迷走神经刺激术治疗药物难治性癫痫的初步研究

Clinical investigation of vagus nerve stimulation for treatment of drug-resistant epilepsy

目的 探讨迷走神经刺激术治疗药物难治性癫痫的方法及效果。方法 回顾性分析上海交通大学医学院附属仁济医院神经外科自2007年1月至2011年1月收治的14例药物难治性、全身性癫痫患者临床资料，其中脑炎后继发癫痫6例，外伤后继发癫痫3例，原因不明5例，所有患者均行左侧迷走神经刺激术治疗。术后3周内开机，初始刺激参数为：刺激电流0．25mA，频率30Hz，刺激时间30S，间歇时间5min，脉宽500μs。刺激电流强度以0．25mA为一调整单位逐渐递增，并综合其他参数调控以到达满意疗效。结果 随访3月以上，14例患者术后发作频率平均减少63．6％，其中3例发作频率减少〈50％，11例发作频率减少≥50％，6例发作频率减少〉80％，2例发作停止。5例患者使用磁铁后发作控制得到改善。结论 迷走神经刺激术是一种治疗药物难治性癫痫有效、安全的方法，对全身性癫痫发作患者同样有效。

Objective To explore the effectiveness and surgical procedures of vagus nerve stimulation （VNS） therapy in patients with drug-resistant epilepsy. Methods Fourteen patients with drug-resistant epilepsy, admitted to our hospital from January 2007 to January 2011, including 6 with epilepsy after cephalitis, 3 with epilepsy after head trauma and 5 with idiopathic epilepsy, were chosen in our study; their clinical data were retrospectively analyzed. VNS was performed in all the patients; the initial programming settings were as follows： output current 0.25 mA, frequency 30 Hz, pluse width 500 ~zs, ON 30 s and OFF 5 min. The optimum settings for each patient should balance the goals of maximizing efficacy, minimizing side effects, and preserving better life. Results The patients experienced a median seizure frequency reduction of 63.6% after 6-44 months of VNS therapy, including 3 patients having 〈50% seizure reduction, 11 （78.6%） having 〉or=50% seizure reduction, 6 （42.3%） having 〉80% seizure reduction, and 2 （14.3%） having seizure free. Seizure termination or seizure diminution was reported in 5 （35.7%） patients after using the magnet. Conclusion VNS is a safe and effective therapy and could improve the quality of life in patients with drug-resistant epilepsy; VNS is also effective for patients with symptomatic generalized epilepsy.