迷走神经刺激术治疗难治性癫痫3例
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摘要
目的:报告迷走神经刺激术(VNS)治疗3例药物难治性癫痫患者的临床疗效。方法:3例患者中女2例,男1例,平均年龄21.6岁,癫痫发作平均为13.7年。所有患者均行左侧迷走神经刺激手术,术后2周开机,分次调试参数至最适,并对临床疗效进行2年随访观察。结果:3例患者均未出现与手术及材料相关并发症,与刺激相关并发症给予对症处理后缓解或消失;刺激2年,McHugh评价为Ⅰ级2例,Ⅱ级1例;同时,3例患者抑郁、焦虑状态均有所改善,简易智力状态检查量表评分也较术前提高。结论:VNS治疗顽固性癫痫相对安全、有效。
Objective: To report the clinical efficacy of vagus nerve stimulation(VNS) in the treatment of 3 patients with refractory epilepsy. Methods: Of the 3 patients in this study, 2 were female and 1 was male. The average age was 21.6 years old, and the average length of disease history was 13.7 years. All patients underwent surgery on the left vagus nerve. Stimulation was implemented at 2 weeks after surgery, and parameters were adjusted to the optimal level. Clinical efficacy was followed up for 2 years. Results: None of the 3 patients had any complications related to surgery or material, and the complications related to stimulation were relieved or disappeared after symptomatic treatment. Two years after stimulation, the McHugh score was rated as grade I in2 cases and grade II in 1 case. In addition, the 3 patients experienced improvement of depression and anxiety as well as increased simple intelligence score compared with before surgery. Conclusion: Vagus nerve stimulation for the treatment of intractable epilepsy is a relatively safe and effective procedure.
Objective: To report the clinical efficacy of vagus nerve stimulation(VNS) in the treatment of 3 patients with refractory epilepsy. Methods: Of the 3 patients in this study, 2 were female and 1 was male. The average age was 21.6 years old, and the average length of disease history was 13.7 years. All patients underwent surgery on the left vagus nerve. Stimulation was implemented at 2 weeks after surgery, and parameters were adjusted to the optimal level. Clinical efficacy was followed up for 2 years. Results: None of the 3 patients had any complications related to surgery or material, and the complications related to stimulation were relieved or disappeared after symptomatic treatment. Two years after stimulation, the McHugh score was rated as grade I in2 cases and grade II in 1 case. In addition, the 3 patients experienced improvement of depression and anxiety as well as increased simple intelligence score compared with before surgery. Conclusion: Vagus nerve stimulation for the treatment of intractable epilepsy is a relatively safe and effective procedure.
引文
[1]Morris GL,Gloss D,Buchhalter J,et al.Evidence-based Guideline update:vagus nerve stimulation for the treatment of epilepsy:report of the Guideline Development Subcommittee of the American Academy of Neurology[J].Neurology,2013,81:1453-1459.
[2]Meng FG,Jia FM,Ren XH,et al.Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant Epilepsy[J].Chin Med J(Engl),2015,128:2599-2604.
[3]孟凡刚,张建国,马延山,等.迷走神经刺激术治疗顽固性癫痫初步探讨[J].中华神经外科杂志,2010,26:497-499.
[4]申玉勤,邓艳春,刘丽娟,等.迷走神经刺激治疗7例难治性癫痫[J].中国神经精神疾病杂志,2014,40:234-236.
[5]孟凡刚,马延山,张凯,等.迷走神经刺激治疗药物难治性癫痫的随访研究(附62例分析)[J].中国临床神经外科杂志,2012,17:579-581.
[6]McHugh JC,Singh HW,Phillips J,el al.Outcome measurement after vagal nerve stimulation therapy:proposal of a new classification[J].Epilepsia,2007,48:375-378.
[7]Ochoa-Gomez L,Lopez-Pison J,Femando-Martinez R,et al.Adescriptive study of non-symptomatic epilepsy according to age at onset at a neumpediatric section of regional reference[J].Rev Neurol,2016,63:447-454.
[8]Lee YK,Ah YM,Choi YJ.Antiepileptic dmg adherence and persistence in children with epilepsy attending a large tertiary care children's hospital[J].Epileptic Disord,2016,53:448-449.
[9]萍郝丽,朱雨岚.癫痫与抑郁障碍共病的研究进展[J].神经损伤与功能重建,2017,12:427-429.
