Vagus nerve stimulation for epilepsy
Vagus nerve stimulation for epilepsy
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DOI：
10.1016/j.cnr.2004.06.007
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发表时间：
2004-07-01
期刊：
影响因子：
--
通讯作者：
Labar, D
中科院分区：
文献类型：
--
作者：
Labar, D
在两项包含300例患者的前瞻性、双盲、3个月试验中，使用皮下手术植入装置（迷走神经刺激，VNS）对颈部迷走神经进行慢性间歇性高强度电刺激，可将耐药部分发作性癫痫发作减少24- 28%，而低强度对照组的癫痫发作率减少6-15%。治疗前3个月的副作用是声音嘶哑（60%），咳嗽（38%），感觉异常（20%）和呼吸困难（20%）; VNS治疗3年后，不到5%的患者出现副作用。癫痫发作率随着VNS治疗持续时间的增加而进一步下降（43%的患者在3年后癫痫发作率降低50%或更多）;这似乎与后期抗癫痫药物（AED）和刺激参数变化无关。VNS的抗癫痫作用可能在治疗终止后持续存在。以下临床特征不能预测癫痫发作率对VNS的反应性：癫痫持续时间、癫痫综合征、年龄、性别、癫痫发作年龄、基线癫痫发作率、既往癫痫手术、合并使用AED的数量和类型、既往AED的数量和癫痫发作类型的数量。在一项小型研究中，在VNS启动后进行的PET扫描中观察到丘脑血流量增加，可预测后期的临床反应。需要开发更好的方法来识别术前可能的VNS反应者。(C)2004 Elsevier B. V.保留所有权利。
In two prospective, double-blind, 3-month trials with 300 patients, chronic intermittent high intensity electrical stimulation of the cervical vagus nerve with a subcutaneous surgically implanted device (vagus nerve stimulation, VNS) reduced medication-resistant partial onset seizures by 24-28%, compared with seizure rate reductions of 6-15% in the low intensity control group. Side effects in the first 3 months of treatment were hoarseness (60%), cough (38%), parasthesias (20%) and dyspnea (20%); after 3 years of VNS, less than 5% of patients experience side effects. Seizure rates decline further with increasing VNS treatment durations (43% of patients have a 50% or more seizure rate reduction after 3 years); this seems independent of later antiepileptic drug (AED) and stimulation parameter changes. Antiepileptic effects of VNS may persist after termination of the therapy. The following clinical features are not predictive of seizure rate responsiveness to VNS: epilepsy duration, epilepsy syndrome, age, gender, epilepsy onset age, baseline seizure rate, prior epilepsy surgery, number and type of concomitant AEDs, number of prior AEDs, and number of seizure types. In one small study, increased thalamic blood flow seen on PET scans performed upon VNS initiation was predictive of later clinical responsiveness. Better methods to identify preoperatively probable VNS responders need to be developed. (C) 2004 Elsevier B.V. All rights reserved.