迷走神经电刺激对难治性磁共振阴性癫痫患者疗效及预测因素分析

Efficacy and predictive factors analysis of vagus nerve stimulation in patients with refractory MRI-negative epilepsy

目的探讨迷走神经刺激术(Vagus nerve stimulation,VNS)在难治性磁共振(Magnetic resonance imaging,MRI)阴性癫痫患者中的疗效,并评估其潜在的临床预测指标。方法对北京天坛医院及北京丰台医院2016年1月—2023年9月随访6个月以上VNS治疗难治性MRI阴性癫痫患者24例的疗效数据进行了回顾性的研究。患者按VNS的疗效分为应答组(癫痫发作频率减少≥50%)和无应答组(癫痫发作频率减少<50%)两个亚组。进一步分析VNS术前临床数据和疗效的关系,筛选VNS疗效的潜在预测指标。结果共纳入24例患者,平均年龄为(14.26±8.39)岁。37.5%的患者癫痫发作频率降低50%以上,经VNS治疗后实现无癫痫发作的患者达到8.3%。术前癫痫发作频率和间期痫样放电类型与VNS疗效显著相关(P<0.05)。多因素回归分析显示,每月发作频率<100次和局灶性间期痫样放电是VNS疗效的独立预测因素(P<0.05)。结论VNS是治疗难治性MRI阴性癫痫患者的有效手段。术前每月发作频率较低和局灶性间期痫样放电是VNS疗效的潜在预测指标。这些发现为临床医生在选择和评估VNS治疗患者时提供了重要参考。

Objective To investigate the efficacy of vagus nerve stimulation(VNS)in patients with refractory magnetic resonance imaging(MRI)-negative epilepsy and to evaluate potential clinical predictors.Methods A retrospective collection of efficacy data was conducted on 24 patients with intractable MRI-negative epilepsy treated with VNS,who were followed up for more than six months,at Beijing Tiantan Hospital and Beijing Fengtai Hospital from January 2016 to September 2023.Patients were divided into two subgroups based on their response to VNS:responders(≥50%reduction in seizure frequency)and non-responders(<50%reduction in seizure frequency).The relationship between preoperative clinical data and VNS efficacy was further analyzed to identify potential predictors of VNS efficacy.Results A total of 24 patients were included,with an average age of(14.26±8.39)years old.Seizure frequency was reduced by more than 50%in 37.5%of patients,and 8.3%of patients achieved seizure-free after VNS treatment.Preoperative seizure frequency and interictal epileptiform discharge type were significantly associated with VNS efficacy(P<0.05).Multivariate regression analysis showed that a monthly seizure frequency of less than 100 and focal interictal epileptiform discharges were independent predictors of VNS efficacy(P<0.05).Conclusion VNS is an effective treatment for patients with refractory MRI-negative epilepsy.Lower monthly seizure frequency and focal interictal epileptiform discharges are potential predictors of VNS efficacy.These findings provide important references for clinicians in selecting and evaluating patients for VNS treatment.