迷走神经刺激术治疗儿童难治性癫癎的初步探讨
|
摘要
目的总结迷走神经刺激术(vagus nerve stimulation,VNS)治疗儿童难治性癫癎的疗效及经验。方法回顾性分析4例经VNS治疗的儿童难治性癫癎,详细分析病程、发作类型、服药情况、术前脑电图、影像学、手术治疗、术后参数调整、术后癫癎控制情况及并发症等,以评估其疗效及安全性。结果 4例病儿均符合儿童难治性癫癎诊断标准并顺利完成手术,术后根据病儿耐受程度及癫癎控制情况调整刺激参数,随访13～20个月,术后癫癎控制达MCHUGHⅠA级2例,ⅡA级2例;出现一过性声嘶2例,无其他并发症,病儿生活质量明显改善。结论 VNS治疗儿童难治性癫癎安全有效,手术创伤小、恢复快,能明显改善病儿生活质量,值得推广。
Objective To summarize the efficacy and experience of vagus nerve stimulation(VNS) for refractory epilepsy in children.Methods Four refractory epilepsy patients undergoing VNS were analyzed retrospectively. The clinical data including course of disease,seizure type, usage of antiepileptic drug, electroencephalography, radiography, surgical procedure, parameter adjustment, seizure control and complications were analyzed in detail. Results Four patients received VNS according to preoperative assessment. According to the degree of tolerance and the control of epilepsy, the stimulation parameters were adjusted. All patients were followed up for 13-20 months after the operation. According to MCHUGH classification, Grade Ⅰ A was achieved in 2 patients and Grade Ⅱ A in 2. There was hoarseness in 2 patients, no other complication occured. The quality of life was improved significantly in these patients. Conclusions VNS is a safe and effective treatment for children with refractory epilepsy. And also its surgical trauma is small, and it can improve patient quality of life, thus being worthy of popularization.
Objective To summarize the efficacy and experience of vagus nerve stimulation(VNS) for refractory epilepsy in children.Methods Four refractory epilepsy patients undergoing VNS were analyzed retrospectively. The clinical data including course of disease,seizure type, usage of antiepileptic drug, electroencephalography, radiography, surgical procedure, parameter adjustment, seizure control and complications were analyzed in detail. Results Four patients received VNS according to preoperative assessment. According to the degree of tolerance and the control of epilepsy, the stimulation parameters were adjusted. All patients were followed up for 13-20 months after the operation. According to MCHUGH classification, Grade Ⅰ A was achieved in 2 patients and Grade Ⅱ A in 2. There was hoarseness in 2 patients, no other complication occured. The quality of life was improved significantly in these patients. Conclusions VNS is a safe and effective treatment for children with refractory epilepsy. And also its surgical trauma is small, and it can improve patient quality of life, thus being worthy of popularization.
引文
[1] HECK C N, KI NG-STEPHENS D, MASSEY A D, et al.Two-year seizure reduction in adults with medically in tractable partial onset epilepsy treated with responsive neurostimulation:final results of the RNS System Pivotal trial[J]. Epilepsia, 2014, 55(3):432-441.
[2] GALBARRIATU L, POMPOSO I, AURRECOECHEA J,et al. Vagus nerve stimulation therapy for treatment-resistant epilepsy:a 15-year experience at a single institution[J]. Clin Neurol Neurosurg, 2015, 137:89-93.
[3] BEEKWILDER J P, BEEMS T. Overview of the clinical applications of vagus nerve stimulation[J]. J Clin Neurophysiol, 2010, 27(2):130-138.
[4]石秀玉,邹丽萍.儿童难治性癫癎间临床诊断现状[J].中国实用儿科杂志, 2011, 26(7):481-484.
[5] MCHUGH J C, SINGH H W, PHILLIPS J, et al. Outcome measurement after vagal nerve stimulation therapy:proposal of a new classification[J]. Epilepsia, 2007, 48(2):375-378.
[6] ENGLOT D J, ROLSTON J D, WRIGHT C W, et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy[J]. Neurosurgery, 2016,79(3):345-353.
[7]关宇光,栾伟,陈思畅,等.岛周大脑半球离断术治疗药物难治性癫癎间[J].中国微侵袭神经外科杂志, 2017, 22(5):209-211.
[8] CERSOSIMO R O, BARTULUCHI M, FORTINI S, et al.Vagus nerve stimulation:effectiveness and tolerability in64 paediatric patients with refractory epilepsies[J]. Epileptic Disord, 2011, 13(4):382-388.
[9] CUNNINGHAM J T, MIFFLIN S W, GOULD G G, et al.Induction of c-Fos and DeltaFosB immunoreactivity in rat brain by Vagal nerve stimulation[J]. Neuropsychopharmacology, 2008, 33(8):1884-1895.
[10]申玉勤,邓艳春.迷走神经刺激术治疗难治性癫癎间的研究进展[J].临床神经病学杂志, 2014, 27(4):313-315.
