迷走神经刺激治疗耐药性癫痫：单中心经验的疗效和临床结果的预测因素分析

Vagus Nerve Stimulation for Drug Resistant Epilepsy: Efficacy and Predictors of Clinical Outcome in a Single Center Experience

摘要: 目的：本研究旨在评估迷走神经刺激(VNS)对难治性癫痫(DRE)患者的长期临床结果，并探讨影响VNS疗效的预测因素。方法：我们对2016年8月至2022年12月期间在安徽医科大学第一附属医院接受VNS植入的56例患者的医疗数据进行了回顾性分析。所有患者均进行了至少1年的随访。良好的临床疗效定义为癫痫发作频率降低不低于50%。二元逻辑回归分析用于识别显着影响疗效的变量。结果：我们的研究表明，长期慢性迷走神经刺激后癫痫发作频率显着降低。在最后一次随访时，26名患者(50%)疗效佳，6名(10.7%)患者无癫痫发作。在我们的研究中，二元逻辑回归分析没有发现任何显著影响疗效的预测因素。此外，31名患者(55.4%)报告在最后一次随访时生活质量(QOL)总体改善。植入后32名患者(57.1%)报告了轻微的短暂不良事件，其中最常见的是声音嘶哑。结论：我们的研究结果表明，长期慢性VNS治疗可以有效降低难治性癫痫患者的发作频率。并且观察到QOL的改善。然而，在我们的队列中没有发现显著影响疗效的预测因素。

Abstract: Objective: This study aimed to evaluate the long-term clinical outcomes of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE), and to investigate the predictors of VNS treatment efficacy. Methods: We conducted a retrospective analysis of medical data from 56 pa-tients who underwent VNS implantation at The First Affiliated Hospital of Anhui Medical University between August 2016 and December 2022. All patients were followed up for at least 1 year. A fa-vorable clinical responder was defined as a ≥50% reduction in seizure frequency. Binary logistic regression analysis was used to identify variables that significantly predicted responder status. Results: Our study demonstrated a significant reduction in seizure frequency after long-term chronic vagus nerve stimulation. At the final follow-up, 26 patients (50%) were responders and 6 (10.7%) patients were seizure-free. Binary logistic regression analysis did not identify any signifi-cant predictors of responder status in our cohort. Furthermore, 31 patients (55.4%) reported an overall improvement in quality of life (QOL) at the last follow-up. Mild transient adverse events were reported by 32 patients (57.1%) after implantation, with hoarseness being the most com-monly reported adverse event. Conclusion: Our study findings indicate that long-term chronic VNS treatment can effectively reduce seizure frequency in patients with drug-resistant epilepsy. Im-proved QOL and mild transient adverse events were also observed. However, no predictors of re-sponder status were identified in our cohort.