Refractory generalized seizures: Response to corpus callosotomy and vagal nerve stimulation
Refractory generalized seizures: Response to corpus callosotomy and vagal nerve stimulation
复制标题
DOI：
10.1111/j.1528-1167.2006.00377.x
复制
发表时间：
2006-01-01
期刊：
影响因子：
5.6
通讯作者：
Sperling, MR
中科院分区：
文献类型：
--
作者：
Nei, M;O'Connor, M;Sperling, MR
目的：迷走神经刺激器（VNS）和胼胝体切开术可以减少药物治疗无效的癫痫发作频率。然而，这两种手术的有效性和安全性尚未进行比较。本研究评估了两个程序为generalization.Methods：所有患者进行了胼胝体切开术（前或完全）（n = 53），而没有其他形式的癫痫手术和那些谁接受VNS放置（n = 25）进行了评估，本研究的难治性全身性癫痫发作（全身强直阵挛，强直，或张力不足）。结果：对于胼胝体切开术和全身强直-阵挛性癫痫发作（n = 50），79.5%的患者全身强直-阵挛性癫痫发作的频率减少>= 50%，60%的患者癫痫发作减少>= 80%。对于VNS和全身强直阵挛发作的患者（n = 21），50%的患者发作减少>= 50%，33%的患者发作减少>= 80%。VNS或胼胝体切开术后强直性和失张力性癫痫发作减少。胼胝体切开术的并发症发生率（21%的所有并发症，3.8%的永久性）高于VNS（8%;无永久性），但胼胝体切开术和VNS的并发症很少是永久性的。结论：胼胝体切开术和VNS是有效的，减少全身性癫痫发作。胼胝体切开术具有更高的疗效，但并发症的风险更高，尽管这些并发症通常是短暂的。
Purpose: The vagal nerve stimulator (VNS) and corpus callosotomy can reduce seizure frequency when seizures are refractory to medications. However, the efficacy and safety of these two procedures have not been compared. This study evaluates the two procedures for generalized seizures.Methods: All patients with refractory generalized seizures (generalized tonic-clonic, tonic, or atonic) who underwent a corpus callosotomy (anterior or complete) (n = 53) without other forms of epilepsy surgery and those who underwent VNS placement (n = 25) were evaluated for this study. Seizure response and procedure complications were evaluated.Results: For those with a corpus callosotomy and generalized tonic-clonic seizures (n = 50), 79.5% had >= 50% decrease in the frequency of generalized tonic-clonic seizures, and 60% had >= 80% seizure reduction. For those with a VNS and generalized tonic-clonic seizures (n = 21), 50% had >= 50% seizure reduction, and 33% had >= 80% seizure reduction. Tonic and atonic seizures decreased after either VNS or a corpus callosotomy. The complication rate for corpus callosotomy was higher (21% all complications, 3.8% permanent) than that for VNS (8%; none permanent), but complications for both corpus callosotomy and VNS were rarely permanent.Conclusions: Both corpus callosotomy and VNS are effective in reducing generalized seizures. Corpus callosotomy is associated with greater efficacy but higher risk for complications, although these were generally transient.