Long-Term Outcome of Vagus Nerve Stimulation for Drug-Resistant Epilepsy.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2025-01-01 Epub Date: 2025-02-14 DOI:10.4103/aian.aian_389_24

Anuja Patil, Sita Jayalakshmi, Shanmukhi Somayajula, Dhrumil Shah, Sudhindra Vooturi, Manas Panigrahi

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引用次数: 0

Abstract

Background and objectives: In this study, we aimed to assess the long-term outcome of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE).

Methods: A retrospective analysis of outcome data of 24 patients with DRE, who had been implanted with VNS and had at least 5 years of post-surgery follow-up was performed. The seizure outcome at the latest follow-up was classified as class I-V as proposed by John C. McHugh. The cognitive, psychiatric, and behavioral outcomes were recorded using standardized tests.

Results: Mean age at the time of VNS implantation was 18.7 (6-38) years; nine (37.5%) of the patients were females. Mean duration of epilepsy was 13.6 years (range: 2.5-35 years); 18 (75%) patients had multiple (≥2) seizure types and 15 (62.5%) had daily seizures. The most common etiology was perinatal hypoxic injury (15, 62.5%). More than 50% seizure reduction (class 1 and 2) was noted in 54.2% of patients at 1 year, which increased to 75% at ≥5 years follow-up. A significantly higher number of patients with other etiologies had >50% reduction in seizures at the latest follow-up, when compared to those with hypoxic-ischemic encephalopathy (53.3% vs. 100%, P = 0.0024). The average intelligence quotient (IQ; 71.17 ± 28.92 vs. 64.65 ± 29.61, P = 0.014) and quality of life (66.64 ± 14.63 vs. 64.65 ± 29.61, P < 0.001) scores were significantly higher in patients post-VNS implantation, when compared to their baseline scores. Furthermore, significant number of patients had improvement in psychiatric diagnosis (29.2% vs. 4.2%, P = 0.047) and behavioral problems (50% vs. 4.2%, P < 0.001) post-VNS implantation.

Conclusions: The present study shows >50% seizure reduction in 75% of patients after VNS implantation at long-term follow-up, with improvement in IQ, quality of life, psychiatric and behavioral problems.

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迷走神经刺激治疗耐药癫痫的远期疗效。

背景与目的：在本研究中，我们旨在评估迷走神经刺激（VNS）治疗耐药癫痫（DRE）患者的长期疗效。方法：回顾性分析24例植入VNS且术后随访至少5年的DRE患者的结局资料。根据John C. McHugh的建议，最近一次随访的癫痫发作结果被归类为I-V类。使用标准化测试记录认知、精神和行为结果。结果：植入VNS时的平均年龄为18.7（6-38）岁；女性9例（37.5%）。癫痫的平均持续时间为13.6年（范围：2.5-35年）；18例（75%）患者有多种（≥2种）发作类型，15例（62.5%）患者每日发作。最常见的病因是围产期缺氧损伤（15.62.5%）。54.2%的患者在随访1年时癫痫发作减少超过50%（1级和2级），在随访≥5年时增加到75%。在最近的随访中，与缺氧缺血性脑病患者相比，其他病因的患者癫痫发作减少了50%（53.3%比100%，P = 0.0024）。平均智商(IQ；vns植入后患者的生活质量评分（66.64±14.63比64.65±29.61,P = 0.014）和生活质量评分（71.17±28.92比64.65±29.61,P < 0.001）均显著高于基线评分。此外，大量患者在植入vns后精神诊断（29.2%比4.2%,P = 0.047）和行为问题（50%比4.2%,P < 0.001）均有改善。结论：长期随访显示，75%的VNS植入患者癫痫发作减少50%，IQ、生活质量、精神和行为问题均有改善。

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

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.