迷走神经刺激术治疗药物难治性癫痫的疗效分析(附110例报道)  

Efficacy analysis of vagus nerve stimulation for the treatment of drug resistant epilepsy:A report of 110 cases

作　　者：张祎鸣 钱若兵 傅先明 魏祥品 江录伟 张栋 牛朝诗 汪业汉 Zhang Yiming;Qian Ruobing;Fu Xianming;Wei Xiangpin;Jiang Luwei;Zhang Dong;Niu Chaoshi;Wang Yehan(Department of Neurosurgery,Provincial Hospital Affiliated to Anhui Medical University(the First Affiliated Hospital of University of Science and Technology of China),Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院(中国科学技术大学附属第一医院)神经外科,脑功能与脑疾病安徽省重点实验室,合肥230001

出　　处：《中华神经外科杂志》2019年第10期1059-1063,共5页Chinese Journal of Neurosurgery

基　　金：安徽省重点研究与开发计划项目(1804h08020244);安徽省科技攻关计划项目(1301042201);安徽省重点实验室绩效考核项目(1306c083028)。

摘　　要：目的探讨迷走神经刺激术(VNS)治疗药物难治性癫痫的临床疗效。方法回顾性分析2014年2月至2018年3月安徽医科大学附属省立医院(中国科学技术大学附属第一医院)神经外科行VNS治疗的110例药物难治性癫痫患者的临床资料。通过门诊复诊对患者术后的癫痫发作频率、发作严重程度等进行随访,并依据McHugh分级标准进行评估,以分析其术后疗效。结果110例患者的术后McHugh分级结果:ⅠA级10例,ⅠB级6例,ⅡA级25例,ⅡB级7例,ⅢA级30例,ⅢB级8例,Ⅳ级1例,Ⅴ级20例,另有3例失访。手术前后癫痫的发作频率差异具有统计学意义(P<0.001);按患者的年龄、性别以及癫痫病程长短进行分组比较,差异均无统计学意义(均P>0.05);按不同癫痫发作类型比较,无法分类组与局灶起源组、全面起源组间的McHugh分级分布差异具有统计学意义(均P<0.05);随着VNS刺激时间的延长,患者的发作频率逐渐下降(P<0.05)。结论VNS可以明显减少和控制药物难治性癫痫患者的发作频率;对于局灶起源、全面起源的癫痫患者疗效较好,而对无法分类的癫痫发作类型疗效较差;随着刺激时间的延长,其疗效逐渐提高,但是患者的年龄、性别以及病程长短对VNS的治疗效果无影响。Objective To explore the efficacy of vagus nerve stimulation(VNS)for the treatment of drug resistant epilepsy.Methods The clinical data of 110 patients with drug resistant epilepsy who underwent VNS at Department of Neurosurgery,Provincial Hospital Affiliated to Anhui Medical University(the First Affiliated Hospital of University of Science and Technology of China)from February 2014 to March 2018 were analyzed retrospectively.The frequency and severity of seizures were followed up by outpatient review,and the efficacy was analyzed according to the McHugh seizure outcome classifications.Results The results of McHugh grade of 110 patients were as follows:gradeⅠA in 10 cases,gradeⅠB in 6,gradeⅡA in 25,gradeⅡB in 7,gradeⅢA in 30,gradeⅢB in 8,gradeⅣin 1 and gradeⅤin 20,and 3 patients were lost to follow-up.There was significant difference in seizure frequency between preoperative and postoperative conditions(P<0.001).None of the factors including the patient′s age,sex,type of seizure and course of disease would be associated with the difference above(all P>0.05).In terms of seizure types,there were significant difference in the distribution of the McHugh classifications between patients with seizures of unclassified onset,focal onset and generalized onset(all P<0.05).The frequency of seizures decreased gradually with prolonged VNS stimulation time(P<0.05).Conclusions VNS could significantly reduce the frequency of seizure.VNS has a better effect on seizures with focal onset and generalized onset,while it has a poor effect on seizure types that cannot be classified.With the increase of stimulation time,the therapeutic effect of VNS is gradually improved.However,the age,sex or duration of disease is not related to the effect of VNS.

关 键 词：癫痫 迷走神经刺激术 治疗结果 McHugh分级 

分 类 号：R74[医药卫生—神经病学与精神病学]