Evaluating vagus nerve stimulation treatment with heart rate monitoring in pediatric patients with intractable epilepsy
Evaluating vagus nerve stimulation treatment with heart rate monitoring in pediatric patients with intractable epilepsy
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评估迷走神经刺激治疗与心率监测对顽固性癫痫儿科患者的影响
DOI：
10.1007/s00381-021-05416-0
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Shaun D. Rodgers
中科院分区：
文献类型：
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作者：
Brandon A. Santhumayor;Shefali N Karkare;S. Kothare;Shaun D. Rodgers
目的迷走神经刺激器（VNS）已成为治疗儿童难治性、耐药性癫痫的有效方法。较新的设备，AspireSR™ 106型和SenTiva™ 1000型（VNS治疗仪，LivaNova™），包含一个“自动刺激”功能，可检测发作性心动过速并传输脉动以减弱癫痫发作。然而，与其风险相比，自动刺激的确切好处仍然值得进一步探索。这项研究评估了这些特定设备的效用在一个异质性的儿童和年轻的成人患者难治性epilepsy.MethodsThis是一个回顾性图表审查的55例患者进行要么VNS插入或不自动刺激使能VNS设备在一个单一的水平4癫痫center。在VNS插入时和植入后12个月，从患者自我报告中收集VNS植入前后的癫痫发作频率、癫痫发作亚型、副作用和抗癫痫药物负荷的变化。有关输出电流，自动刺激电流，占空比，和自动刺激阈值的设备是从记录的VNS询问与自动刺激启用VNS设备的患者。（SD = 0.414）VNS插入后12个月癫痫发作频率降低，而没有自动刺激使能VNS装置的患者在相同的时间间隔内癫痫发作频率平均减少41.6%（SD = 0.456）。使用SenTiva™ 1000型号的患者在VNS插入后12个月的平均癫痫发作频率降低为66.0%（SD = 0.426）。对于使用自动刺激VNS装置的患者，治疗后癫痫发作减少与每日自动刺激激活显著相关（R= 0.432，p = 0.025）。结论本研究支持自动刺激VNS模型的临床安全性和实用性，特别是SenTiva™ 1000，用于治疗患有各种亚型和病因的顽固性癫痫的儿科患者。需要进一步的研究来评估自刺激对长期结局的持续影响（VNS后随访≥ 2年）。
PurposeVagus nerve stimulators (VNS) have emerged as an effective treatment modality for pediatric patients suffering from intractable, drug-resistant epilepsy. Newer devices, AspireSR™ Model 106 and the SenTiva™ Model 1000 (VNS TherapyⓇ, LivaNova™), contain an “auto-stimulation” feature that detects ictal tachycardia and transmits pulsations to attenuate seizures. However, the exact benefits of auto-stimulation compared to its risks still merit further exploration. This study evaluates the utility of these specific devices in a heterogeneous population of pediatric and young adult patients with intractable epilepsy.MethodsThis is a retrospective chart review of 55 patients who underwent either VNS insertion with or without an auto-stimulation-enabled VNS device at a single level four epilepsy center. Seizure frequency, seizure subtype, side effects, and change in anti-seizure medication load both before and after VNS implantations were collected from patient self-reporting at the time of VNS insertion and 12 months following implantation. Information regarding output current, auto-stimulation current, duty cycling, and auto-stimulation threshold of the device was obtained from documented VNS interrogation for patients with auto-stimulation-enabled VNS devices.ResultsPatients with auto-stimulation-enabled VNS devices had a mean 56.0% (SD = 0.414) seizure frequency reduction 12 months post-VNS insertion, while patients without auto-stimulation-enabled VNS devices had a mean 41.6% (SD = 0.456) seizure frequency reduction during the same interval. The mean seizure frequency reduction 12 months post-VNS insertion for patients with a SenTiva™ 1000 model was 66.0% (SD = 0.426). For patients with auto-stimulation-enabled VNS devices, post-treatment seizure reduction was significantly correlated with daily auto-stimulation activation (R= 0.432,p= 0.025).ConclusionThis study supports the clinical safety and utility of auto-stimulation-enabled VNS models, specifically the SenTiva™ 1000, in treating pediatric patients with intractable epilepsy of various subtypes and etiologies. Further research is needed to evaluate the sustained impact of auto-stimulation on long-term outcomes (≥ 2 years follow-up post-VNS).