideration of VNS therapy for patients with pharmacoresistant generalized seizure syndromes.     

Seizure reduction and quality of life improvements in people with epilepsy

PURPOSE: Previous research suggests that seizure freedom may be necessary to improve health-related quality of life (HRQOL) for epilepsy surgery patients, but little is known regarding the seizure-frequency reduction needed to improve HRQOL among medically treated individuals. METHODS: With data from 134 adults with refractory complex partial seizures participating in a randomized controlled antiepileptic drug (AED) trial, we compared the change in HRQOL across groups having different levels of change in seizure frequency: 100%, 75-99%, 50-74% reduction, and 0-50% increase or decrease. Changes over time within each seizure-reduction group also were assessed. HRQOL was measured by the QOLIE-31, QOLIE-89, and SF-36. RESULTS: Subjects who became seizure free reported significantly more positive change than those who did not on the QOLIE-31 and QOLIE-89 overall scores, the QOLIE-89 mental health, physical health, and epilepsy-targeted composites, as well as the SF-36 mental health summary score. Changes over time in overall QOLIE-31 and QOLIE-89 scores were significantly more positive for subjects who achieved seizure freedom (i.e., 100% reduction in seizure frequency) than for those who did not. No significant change in QOLIE-31 and QOLIE-89 overall scores was observed for subjects who did not achieve seizure freedom. CONCLUSIONS: In this study, HRQOL improvement occurred primarily among patients who achieved complete seizure freedom. Many AED trials use a 50% seizure-frequency reduction criterion as a trial end point, but measurable impacts of this degree of reduction in seizure frequency on HRQOL in this sample were not observed. These results further support striving for seizure freedom as an epilepsy care goal.     

拉莫三嗪对癫痫患者生活质量影响的研究

目的：评价拉莫三嗪对癫痫患者生活质量的影响。方法：采用多中心、前瞻性的研究方法，对新诊断癫痫患者应用拉莫三嗪治疗，并在基线期及用药6个月后，采用QOLIE-31、MOSSF-36量表、数字符号转换测验、HAMD抑郁量表和女性专用调查问卷对患者进行生活质量评价。结果：共纳入新诊断癫痂患者282例。MOSSF-36量表的8个项目得分在用药后均有显著提高（P〈0．01）；QOLIE-31问卷中“对癫痫的担心”、“情绪”、“活力”、“认知”、“药物不良反应”、“社会功能”及“总体自身健康评价”项目得分在用药后均有显著提高（P〈0．01）。用药后，患者Hamilton抑郁量表平均3．65分，显著低于基线期6．42分（P〈0．01）；数字符号转换测验得分在用药后与基线期比较有显著提高（P〈0．01）。结论：拉莫三嗪初始单药治疗能在一定程度上改善新诊断癫痫患者的生活质量。     

Exploration of Changes in Health-Related Quality of Life after 3 Months of Vagus Nerve Stimulation

Purpose. The goal of this work was to explore changes in health-related quality of life (HRQOL) and reductions in seizure frequency among patients initiating vagus nerve stimulation (VNS) for medication-refractory epilepsy.Methods. Patients receiving VNS completed the Quality of Life in Epilepsy-10 (QOLIE-10) at baseline and after 3 months of stimulation. Patients were categorized as responders (>/=50% seizure reduction) and nonresponders (<50% seizure reduction). Data were analyzed for change from baseline to 3 months within each group and between groups.Results. Both groups reported improvements in almost all aspects of HRQOL. Statistically significant improvements were reported by responders in energy, memory, social aspects, mental effects, and fear of seizures; and by nonresponders in downheartedness and overall QOL. Responders improved significantly more than nonresponders in energy.Conclusions. These exploratory analyses showed little difference in HRQOL between responders and nonresponders, with both reporting improvements after 3 months of VNS. Follow-up may determine whether improvements are sustained or attributable to placebo effect.     

