儿童药物难治性癫痫迷走神经刺激术机械刺激效应对疗效影响的初步研究  

Preliminary observation of the mechanical stimulation effect on the therapeutic outcome of vagus nerve stimulation for children with drug-resistant epilepsy

作　　者：李云林[1] 谭泊静[1] 龚铭鲲 陈倩[2] 马康平[1] 易林华[1] 秦广彪[1] 毛莹莹[2] 姬辛娜[2] 刘晓娇 Li Yunlin;Tan Bojing;Gong Minghun;Chen Qian;Ma Kangping;Yi Linhua;Qin Guangbiao;Mao Yingying;Ji Xinna;Liu Xiaojiao(Department of Neurosurgery,Children's Hospital Afiliated 10 Capital Instinute of Pediatrics,Beijing 100020,China;Department of Neurology,Children's Hopital Afiliated to Capital Instiute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院神经外科,北京100020 [2]首都儿科研究所附属儿童医院神经内科,北京100020

出　　处：《中华神经外科杂志》2021年第4期365-368,共4页Chinese Journal of Neurosurgery

摘　　要：目的初步观察儿童药物难治性癫痫患者迷走神经刺激术机械刺激效应(简称“蜜月期”效应)对后期疗效的影响.方法回顾性分析2016年10月至2019年12月首都儿科研究所附属儿童医院神经外科接受迷走神经刺激术治疗的81例儿童药物难治性癫痫患者的临床资料.在术后未开机刺激、仅有机械刺激的情况下,患儿癫痫发作频率降低≥50%,定义为存在“蜜月期”效应.所有患儿均接受迷走神经刺激治疗以及为期1年以上的随访(≥2次).随访内容主要包括患儿癫痫发作控制情况、有无“蜜月期”效应及其持续时间.癫痫发作控制效果采用McHugh量表评估,Ⅰ、Ⅱ级(发作频率降低≥50%)为治疗有效,Ⅲ~Ⅴ级(发作频率降低<50%)为治疗无效.分析不同年龄、性别、病程、病因及有无“蜜月期”对疗效的影响.比较出现“蜜月期”的患儿中,治疗有效者与治疗无效者的“蜜月期”效应持续时间是否存在差异.结果81例患儿均顺利完成手术.81例患儿的随访时间中位数(范围)为27.6(12~47)个月.至末次随访,McHugh分级为Ⅰ级41例,Ⅱ级15例,Ⅲ级9例,Ⅳ~Ⅴ级16例.22例患儿出现“蜜月期”效应,其中Ⅰ、Ⅱ级共16例,Ⅲ~Ⅴ级共6例;“蜜月期”效应的持续时间中位数(范围)为23(10~115)d.比较不同McHugh癫痫疗效分级患儿的性别、年龄、病程、病因及有无“蜜月期”效应,差异均无统计学意义(均P>0.05).出现“蜜月期”效应的患儿治疗有效率为72.7%(16/22),而未出现者治疗有效率为67.8%(40/59),两组比较差异无统计学意义(P>0.05).22例出现“蜜月期”效应的患儿中,治疗有效者比无效者的“蜜月期”持续时间长,差异有统计学意义[中位时间(范围)分别为28(11~115)d和13(10~15)d;U=9.000,P<0.01].结论初步研究未观察到药物难治性癫痫患儿迷走神经刺激术后出现“蜜月期”效应对疗效有影响,但出现“蜜月期”效应的患儿中,治疗有�Objective To preliminarily observe the mechanical stimulation ffect("honeymoon period"effeet)on the later therapeutie effect of vagus nerve stimulation(VNS)in children with drug-resistant epilepsy.Methods The clinical data of 81 children with drug-resistant epilepsy who underwent VNS at Department of Neurosurgery,Children's Hospital Afiliated to Capital Institute of Pediatrics from October 2016 to December 2019 were retrospectively analyzed.The MSE(mechanical stimulation effect)was defined as the decrease of epileptic seizure frequency≥50% in pediatrie patients with merely mechanical stimulation and no electrical stimulation when the device was not turned on.All children in this series were treated with VNS and fllowed up for over 1 year(≥2 times).The content of the follow-up mainly included the control of epileptic scizures,presence or absence of MSE and their durations.The ffect of epileptic seizure control was evaluated based on the MeHugh scale.Grades Ⅰ and Ⅱ(seizure frequency reduetion≥50%)were considered as efective,and grades Ⅱ and Ⅴ(seizure frequency reduction<50%)as ineffctive.We then analyzed the relationship of age,gender,etiology and the presence or absence of MSE to the therapeutic effet of VNS.Among the patients with"honeymoon period"ffet,the duration of MSE was compared between those who demonstrated flectiveness and those who did not.Results All 81 patients underwent successful operations and were ollowed up for a median(range)of 27.6(12-47)months.At the last follow-up,the MeHugh grades of 81 patients were grade Ⅰ in 41 cases,grade Ⅱ in 15,grade Ⅱ in 9,and grade Ⅳ or Ⅴ in 16.The MSE was observed in 22 children,out of whom 16 reported grade Ⅰ or Ⅱ and 6 cases reported grade Ⅱ or Ⅳ.The median(range)of MSE duration was 23(10-115)days.There was no statistical difference in genders,ages,course,etiology and the presence or absence of MSE between patients with diferent MeHugh grade(all P>0.05).The flfective rate of patients with MSE was 72.7%(16/22),while the ffective rate

关 键 词：癫痫 儿童 迷走神经 治疗结果 机械刺激效应 

分 类 号：R742.1[医药卫生—神经病学与精神病学]