迷走神经刺激术早期不同程控方案在儿童难治性癫痫中的应用效果

目的通过比较迷走神经刺激术(VNS)早期不同程控方案在儿童难治性癫痫中的应用效果和安全性,寻找最佳早期程控方案。方法回顾性分析首都儿科研究所附属儿童医院神经外科2016年8月至2018年12月行VNS治疗的54例难治性癫痫患儿的临床资料。根据术后程控方案的刺激电流幅度,分为低参数组(≤1 mA,28例)和高参数组(>1 mA,26例)。术后6个月行临床随访,对比两组的治疗有效率和治疗相关并发症的发生率。结果VNS治疗6个月,54例患儿的无发作率为13.0%(7/54),总体有效率为66.7%(36/54)。其中低参数组的有效率(82.1%,23/28)高于高参数组(50.0%,13/26)(χ^2=6.268,P=0.012)。54例患者术后总体并发症的发生率为7.4%(4/54)。低参数组治疗相关并发症的发生率(0%)与高参数组(15.4%,4/26)之间的差异无统计学意义(χ^2=4.652,P=0.102)。结论VNS是治疗儿童难治性癫痫的有效手段,相对于高参数程控方案,患儿可能从低参数程控方案获益更多。

Effect of vagus nerve stimulation with different early programming regimens on childhood refractory epilepsy

Objective To compare the outcome and safety of different early programming regimens of vagus nerve stimulation(VNS)to determine the optimal VNS programming regimen for the treatment of pediatric drug-resistant epilepsy.Methods The clinical data of 54 children with intractable epilepsy treated with VNS from August 2016 to December 2018 at Department of Neurosurgery,Children′s Hospital Affiliated to Capital Institute of Pediatrics were analyzed retrospectively.According to the stimulation current intensity of post-operative programming regimen,the patients were divided into low-parameter group(≤1 mA,28 cases)and high-parameter group(>1 mA,26 cases).After 6 months of clinical follow-up,the effective rate of treatment and the incidence of treatment-related complications were compared between the two groups.Results Six months after VNS treatment,the rate of seizure free in 54 cases was 13.0%(7/54),and the overall effective rate was 66.7%(36/54).The effective rate of low-parameter group(82.1%,23/28)was higher than that of high-parameter group(50.0%,13/26).The difference between the two groups was statistically significant(χ^2=6.268,P=0.012).The overall incidence of complications was 7.4%(4/54).There was no significant difference in the incidence of complications between the two groups[0%vs.15.4%(4/26),χ^2=4.652,P=0.102].Conclusion VNS seems to be an effective treatment for pediatric drug-resistant epilepsy.Children may benefit more from low-parameter programming than high-parameter programming in the early stage of VNS.