停止迷走神经刺激术后2年内7例癫癎患者的临床与EEG分析

目的：总结迷走神经刺激术(VNS)对顽固性癫痫的疗效及评价其临床应用的价值。方法：用VNS治疗7例顽固性癫痫患者，治疗期为3年，结束治疗后继续观察2年，共观察5年。整个观察期内患者仍用足量抗癫痫药物。比较治疗前、治疗期及结束治疗后癫痫的发作情况及EEG变化。结果：7例患者在VNS治疗期内5例有效，其中3例发作频率减少25％～50％，2例终止发作，另2例无效。结束VNS治疗后原有效的3例中，2例发作加重，1例发作类型改变，发作次数增加，但强度减轻；2例终止发作者中1例目前仍未发作，另1例癫痫复发。EEG情况与临床相一致，当癫痫发作被控制时，EEG明显好转，棘(尖)慢复合波减少。癫痫复发时EEG会出现相应的痫样放电。7例患者在结束随访的第五年，有6例EEG仍明显异常，有棘(尖)或棘(尖)慢复合波。结论：VNS治疗顽固性癫痫具有安全性，且治疗期间有一定的疗效，但由于其对发作的完全控制率低，停止刺激后易复发，且费用昂贵，很难作为一种令人满意的治疗方法。

Clinical and EEG analysis in seven patients with epilepsy for two years after stopping vagal nerve stumulation

Objective:To evaluate the therapeutic effect of vagal nerve stimulation(VNS) on intractable epilepsy and its clinical applicational value.Methods:VNS was applied to seven intractable epilepsy for three years,continued observation was performed for two years after the end of treatment.The clinical epileptic seizures and EEG changes were observed before VNS,also during and after stopping VNS.During the period of five-year observation,enough antiepileptic drugs were still administered.Results:Therapeutic effect was observed in 5 patients during period of VNS,and 2 patients did not show any therapeutic effect.Seizure frequency decreased 25%-50% in 3 of the five patients showing therapeutic effect and two of the five were seizure free.After stopping VNS,two of the three patients with decreased frequency was aggravated.one showed alterated seizure type,showing increase of seizure frequency,but decrease of severity degree.In two seizure-free patients,one remained seizure-free,the other relapsed.EEG was consistent with the clinics.EEG was improved significantly,showing decreased spike (sharp)wave,spike(sharp)and slow waves as the epileptic seizure were controlled.When seizure relapsed,EEG showed corresponding epileptiform discharges.At the end of follow-up study in the 5 th year,6 out of the seven patients still showed abnormal EEG with spike(sharp) or spike(sharp) and slow waves.Conclusion:VNS might be of certain therapeutic effect for intractable epilepsy,but it might be difficult to be a satisfied method because of easy relapse after stopping stimulation and expensive expenditure.