Clinical outcomes of VNS therapy with AspireSR® (including cardiac-based seizure detection) at a large complex epilepsy and surgery centre
Clinical outcomes of VNS therapy with AspireSR® (including cardiac-based seizure detection) at a large complex epilepsy and surgery centre
复制标题
DOI：
10.1016/j.seizure.2018.03.022
复制
发表时间：
2018-05-01
影响因子：
3
通讯作者：
Chelvarajah, Ramesh
中科院分区：
文献类型：
--
作者：
Hamilton, Preci;Soryal, Imad;Chelvarajah, Ramesh
目的：比较AspireSR（R）与之前的VNS电池型号在电池更换方面的有效性，并确定AspireSR（R）用于新植入物的有效性。方法：回顾性收集了2014年6月至2017年6月期间由一名外科医生在三年内植入VNS AspireSR（R）的癫痫患者的数据。病例被分为两个队列，一组是新插入VNS的病例，另一组是VNS电池从之前的型号改为AspireSR（R）的病例。在每组中，比较AspireSR（R）插入前后的癫痫发作负担。结果：51例新插入AspireSR（R）VNS模型的患者癫痫发作频率显著降低（p < 0.001），59%（n = 30）报告降低>50%。在62名已有VNS的患者中，53%（n = 33）报告在插入原始VNS时癫痫发作负担减少>50%。电池更换为AspireSR（R）后，71%（n = 44）的患者报告癫痫发作负担进一步减少>50%。在98%（61/62）的患者中，这种减少的大小至少与插入现有VNS所产生的减少一样大。结论：结果表明，大约70%的现有VNS插入的患者可以从基于心脏的癫痫发作检测和AspireSR（R）设备的闭环刺激中获得显著的额外益处。对于新的插入，AspireSR（R）设备在59%的患者中有效。在咨询病人时使用的“三分法”可能需要相应地修改。皇冠版权所有（C）2018由爱思唯尔有限公司代表英国癫痫协会发布。All rights reserved.
Purpose: To compare the efficacy of AspireSR (R) to preceding VNS battery models for battery replacements, and to determine the efficacy of the AspireSR (R) for new implants.Methods: Data were collected retrospectively from patients with epilepsy who had VNS AspireSR (R) implanted over a three-year period between June 2014 and June 2017 by a single surgeon. Cases were divided into two cohorts, those in whom the VNS was a new insertion, and those in whom the VNS battery was changed from a previous model to AspireSR (R). Within each group, the seizure burden was compared between the periods before and after insertion of AspireSR (R).Results: Fifty-one patients with a newly inserted AspireSR (R) VNS model had a significant reduction in seizure frequency (p < 0.001), with 59% (n = 30) reporting >50% reduction. Of the 62 patients who had an existing VNS, 53% (n = 33) reported >50% reduction in seizure burden when the original VNS was inserted. After the battery was changed to the AspireSR (R), 71% (n = 44) reported a further reduction of >50% in their seizure burden. The size of this reduction was at least as large as that resulting from the insertion of their existing VNS in 98% (61/62) of patients.Conclusion: The results suggest that approximately 70% of patients with existing VNS insertions could have significant additional benefit from cardiac based seizure detection and closed loop stimulation from the AspireSR (R) device. For new insertions, the AspireSR (R) device has efficacy in 59% of patients. The 'rule of thirds' used in counseling patients may need to be modified accordingly. Crown Copyright (C) 2018 Published by Elsevier Ltd on behalf of British Epilepsy Association. All rights reserved.