[10]Kwan P,Brodie MJ.Early identification of refractory epilepsy[J].N Engl J Med,2000,342:314-319.
[11]Revesz D,Rydenhag B,Ben-Menachem E.Complications and safety of vagus nerve stimulation:25 years of experience at a single center[J].JNeurosurg Pediatr,2016,18:97-104.
[12]Englot DJ,Rolston JD,Wright CW,et al.Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy[J].Neurosurgery,2016,79:345-353.
[13]Morris GL,Gloss D,Buchhalter J,et al.Evidence-Based guideline update:vagus nerve stimulation for the treatment of epilepsy:report of the guideline development subcommittee of the American academy of neurology[J].Epilepsy curr,2013,13:297-303.
[14]孟凡刚,张凯,邵晓秋,等.国产迷走神经刺激器治疗药物难治性癫痫的前瞻性多中心随机对照临床试验研究[J].中华神经外科杂志,2016,32:913-917.
[15]Ramani R.Vagus nerve stimulation therapy for seizures[J].Neurosurg Anesthesiol,2008,20:29-35.
[16]Henry TR,Bakay RA,Pennell PB,et al.Brain blood-flow Alterations induced by therapeutic vagus nerve stimulation In partial epilepsy:II.Prolonged effects at high and low levels of stimulation[J].Epilepsia,2004,45:1064-1070.
[17]Rong P,Liu J,Wang L,et al.Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder:A nonrandomized controlled pilot study[J].J Affect Disord,2016,195:172-179.
[2]Meng FG,Jia FM,Ren XH,et al.Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant Epilepsy[J].Chin Med J(Engl),2015,128:2599-2604.
[3]孟凡刚,张建国,马延山,等.迷走神经刺激术治疗顽固性癫痫初步探讨[J].中华神经外科杂志,2010,26:497-499.
[4]申玉勤,邓艳春,刘丽娟,等.迷走神经刺激治疗7例难治性癫痫[J].中国神经精神疾病杂志,2014,40:234-236.
[5]孟凡刚,马延山,张凯,等.迷走神经刺激治疗药物难治性癫痫的随访研究(附62例分析)[J].中国临床神经外科杂志,2012,17:579-581.
[6]McHugh JC,Singh HW,Phillips J,el al.Outcome measurement after vagal nerve stimulation therapy:proposal of a new classification[J].Epilepsia,2007,48:375-378.
[7]Ochoa-Gomez L,Lopez-Pison J,Femando-Martinez R,et al.Adescriptive study of non-symptomatic epilepsy according to age at onset at a neumpediatric section of regional reference[J].Rev Neurol,2016,63:447-454.
[8]Lee YK,Ah YM,Choi YJ.Antiepileptic dmg adherence and persistence in children with epilepsy attending a large tertiary care children's hospital[J].Epileptic Disord,2016,53:448-449.
[9]萍郝丽,朱雨岚.癫痫与抑郁障碍共病的研究进展[J].神经损伤与功能重建,2017,12:427-429.
[10]Kwan P,Brodie MJ.Early identification of refractory epilepsy[J].N Engl J Med,2000,342:314-319.
[11]Revesz D,Rydenhag B,Ben-Menachem E.Complications and safety of vagus nerve stimulation:25 years of experience at a single center[J].JNeurosurg Pediatr,2016,18:97-104.
[12]Englot DJ,Rolston JD,Wright CW,et al.Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy[J].Neurosurgery,2016,79:345-353.
[13]Morris GL,Gloss D,Buchhalter J,et al.Evidence-Based guideline update:vagus nerve stimulation for the treatment of epilepsy:report of the guideline development subcommittee of the American academy of neurology[J].Epilepsy curr,2013,13:297-303.
[14]孟凡刚,张凯,邵晓秋,等.国产迷走神经刺激器治疗药物难治性癫痫的前瞻性多中心随机对照临床试验研究[J].中华神经外科杂志,2016,32:913-917.
[15]Ramani R.Vagus nerve stimulation therapy for seizures[J].Neurosurg Anesthesiol,2008,20:29-35.
[16]Henry TR,Bakay RA,Pennell PB,et al.Brain blood-flow Alterations induced by therapeutic vagus nerve stimulation In partial epilepsy:II.Prolonged effects at high and low levels of stimulation[J].Epilepsia,2004,45:1064-1070.
[17]Rong P,Liu J,Wang L,et al.Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder:A nonrandomized controlled pilot study[J].J Affect Disord,2016,195:172-179.