迷走神经刺激术对儿童癫痫性脑病癫痫发作的疗效分析

Analysis of the effect of vagus nerve stimulation on epileptic encephalopathy in children

目的探讨迷走神经刺激术(VNS)治疗儿童癫痫性脑病癫痫发作的疗效。方法在2016年10月至2018年8月苏州大学附属儿童医院完成了VNS的患儿中,根据入选标准和排除标准筛选出15例癫痫性脑病患儿。收集该15例患儿的临床病例资料,并进行1~2年随访。VNS开机后2周时首次随访,开机后3个月随访第2次,之后每间隔3个月随访1次,1年后每间隔6个月随访1次,共随访1~2年。随访内容包括VNS治疗后癫痫发作频率等。督促患儿家长详细记录癫痫日记。对比分析不同随访时间的发作频率减少率、有效率。结果本研究共有15个病例入组,其中男7例,女8例;平均年龄(7.3±1.76)岁;Lennox-Gastaut综合征(LGS)8例,Dravet综合征4例,Doose综合征3例;癫痫病程1~9年,平均(5.46±2.19)年。主要的发作形式包括不典型失神发作、失张力发作、肌阵挛发作、强直发作、局灶性发作、全面性强直-阵挛发作等。抗癫痫药物保留种类2~4种,平均(3±0.6)种。VNS治疗2周的平均发作减少率为7.80%,3个月、6个月、9个月、12个月、18个月、24个月分别为31.81%、42.78%、50.58%、59.39%、63.89%、62.55%。LGS患儿的发作减少率在治疗2周、3个月、6个月、9个月、12个月、18个月、24个月时分别为6.77%、34.58%、43.54%、50.56%、60.83%、63.44%、61.53%;Dravet综合征的分别为11.56%、25.14%、39.31%、51.77%、59.38%、63.70%、64.58%;Doose综合征的分别为5.93%、33.33%、45.37%、49.07%、55.56%、66.67%(Doose综合征的随访时间未达24个月)。癫痫发作频率减少最多的主要发作形式为肌阵挛发作、不典型失神发作、强直发作。在治疗2周时未见发作减少率≥50%的患儿,3个月、6个月、9个月、12个月、18个月、24个月时发作减少率≥50%的患儿占全部患儿的比例分别为20.00%、46.67%、53.33%、66.67%、77.78%、66.67%。随访时间12个月时三种癫痫性脑病的有效率分别为LGS 62.50%、Dravet综合征75.00%、Doose综合征66.67%。结论 VNS是治疗儿童癫痫性脑病安全有效的手段,可减少癫痫性脑病患儿癫痫发作频率,对不同癫痫发作类型改善最显著的为不典型失神发作和跌倒发作(肌阵挛发作、失张力发作、强直发作),有时间积累效应,即治疗时间越长,癫痫发作控制效果越好。

Objective To investigate the effect of vagus nerve stimulation(VNS) on epileptic seizures in children with epileptic encephalopathy. Methods From October 2016 to August 2018, 15 children with epileptic encephalopathy were selected according to the inclusion criteria and exclusion criteria from the Children’s Hospital Affiliated to Soochow University who had completed VNS. Clinical data of the 15 children were collected and followed up for 1-2 years. The patients were followed up for the first time 2 weeks after starting up, for the second time 3 months after starting up, once every 3 months after starting up, and once every 6 months after 1 year, for a total of 1-2 years. Follow-up included the frequency of seizures after VNS treatment. Urge the parents to record the epilepsy diary in detail. The frequency reduction rate and effective rate of seizures at different follow-up time were compared and analyzed. Results A total of 15 cases were enrolled in this study, including 7 males and 8 females, with an average age of(7.3±1.76) years. There were 8 cases of Lennox-Gastaut syndrome(LGS), 4 cases of Dravet syndrome and 3 cases of Doose syndrome. The course of epilepsy was 1-9 years, with an average of(5.46±2.19) years. The main seizure forms include atypical absence, atonic, myoclonic, tonic, focal seizure, general tonic-clonic seizure and so on. There were 2-4 types of antiepileptic drugs, with an average of(3.0±0.6). The mean seizure reduction rate at 2 weeks of VNS treatment was 7. 80%,at 3 months,6 months,9 months,12 months,18 months and 24 months were 31. 81%,42. 78%,50. 58%,59. 39%,63. 89%,and 62. 55%,respectively. The reduction rate of seizures in children with LGS at 2 weeks,3 months,6 months,9 months,12 months,18 months and 24 months after treatment were 6. 77%,34. 58%,43. 54%,50. 56%,60. 83%,63. 44% and 61. 53%,respectively.While in Dravet syndrome were 11. 56%,25. 14%,39. 31%,51. 77%,59. 38%,63. 70% and 64. 58%,respectively. In Doose syndrome were 5. 93%,33. 33%,45. 37%,49. 07%,55. 56% and 66. 67%,respectively( Doose syndrome was followed up for less than 24 weeks). The main seizure form with the largest decrease in seizure frequency was myoclonic seizure,atypical absence seizure and tonic seizure. At 2 weeks of treatment,there was no children with seizure reduction rate ≥50%,while at 3 months,6 months,9 months,12 months,18 months and 24 months,the proportion of children with seizure reduction rates ≥ 50% were 20. 00%,46. 67%,53. 33%,66. 67%,77. 78% and 66. 67%,respectively. The effective rates of the three epileptic encephalopathy were62. 50% of LGS,75. 00% of Dravet syndrome and 66. 67% of Doose syndrome at 12 months of follow-up.Conclusions VNS is a safe and effective treatment method,it can reduce seizure frequency in children with epileptic encephalopathy. The seizure type with the best effect is atypical absence seizure,myoclonic seizure,atonic seizure,tonic seizure,the treatment has time accumulation effect,the longer the time of treatment,the better the control effect of epileptic seizure.