[11] WASEEM H, RAFFA S J, BENBADIS S R, et al. Lead revision surgery for vagus nerve stimulation in epilepsy:outcomes and efficacy[J]. Epilepsy Behav, 2014, 31:110-113.
[12] OROSZ I, MCCORMICK D, ZAMPONI N, et al. Vagus nerve stimulation for drug-resistant epilepsy:a European long-term study up to 24 months in 347 children[J]. Epilepsia,2014, 55(10):1576-1584.
[13] MAJKOWSKA-ZWOLINSKA B, ZWOLINSKI P,ROSZKOWSKI M, et al. Long-term results of vagus nerve stimulation in children and adolescents with drug-resistant epilepsy[J]. Childs Nerv Syst, 2012, 28(4):621-628.
[14]孟凡刚,马延山,张凯,等.迷走神经刺激治疗药物难治性癫癎间的随访研究(附62例分析)[J].中国临床神经外科杂志, 2012, 17(10):579-581.
[15] MORRIS G L, 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(16):1453-1459.
[16]方铁,方方,张杰,等.迷走神经刺激治疗儿童难治性癫癎间的初步疗效分析[J].中华神经外科疾病研究杂志,2017, 16(5):407-411.
[17] BODIN E, LE MOING A G, BOUREL-PONCHEL E, et al.Vagus nerve stimulation in the treatment of drug-resistant epilepsy in 29 children[J]. Eur J Paediatr Neurol, 2016, 20(3):346-351.
[2] GALBARRIATU L, POMPOSO I, AURRECOECHEA J,et al. Vagus nerve stimulation therapy for treatment-resistant epilepsy:a 15-year experience at a single institution[J]. Clin Neurol Neurosurg, 2015, 137:89-93.
[3] BEEKWILDER J P, BEEMS T. Overview of the clinical applications of vagus nerve stimulation[J]. J Clin Neurophysiol, 2010, 27(2):130-138.
[4]石秀玉,邹丽萍.儿童难治性癫癎间临床诊断现状[J].中国实用儿科杂志, 2011, 26(7):481-484.
[5] MCHUGH J C, SINGH H W, PHILLIPS J, et al. Outcome measurement after vagal nerve stimulation therapy:proposal of a new classification[J]. Epilepsia, 2007, 48(2):375-378.
[6] ENGLOT D J, ROLSTON J D, WRIGHT C W, et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy[J]. Neurosurgery, 2016,79(3):345-353.
[7]关宇光,栾伟,陈思畅,等.岛周大脑半球离断术治疗药物难治性癫癎间[J].中国微侵袭神经外科杂志, 2017, 22(5):209-211.
[8] CERSOSIMO R O, BARTULUCHI M, FORTINI S, et al.Vagus nerve stimulation:effectiveness and tolerability in64 paediatric patients with refractory epilepsies[J]. Epileptic Disord, 2011, 13(4):382-388.
[9] CUNNINGHAM J T, MIFFLIN S W, GOULD G G, et al.Induction of c-Fos and DeltaFosB immunoreactivity in rat brain by Vagal nerve stimulation[J]. Neuropsychopharmacology, 2008, 33(8):1884-1895.
[10]申玉勤,邓艳春.迷走神经刺激术治疗难治性癫癎间的研究进展[J].临床神经病学杂志, 2014, 27(4):313-315.
[11] WASEEM H, RAFFA S J, BENBADIS S R, et al. Lead revision surgery for vagus nerve stimulation in epilepsy:outcomes and efficacy[J]. Epilepsy Behav, 2014, 31:110-113.
[12] OROSZ I, MCCORMICK D, ZAMPONI N, et al. Vagus nerve stimulation for drug-resistant epilepsy:a European long-term study up to 24 months in 347 children[J]. Epilepsia,2014, 55(10):1576-1584.
[13] MAJKOWSKA-ZWOLINSKA B, ZWOLINSKI P,ROSZKOWSKI M, et al. Long-term results of vagus nerve stimulation in children and adolescents with drug-resistant epilepsy[J]. Childs Nerv Syst, 2012, 28(4):621-628.
[14]孟凡刚,马延山,张凯,等.迷走神经刺激治疗药物难治性癫癎间的随访研究(附62例分析)[J].中国临床神经外科杂志, 2012, 17(10):579-581.
[15] MORRIS G L, 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(16):1453-1459.
[16]方铁,方方,张杰,等.迷走神经刺激治疗儿童难治性癫癎间的初步疗效分析[J].中华神经外科疾病研究杂志,2017, 16(5):407-411.
[17] BODIN E, LE MOING A G, BOUREL-PONCHEL E, et al.Vagus nerve stimulation in the treatment of drug-resistant epilepsy in 29 children[J]. Eur J Paediatr Neurol, 2016, 20(3):346-351.