Vagus nerve stimulation for pharmacoresistant epilepsy secondary to encephalomalacia: A single-center retrospective study

被引:2
作者
Guo, Mengyi [1 ,2 ]
Wang, Jing [2 ]
Xiong, Zhonghua [1 ,2 ]
Deng, Jiahui [1 ]
Zhang, Jing [1 ,2 ]
Tang, Chongyang [1 ,3 ]
Kong, Xiangru [1 ]
Wang, Xiongfei [1 ,3 ]
Guan, Yuguang [1 ,3 ]
Zhou, Jian [1 ,3 ]
Zhai, Feng [1 ,3 ]
Luan, Guoming [1 ,3 ]
Li, Tianfu [1 ,2 ]
机构
[1] Capital Med Univ, Sanbo Brain Hosp, Dept Brain Inst, Beijing Inst Brain Disorders,Ctr Epilepsy,Beijing, Beijing, Peoples R China
[2] Capital Med Univ, Sanbo Brain Hosp, Beijing Inst Brain Disorders, Ctr Epilepsy,Dept Neurol, Beijing, Peoples R China
[3] Capital Med Univ, Sanbo Brain Hosp, Beijing Inst Brain Disorders, Ctr Epilepsy,Ctr Epilepsy,Beijing Key Lab Epilepsy, Beijing, Peoples R China
来源
FRONTIERS IN NEUROLOGY | 2023年 / 13卷
基金
中国国家自然科学基金;
关键词
encephalomalacia; pharmacoresistant epilepsy; vagus nerve stimulation; effectiveness; predictor; INTRACTABLE EPILEPSY; INTERICTAL EEG; CHILDREN; EFFICACY; PREDICTORS; THERAPY; VNS; METAANALYSIS; SAFETY;
D O I
10.3389/fneur.2022.1074997
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
ObjectiveVagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy. Encephalomalacia is one of the most common MRI findings in the preoperative evaluation of patients with pharmacoresistant epilepsy. This is the first study that aimed to determine the effectiveness of VNS for pharmacoresistant epilepsy secondary to encephalomalacia and evaluate the potential predictors of VNS effectiveness. MethodsWe retrospectively analyzed the seizure outcomes of VNS with at least 1 year of follow-up in all patients with pharmacoresistant epilepsy secondary to encephalomalacia. Based on the effectiveness of VNS (>= 50% or <50% reduction in seizure frequency), patients were divided into two subgroups: responders and non-responders. Preoperative data were analyzed to screen for potential predictors of VNS effectiveness. ResultsA total of 93 patients with epilepsy secondary to encephalomalacia who underwent VNS therapy were recruited. Responders were found in 64.5% of patients, and 16.1% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 36.6, 50.5, 64.5, and 65.4% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, seizure onset in adults (>18 years old) (OR: 0.236, 95%CI: 0.059-0.949) was found to be a positive predictor, and the bilateral interictal epileptic discharges (IEDs) (OR: 3.397, 95%CI: 1.148-10.054) and the bilateral encephalomalacia on MRI (OR: 3.193, 95%CI: 1.217-8.381) were found to be negative predictors of VNS effectiveness. ConclusionThe results demonstrated the effectiveness and safety of VNS therapy in patients with pharmacoresistant epilepsy secondary to encephalomalacia. Patients with seizure onset in adults (>18 years old), unilateral IEDs, or unilateral encephalomalacia on MRI were found to have better seizure outcomes after VNS therapy.
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页数:13
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