Long-Term Seizure Outcome With or Without Vagal Nerve Stimulation Therapy.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI:10.1212/CPJ.0000000000200358

Sonia Gill, Kathryn N Devlin, Hsiangkuo Yuan, Scott Mintzer, Christopher Skidmore, Chengyuan Wu, Michael R Sperling, Maromi Nei

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引用次数: 0

Abstract

Background and objectives: To compare long-term seizure control in patients with long-term VNS (vagal nerve stimulator) stimulation (VNS-on) with those who discontinued VNS after >3 years (VNS-off).

Methods: Patients with refractory epilepsy with VNS therapy for >3 years (and follow-up for >2 years after VNS discontinuation for VNS-off patients) were included. Patients with brain surgery <3 years after VNS were excluded. We compared the percentage of patients with ≥50% seizure reduction (50% responder rate) and change in seizure frequency within and between groups in follow-up.

Results: Thirty-three VNS-on and 16 VNS-off patients were evaluated. VNS-on patients underwent stimulation for 9.7 years (mean). VNS-off patients had VNS treatment for 6.5 years (mean), discontinued treatment, then had additional 8.0 years (mean) follow-up. 50% responder rates were similar between groups (VNS-on: 54.5% vs VNS-off at last-on: 37.5%, p = 0.26; vs VNS-off at the last follow-up: 62.5%, p = 0.60). VNS-on patients had a significant reduction in seizure frequency at the last follow-up compared with baseline (median [Mdn] = -4.5 seizures/month, interquartile range [IQR] = 14.0, 56% reduction, p = 0.013). VNS-off patients also showed significant seizure reduction while still continuing VNS therapy (Mdn = -1.0 seizures/month, IQR = 13.0, 35% reduction, p = 0.020) and, after discontinuing therapy, at the last follow-up compared with baseline (Mdn = -3.2, IQR = 11.0, 52% reduction, p = 0.020). The 2 groups were comparable in seizure frequency change both at the last-on visit (absolute change, p = 0.62; relative change, p = 0.50) at the last follow-up (absolute change, p = 0.67; relative change, p = 0.76).

Discussion: Patients who discontinued VNS therapy and those who continued therapy had similar response during active treatment and similar long-term outcomes, suggesting that factors such as the natural disease course and/or medication treatment strongly affect long-term outcomes.

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接受或不接受迷走神经刺激疗法的长期癫痫发作结果

背景和目的：比较长期使用迷走神经刺激器（VNS-on）和停用 VNS 超过 3 年的患者（VNS-off）的长期癫痫控制情况：比较长期接受 VNS（迷走神经刺激器）刺激（VNS-on）的患者与停用 VNS 超过 3 年的患者（VNS-off）的长期癫痫发作控制情况：方法：纳入接受 VNS 治疗超过 3 年的难治性癫痫患者（VNS-off 患者在 VNS 停用后随访超过 2 年）。接受脑部手术的患者结果评估了 33 名启用 VNS 的患者和 16 名停用 VNS 的患者。使用 VNS 的患者接受刺激的时间为 9.7 年（平均值）。VNS-off 患者接受 VNS 治疗 6.5 年（平均值），停止治疗后又接受了 8.0 年（平均值）的随访。两组患者的 50%应答率相似（VNS-on：54.5% vs VNS-off at last-on：37.5%，p = 0.26；vs VNS-off at the last follow-up：62.5%，p = 0.60）。与基线相比，最后一次随访时 VNS 开启患者的癫痫发作频率显著减少（中位数 [Mdn] = -4.5 次/月，四分位数间距 [IQR] = 14.0，减少 56%，p = 0.013）。停用 VNS 的患者在继续接受 VNS 治疗时发作次数也显著减少（Mdn = -1.0 次发作/月，IQR = 13.0，减少 35%，p = 0.020），停止治疗后，最后一次随访时与基线相比发作次数也显著减少（Mdn = -3.2，IQR = 11.0，减少 52%，p = 0.020）。两组患者在最后一次就诊时的发作频率变化（绝对变化，p = 0.62；相对变化，p = 0.50）和最后一次随访时的发作频率变化（绝对变化，p = 0.67；相对变化，p = 0.76）相当：讨论：停止 VNS 治疗和继续治疗的患者在积极治疗期间的反应相似，长期疗效也相似，这表明自然病程和/或药物治疗等因素对长期疗效有很大影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.