Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy.
Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy.
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DOI：
10.1227/neu.0000000000001165
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发表时间：
2016-09
期刊：
影响因子：
4.8
通讯作者：
Chang EF
中科院分区：
文献类型：
--
作者：
Englot DJ;Rolston JD;Wright CW;Hassnain KH;Chang EF
补充数字内容可在正文中找到。以神经调节为基础的治疗在癫痫治疗中变得越来越重要。大多数接受神经调节治疗的癫痫患者并不能完全缓解癫痫发作，因此，以往对迷走神经刺激(VNS)治疗的研究重点放在减少癫痫发作频率作为治疗反应的指标上。目的：阐明迷走神经痉挛发作自由的发生率和预测因素。我们从VNS治疗患者结局登记处检查了5554名患者，并对包括78项研究中的2869名患者的文献进行了系统回顾。登记数据显示，在VNS治疗后，癫痫发作自由程度随着时间的推移而逐渐增加。总体而言，49%的患者在植入后0至4个月有反应(≥将癫痫发作频率减少50%)，5.1%的患者癫痫发作消失，而63%的患者在24至48个月时有反应，8.2%的患者癫痫发作缓解。在多因素分析中，癫痫发作缓解的预测因素为发病年龄和12岁(优势比[OR]，1.89；95%可信区间[CI]，1.38-2.58)和以全身性发作为主的发作类型(OR，1.36；95%CI，1.01-1.82)，而对VNS的总体反应则由非狼疮性癫痫预测(OR，1.38；95%CI，1.06-1.81)。系统的文献综述结果与注册分析结果一致：在0-4个月时，40.0%的患者对VNS有反应，2.6%的患者癫痫消失，而在最后的随访中，60.1%的患者是应答者，8.0%的患者实现了癫痫自由。VNS治疗的反应和发作自由率随着时间的推移而增加，尽管在一小部分患者中实现了完全的癫痫发作自由。AED、抗癫痫药物VNS、迷走神经刺激
Supplemental Digital Content is Available in the Text. Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response. To elucidate rates and predictors of seizure freedom with VNS. We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies. Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset >12 years (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom. Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients. AED, antiepileptic drug VNS, vagus nerve stimulation