迷走神经刺激术治疗难治性癫痫的临床疗效

Clinical effect of vagus nerve stimulating for patients with drug⁃resistant epilepsy

目的 探讨迷走神经刺激术(VNS)治疗难治性癫痫的疗效、安全性和可行性。方法 收集我院2016年1月至2021年5月收治的26例随访超过6个月的难治性癫痫行VNS治疗的患者的临床资料,对癫痫发作控制、术后认知能力变化、不良反应情况等进行分析。结果 26例患者经过6~36个月的刺激后,发作减少50%以上的患者占57%。4例患者癫痫发作停止,占总人数15%;2例患者癫痫发作减少80%以上;9例发作减少50%~80%;9例发作减少50%以下;2例仅在使用磁铁时发作减少。65%患者发作严重程度减轻;75%患者发作持续时间减少。按McHugh分级为Ⅰ级6例,Ⅱ级9例,Ⅲ级9例,Ⅳ级2例。发病时间低于5年的患者中有28%获得刺激后发作减少≥80%的效果,有75%的患者经刺激后获得了发作减少效果;而发病时间超过5年的患者中只有15%获得刺激后发作减少≥80%的效果,46%患者获得了发作减少的效果。手术年龄小的患者,术后有效率更高,无发作率也更高。结论 难治性癫痫VNS治疗疗效良好,该治疗方式具有创伤小、不良反应轻的优点。为保证该治疗方法的疗效,应当严格术前评估,术中精细手术,术后个体化程控。

Objective To investigate the efficacy,safety and feasibility of vagus nerve stimulating(VNS)for drug⁃resistant epilepsy.Methods The clinical data of 26 patients who had underwent VNS for drug⁃resistant epilepsy and had been followed up more than 6 months in our hospital from January 2016 to May 2021 were collected,the control situation of epileptic seizure,cognitive change after operation and operation were analyzed.Results After 6 to 36 months of stimulation in 26 cases,57%of the patients had a more than 50%reduction in seizures.Four patients(15%)were seizurefree.Seizures were reduced by more than 80%in 2 patients.In 9 cases,seizures were reduced by 50%-80%.Nine patients had less than 50%seizure reduction.Two had a reduction in seizures only with the use of magnets.The severity of seizures was reduced in 65%patients.The duration of attacks was reduced in 75%of patients.According to the McHugh classification,there were 6 cases of grade I,9 cases of gradeⅡ,9 cases of gradeⅢ,and 2 cases of gradeⅣ.In the patients whose onset time was less than 5 years,28%of the patients achieved a≥80%reduction in seizures after stimulation,and 75%of the patients achieved a reduction in seizures after stimulation.Among patients with a duration of more than 5 years,only 15%achieved an 80%or greater reduction in seizures after stimulation,and 46%achieved a reduction in seizures.The patients with younger surgical age had higher postoperative effective rate and higher seizure⁃free rate.Conclusions All of the 26 cases of refractory epilepsy were well treated by VNS,this treatment has less injury and less side effects.In order to ensure the curative effect of this treatment method,strict preoperative evaluation,fine operation during operation and individualized program control after operation should be required.