Efficacy analysis of vagus nerve stimulation in treatment of drug-resistant epilepsy
Objective To investigate the clinical efficacy and influencing factors of vagus nerve stimulation(VNS)for drug-resistant epilepsy.Methods The clinical data of 61 patients diagnosed with drug-refractory epilepsy and treated with VNS in the Epilepsy Center,the Second People's Hospital of Hunan Province(Hunan Brain Hospital)from January 2016 to January 2023 were retrospectively collected.Apiong them,there were 28 cases of primary disease,4 cases of epilepsy due to brain trauma,4 cases of stroke,and 25 cases of other secondary etiologies.The disease duration was 7.21±1.87 years(0.5-18.0 years),and 2(1,3)types of antiseizure drugs[M(Q1,Q3)]were taken.Preoperative Quality of Life in Epilepsy-31(QOLIE-31)score of patients was 59.18±6.66.Patients were clinically followed up at 6,12 and 18 months after VNS,and their quality of life was assessed using the QOLIE-31 score.McHugh grading criteria were used to evaluate the therapeutic effect of VNS 18 months after surgery,and the factors that might affect postoperative effect were analyzed.Results The VNS operations were successfully completed in 61 patients.After operation,5 patients(8.20％)had transient adverse reactions,including transient hoarseness in 3 cases and nausea in 2 cases at the first boot.Sixty-one patients took 2(1,3)types of antiseizure drugs[M(Q1,Q3)]after surgery,and there was no statistically significant difference compared with preoperative levels(Z=-0.83,P=0.405).The scores of QOLIE-31 were 82.50±1.82,87.80±3.11 and 88.11±3.11 at 6,12 and 18 months after operation respectively.The scores of QOLIE-31 were significantly different before and after surgery(F=849.68,P＜0.001).Compared with preoperative conditions,the QOLIE-31 scores were higher at different postoperative times,and the differences were statistically significant(all P＜0.05).At 18 months after surgery,13 cases were classified as McHugh grade Ⅰ,24 cases as grade Ⅱ,13 cases as grade Ⅲ,8 cases as grade Ⅳ,and 3 cases as grade V.There were no significant differences in age,gender,type of medication,seizure type,brain MRI results,or the origin of VEEG seizures among patients with different MuHugh grades(all P＞0.05).Patients with MuHugh grades Ⅰ-Ⅱ have a shorter disease course than those with grades Ⅲ-Ⅴ.Among patients with traumatic brain injury,stroke,and other secondary causes,patients with MuHugh grades Ⅰ-Ⅱ have a higher proportion than those with grades Ⅲ-Ⅴ,and the differences are statistically significant(both P＜0.05).Conclusions VNS can effectively treat drug-refractory epilepsy and improve the quality of life of patients.VNS seems to be associated with better therapeutic effects for patients with short disease duration and epilepsy caused by stroke,traumatic brain injury and other subsequent factors.
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