迷走神经刺激术治疗儿童难治性癫痫的临床疗效初步分析

The preliminary analysis of clinical effect of vagus nerve stimulation in the treatment of refractory epilepsy in children

目的探讨迷走神经刺激术(Vagus nerve stimulation,VNS)治疗儿童药物难治性癫痫的疗效以及影响其疗效的关键因素。方法回顾性分析2016年1月—2023年4月于湖南省第二人民医院行VNS治疗的22例药物难治性癫痫患儿的临床资料;术后随访至少1年,以平均癫痫发作减少率、有效率及McHugh分级作为VNS疗效的指标,评估VNS的疗效;将发作减少率≥50%的患者定义为应答者,分别使用Mann-Witney U检验、χ^(2)检验,将具有统计学意义的指标(P<0.05)进行单因素和多因素Logistics回归分析。结果本组22例患者中,术后1、3、6、9、12个月的平均发作减少率分别为12.66%、26.10%、37.47%、48.18%、54.38%,有效率分别为5.00%、9.00%、36.00%、50.00%、68.00%;术后12个月McHugh疗效分级Ⅰ级3例,Ⅱ级12例,Ⅲ级7例,Ⅴ级0例;单因素及多因素Logistic回归分析表明,儿童癫痫疗效与发作类型相关,其中全面性发作相比于局灶性发作术后疗效更佳(OR=0.062,P=0.014),且在全面性发作中,肌阵挛发作、强直发作手术疗效优于其他类型。结论VNS治疗儿童药物难治性癫痫的临床疗效具有时间累积性,全面性发作中的肌阵挛发作以及强直发作手术效果更优。

Objective To investigate the efficacy of vagus nerve stimulation(VNS)in the treatment of refractory epilepsy in children and the key factors affecting its efficacy.Methods The clinical data of 22 children with drug-resistant epilepsy who received VNS treatment in the Second People's Hospital of Hunan Province from January 2016 to April 2023 were analyzed.The average seizure reduction rate,effective rate and McHugh grade were used to evaluate the efficacy of VNS after at least 1 year follow-up.Patients with an attack reduction rate of≥50%were defined as respondents,and Mann-Witney U test and χ^(2) test were used,respectively,to conduct univariate and multifactor Logistics regression analysis with statistically significant indicators(P<0.05).Results Among the 22 patients,the average attack reduction rate was 12.66%at 1 month,26.10%at 3 months,37.47%at 6 months,48.18%at 9 months and 54.38%at 12 months.The effective rate was 5.00%,9.00%,36.00%,50.00%and 68.00%,respectively.12 months after operation,there were 3 cases of grade I,12 cases of grade II,7 cases of grade III,and 0 cases of grade V.Unifactorial and multivariate Logistic regression analysis showed that the curative effect of epilepsy in children was related to the seizure type,among which the curative effect of general seizure was better than that of focal seizure(OR=0.062,P=0.014),and the curative effect of myoclonic seizure and tonic seizure was better than that of other types in general seizure.Conclusion The clinical effect of VNS in the treatment of refractory epilepsy in children is time cumulative,and the surgical effect of myoclonic seizures and tonic seizures in general seizures is better.