Objective:

We describe a multicenter experience with vagus nerve stimulator implantation in pediatric patients with drug-resistant epilepsy. Our goal was to assess vagus nerve stimulation efficacy and identify potential predictors of favorable outcome.

Methods:

This is a retrospective study. Inclusion criteria: ≤18 years at time of vagus nerve stimulator implantation, at least 1 year of follow-up. All patients were previously found to be unsuitable for an excisional procedure. Favorable clinical outcome and effective vagus nerve stimulation therapy were defined as seizure reduction >50%. Outcome data were reviewed at 1, 2, 3, and 5 years after vagus nerve stimulator implantation. Fisher exact test and multiple logistic regression analysis were employed.

Results:

Eighty-nine patients met inclusion criteria. Responder rate (seizure frequency reduction >50%) at 1-year follow-up was 25.8% (4.5% seizure-free). At last follow-up, 31.5% had a favorable outcome and 5.2% were seizure free. The only factor significantly predicting favorable outcome was time to vagus nerve stimulator implantation, with the best outcome achieved when vagus nerve stimulator implantation was performed within 3 years of seizure onset. Implantation between 3 and 5 years after epilepsy onset correlated with better long-term seizure freedom (13.3% at T5). Overall, 65.2% of patients evidenced improved quality of life at last follow-up. However, 12.4% had adverse events, but most were mild and disappeared after 3-4 months.

Conclusions:

Early vagus nerve stimulator implantation within 5 years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients. Improved quality of life and a low incidence of significant adverse events were observed.

中文翻译：

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早期植入是儿童难治性癫痫迷走神经刺激反应的主要预测指标

客观的：

我们描述了在患有耐药性癫痫的儿科患者中植入迷走神经刺激器的多中心经验。我们的目标是评估迷走神经刺激的功效并确定有利结果的潜在预测因素。

方法：

这是一项回顾性研究。纳入标准：迷走神经刺激器植入时≤18年，至少随访1年。之前发现所有患者都不适合切除手术。良好的临床结果和有效的迷走神经刺激治疗被定义为癫痫发作减少>50%。在迷走神经刺激器植入后 1、2、3 和 5 年审查结果数据。采用Fisher精确检验和多元逻辑回归分析。

结果：

89 名患者符合纳入标准。1 年随访时的反应率（癫痫发作频率降低 >50%）为 25.8%（4.5% 无癫痫发作）。最后一次随访时，31.5% 的患者预后良好，5.2% 的患者无癫痫发作。显着预测有利结果的唯一因素是迷走神经刺激器植入的时间，最好的结果是在癫痫发作后 3 年内进行迷走神经刺激器植入。癫痫发作后 3 至 5 年之间的植入与更好的长期无癫痫发作相关（T5 时为 13.3%）。总体而言，65.2% 的患者在最后一次随访时证明生活质量有所改善。然而，12.4% 的患者出现了不良事件，但大多数是轻微的，并在 3-4 个月后消失。

结论：

癫痫发作后 5 年内早期植入迷走神经刺激器是儿科患者临床预后良好的唯一预测因素。观察到生活质量提高和显着不良事件发生率低。