Vagus Nerve Stimulation for Treatment of Partial Seizures: 1. A Controlled Study of Effect on Seizures

Summary: Vagus nerve stimulation (VNS) was shown to reduce seizure frequency in refractory epilepsy patients in two pilot studies. Based on these results, a multicenter, prospectively randomized, parallel, double-blind study of patients with refractory partial seizures was initiated. After a 12–week baseline period, identical vagus nerve stimulators were implanted and patients randomized to either a high or low 14–week VNS treatment paradigm. The primary objective was to demonstrate that high VNS (therapeutic parameters) was more effective in reducing partial seizure frequency than was low VNS (less or noneffective parameters). Patients continued receiving antiepileptic drugs (AEDs) with plasma concentrations held constant throughout the study. We report results of the first 67 patients to exit the 14-week acute phase. After 14 weeks of VNS, 31 patients receiving high VNS experienced a mean seizure frequency percentage reduction of 30.9%, which was statistically significant as compared with the mean seizure frequency percentage reduction of 11.3% in 36 patients receiving low VNS (p = 0.029, t test; p = 0.036, Wilcoxon rank-sum test). In addition to the significant intra group p-values, mean seizure frequency percentage change reached statistical significance for high VNS (p < 0.001) but not low VNS (p = 0.072) as compared with baseline. Twelve of 31 (38.7%) patients receiving high VNS achieved at least 50% reduction in seizure frequency whereas 7 of 36 (19.4%) patients receiving low VNS experienced at least 50% reduction after 14 weeks. The implant procedure and VNS therapy were well tolerated. Our study confirmed the effectiveness of VNS as treatment for epilepsy patients with refractorypartial seizures.     

Vagus nerve stimulation has a positive effect on mood in patients with refractory epilepsy

Background

Preliminary research on the efficacy of vagus nerve stimulation (VNS) indicated additional effects on neuropsychological variables like mood and quality of life (QOL).

Objectives

The objectives of this prospective longitudinal observational cohort study were to assess the effects of VNS on mood, QOL and cognition in patients with refractory epilepsy and to determine whether these effects occur dependent of seizure control.

Methods

We included 41 patients with refractory epilepsy; treated with VNS as part of usual patient care. A neuropsychological battery was performed during baseline and repeated after 6 months of VNS in order to compare neuropsychological variables before and after VNS. All patients completed seizure diaries.

Results

Significant improvements were observed for both mood and QOL after 6 months of VNS; based on the results in the POMS and QOLIE-89 questionnaires (p < 0.05). There was no significant change in cognition. Mean percentage change in seizure frequency was −9.0%, while 20% of the patients achieved a seizure frequency reduction of 50% or more. No significant correlation was found between changes in seizure frequency and improvements in mood or QOL.

Conclusions

VNS is associated with improvements in both mood and QOL in patients with refractory epilepsy. Since these improvements appeared to be independent of seizure control, the results of this study indicate an additional antidepressant effect of VNS, which can be of extra value in view of the high co-morbidity of mood disturbances in patients with epilepsy.     

Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children

Objectives The management of intractable epilepsy in children is a challenging problem. For those patients who do not respond to antiepileptic drugs and are not candidates for epilepsy surgery, vagal nerve stimulation (VNS), can be a viable alternative for reducing seizure frequency. We have reviewed the historical and clinical background of VNS treatment. We also include our experience at The Hospital for Sick Children in children who underwent VNS implantation.Methods Forty-one children underwent VNS implantation for epilepsy over 6 years. After a mean follow-up of 31 months, 15 (38%) patients had a seizure frequency reduction of more than 90%. Fifteen (38%) children failed to respond to the VNS treatment. The device was removed in five children: in one, due to late infection; the other four could not tolerate the side effects of chronic VNS therapy. Two patients required reimplantation due to electrode failure. The most common side effects in our series were cough and vocal disturbances.Conclusions Our results show that VNS implantation can be a safe and effective alternative therapy for children with drug-resistant epilepsy who are not candidates for epilepsy surgery.