植入式迷走神经刺激术对脑瘫伴耐药性癫痫患儿的疗效及其影响因素

Efficacy and Influencing Factors of Implanted Vagus Nerve Stimulation in Children with Cerebral Palsy and Drug-Resistant Epilepsy

目的探讨植入式迷走神经刺激(iVNS)对脑瘫伴耐药性癫痫患儿的疗效,以及影响疗效的因素。方法选取2015年9月至2018年3月于郑州大学第五附属医院接受iVNS治疗的58例脑瘫伴耐药性癫痫患儿。记录iVNS治疗前后患儿的癫痫发作情况及治疗后并发症情况。将受试者术前3个月的癫痫发作情况作为基线参考指标,占主导地位的癫痫发作频率较基线发作频率减少50%的患儿被定义为"应答者"。根据上述定义将患儿分为应答组(29例)和无应答组(29例)。分析癫痫发作年龄、iVNS植入年龄、智商、改良Ashworth痉挛分级、优势发作类型和是否接受颈动脉交感神经网剥脱术等因素与疗效的关系。结果术后6、12、24个月的癫痫控制有效率分别为48.28%、50.00%、56.90%。术后2周有2例患者出现声音嘶哑,1例感觉异常,1例饮水呛咳,均在2周内自行缓解。两组性别、癫痫发作年龄、iVNS植入年龄、智商、改良Ashworth痉挛分级比较,差异无统计学意义(P>0.05);与非应答组比较,应答组局灶性发作占比和接受iVNS联合颈动脉交感神经网剥脱术治疗的患者占比均较高(P<0.05)。多因素logistic回归分析显示,接受颈动脉交感神经网剥脱术治疗是影响iVNS疗效的独立保护因素(P<0.05)。结论iVNS是一种耐受性好、有效的辅助治疗脑瘫伴癫痫的方法。接受颈动脉交感神经网剥脱术治疗的脑瘫伴耐药性癫痫患儿可能对iVNS的反应更好。

Objective To explore the curative effect of implanted vagus nerve stimulation(iVNS)in children with cerebral palsy and drug-resistant epilepsy,and the factors influencing the curative effect.Methods Fifty-eight cases of children with cerebral palsy and drug-resistant epilepsy who received iVNS treatment admitted to the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to March 2018 were selected.The seizures of the children before and after iVNS surgery and the complications after iVNS were recorded.Taking the epileptic seizures of the subjects 3 months before operation as the baseline reference index,the children whose dominant epileptic seizure frequency was reduced by 50%compared with the baseline seizure frequency were defined as"responders".According to the above definition,children were divided into response group(29 cases)and non-response group(29 cases).The relationships between the age of epilepsy onset,the age of iVNS implantation,intelligence quotient,modified Ashworth spasticity grading,type of dominant seizures and whether they received carotid sympathetic nerve net stripping and the efficacy were analyzed.Results The effective rates of seizure control at 6,12,and 24 months after surgery were 48.28%,50.00%and 56.90%,respectively.Two weeks after the operation,there were two patients with hoarseness,one case with abnormal sensation,and one case with choked on drinking water,all of which in self-remission within two weeks.There was no statistical difference in gender,the age of epilepsy onset,the age of iVNS implantation,intelligence quotient and modified Ashworth spasticity grading between the two groups(P>0.05).Compared with non-response group,the proportions of focal seizures and patients receiving iVNS combined with carotid sympathetic nerve network stripping in response group were higher(P<0.05).Multivariate logistic regression analysis showed that carotid sympathetic nerve net stripping was an independent protective factor affecting the efficacy of iVNS(P<0.05).Conclusion iVNS is a well-tolerated and effective adjuvant treatment for cerebral palsy with epilepsy.Children with cerebral palsy and drug-resistant epilepsy undergoing carotid sympathetic nerve network stripping may have better response to iVNS.