胼胝体切开术与迷走神经刺激术治疗儿童耐药性癫痫疗效对比  

Efficacy comparison of corpus callosotomy versus vagus nerve stimulation in children with drug-refractory epilepsy

作　　者：蔡璞 刘长青[1] 栾国明[1] Cai Pu;Liu Changqing;Luan Guoming(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《中华小儿外科杂志》2021年第10期872-877,共6页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(81790654)。

摘　　要：目的探讨运用胼胝体切开术(corpus callosotomy,CC)和迷走神经刺激术(vagus nerve stimulation,VNS)治疗儿童耐药性癫痫(drug-resistant epilepsy,DRE)的疗效对比。方法2008年1月至2013年12月首都医科大学三博脑科医院神经外科收治了55例接受CC或VNS治疗的患儿。其中,男41例,女14例;平均年龄为7.2岁,年龄范围为1.6~13.9岁;病程时间范围为1.2~10.0年;术前用药的平均种类数量为2.3种。将30例行CC治疗的患儿作为胼胝体切开术组(CC组),其中男20例,女10例。将25例行VNS的患儿作为迷走神经刺激术组(VNS组);其中男21例,女4例。收集患儿的性别、年龄、病程、临床诊断、服用抗癫痫药物种类、影像学检查结果、对≥6岁的患儿使用韦氏儿童智力量表(wechsler intelligence scale for children,WISC)第四版(WISC-IV)、对<6岁的患儿使用Gesell发育量表评分等临床资料进行分析,对术后1年、3年的复查随访结果,比较癫痫发作频率、不同发作类型的手术有效率、Gesell发育量表评分、WISC-IV量表评分。结果①在术后癫痫发作控制情况方面,CC组在术后1年、3年的癫痫发作消失的有效率分别为16.7%(5/30)和40.0%(12/30),术后1年、3年的癫痫发作减少≥75%(不含发作消失)的有效率分别为20.0%(6/30)和16.7%(5/30),术后1年、3年的癫痫发作减少情况在50%<发作减少<75%的有效率分别为40.0%(12/30)和13.3%(4/30),术后1年、3年的癫痫发作减少≤50%的有效率分别为76.7%(23/30)和70.0%(21/30)。VNS组在术后1年、3年的癫痫发作消失的有效率分别为12.0%(3/25)和4.0%(1/25),术后1年、3年的癫痫发作减少≥75%(不含发作消失)的有效率分别为24.0%(6/25)和12.0%(3/25),术后1年、3年的癫痫发作减少情况在50%<发作减少<75%的有效率分别为12.0%(3/25)和32.0%(8/25),术后1年、3年的癫痫发作减少≤50%的有效率分别为40.0%(10/25)和56.0%(14/25)。CC组与VNS组在术后1年癫痫发作减少≤50%的有效率之间�Objective To explore the efficacy of corpus callosotomy(CC)versus vagus nerve stimulation(VNS)in the treatment of drug-refractory epilepsy(DRE)in children and evaluate their advantages and disadvantages.Methods Clinical data were reviewed for 55 hospitalized children receiving CC/VNS from January 2008 to December 2013.There were 41 boys and 14 girls with a mean age of 7.2(1.6-13.9)years.The duration of disease ranged from 1.2 to 10.0 years.The average number of preoperative medication category was 2.3.Thirty CC children(20 boys,10 girls)were treated as the group of corpus callosotomy(CC).Twenty-five VNS children(21 boys,4 girls)were treated as VNS group.Gender,age,course of disease,clinical diagnosis,types of antiepileptics,imaging findings and children aged≥6 years were analyzed by the Wechsler Intelligence Scale for Children(WISC-IV).Follow-up results of 1/3 year postoperatively were collected for comparing the frequency of seizures,surgical efficiency of different seizure types,Gesell developmental scale scores and WISC-IV scores.Results In terms of postoperative seizure control,the effective rate of seizure disappearance at 1/3 years postoperatively in CC group was 16.7%(5/30)and 40.0%(12/30)respectively.The effective rates were 20.0%(6/30)and 16.7%(5/30)for seizure reduction≥75%(excluding disappearance of seizures)at 1/3 year postoperatively.The effective rates were 40.0%(12/30)and 13.3%(4/30)for seizure reduction of 50%<seizure reduction<75%at 1/3 years postoperatively respectively.The effective rates were 76.7%(23/30)and 70.0%(21/30)respectively.In VNS group,the effective rates of seizure disappearance at 1/3 years postoperatively were 12.0%(3/25)and 4.0%(1/25)and the effective rates of seizure reduction≥75%(excluding seizure disappearance)at 1/3 years postoperatively 24.0%(6/25)and 12.0%(3/25)respectively.The effective rates were 12.0%(3/25)and 32.0%(8/25)for seizure reduction of 50%<seizure reduction<75%at 1/3 years postoperatively and 40.0%(10/25)and 56.0%(14/25)for seizure reduction of 50%at 1/3

关 键 词：儿童 耐药性癫痫 胼胝体切开术 迷走神经刺激术 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]