Long-term effect of vagus nerve stimulation on interictal epileptiform discharges in refractory epilepsy
Long-term effect of vagus nerve stimulation on interictal epileptiform discharges in refractory epilepsy
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DOI：
10.1016/j.jns.2009.04.012
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发表时间：
2009-09-15
影响因子：
4.4
通讯作者：
Liu, Li
中科院分区：
文献类型：
--
作者：
Wang, Haiyang;Chen, Xiaoguang;Liu, Li
背景：迷走神经刺激（VNS）疗法已被广泛认为是治疗难治性癫痫的有效替代方法。然而，人们对 VNS 的确切机制知之甚少。本研究的目的是观察VNS引起的长期发作间期脑电图变化，并探讨VNS控制癫痫发作的可能作用机制。方法：选取2001年至2004年中国两个癫痫中心（哈尔滨和上海）的8例VNS患者，通过长期随访（37至81个月（平均55.8个月））研究其临床疗效。此外，在不同时间（术前基线、VNS 启动后 3、6、12 和 24 个月）和 VNS 刺激器的不同状态（“激活”、“停用”和“重新激活”）进行连续脑电图检查。 结果：12.5%、62.5%、75%、62.5% 和 75% 的患者中癫痫发作减少≥ 50%（n = 8) 分别为 VNS 术后第 6、12、18、24 和 36 个月。结果显示，脑电图上的 IED（发作间期癫痫样放电）数量随着时间的推移呈统计学显着的逐渐减少（P < 0.01）。经过 6 个月的 VNS 刺激后，癫痫发作频率的减少与简易爆炸装置的减少之间存在显着相关性（P < 0.01）。此外，当分别将“停用”状态与“激活”和“重新激活”状态进行比较时，可以看到IED具有统计学上的显着差异（P < 0.01）。然而，“激活”和“再激活”之间的IEDs没有显着差异（P>0.05）。结论：VNS是一种有效的、耐受性良好的难治性癫痫治疗方法。随着时间的推移，它可以对癫痫样活动产生渐进的电生理效应。这可能反映了 VNS 与 EEG 不同步的慢性作用机制，以实现癫痫发作控制。 (C) 2009 Elsevier B.V. 保留所有权利。
Background: Vagus nerve stimulation (VNS) therapy has been widely recognized as an effective alternative for the treatment of refractory epilepsy. However, the precise mechanism of VNS is poorly understood. The purpose of this study was to observe the long-term interictal EEG changes induced by VNS, and to investigate the probable mechanism of action of VNS in achieving seizure control.Methods: Eight patients with VNS were selected from two epilepsy centers in China (Harbin and Shanghai) between 2001 and 2004. We studied the clinical efficacy by long-term follow-up, ranging from 37 to 81 months (mean 55.8 months). Moreover, serial EEGs were performed at the different time (preoperative baseline, 3, 6, 12, and 24 months after VNS initiation) and the different states of VNS stimulator ("activation", "deactivation" and "reactivation").Results: A >= 50% seizure reduction was achieved in 12.5%, 62.5%, 75%, 62.5% and 75% of the total patients (n = 8) at 6, 12, 18, 24 and 36 months of post-VNS, respectively. The results revealed a statistically significant progressive decrease in the number of IEDs (interictal epileptiform discharges) on EEG with time (P < 0.01). Significant correlation had been highlighted after 6 months of VNS stimulation, between the reduction of seizure frequency and the decreasing of IEDs (P < 0.01). Furthermore, statistically significant difference of IEDs was seen when comparing the state of "deactivation" with the states of "activation" and "reactivation", respectively (P < 0.01). However, there was no significant difference in IEDs between "activation" and "reactivation" (P > 0.05).Conclusions: VNS is an efficient, well-tolerated therapy for refractory epilepsy. It can induce progressive electrophysiological effect on epileptiform activity over time. This may reflect the mechanism of chronic action of VNS with desynchronization of EEG in achieving seizure control. (C) 2009 Elsevier B. V. All rights reserved.