Objective

The effect of vagus nerve stimulation (VNS), an important auxiliary therapy for treating drug-resistant epilepsy (DRE), on autonomic nerve function is still controversial. Heart rate variability is a widely used indicator of autonomic nerve function. To clarify the relationship between VNS and heart rate variability (HRV), we performed a meta-analysis to systematically evaluate the effect of VNS on HRV in patients with epilepsy.

Methods

We performed a systematic review by searching the following online databases: PubMed, Web of Science, EMBASE and the Cochrane Library. The key search terms were “vagal nerve stimulation,” “epilepsy” and “heart rate variability”. Other features of VNS in patients with epilepsy include postoperative changes in low-frequency (LF), high-frequency (HF) and low-frequency/high-frequency (LF/HF) heart rate variability, which were used as evaluation indices, and the Newcastle-Ottawa Quality Assessment Scale and Stata 14.0 statistical software were used for literature quality evaluation and meta-analysis.

Results

Twelve studies published in English were obtained, and 229 patients with epilepsy who underwent VNS were ultimately included after elimination of duplicate articles and those that did not meet the inclusion criteria. Regarding LF heart rate variability, in the response subgroup, patients with DRE with VNS presented a lower value (-0.58) before surgery than after surgery, with a 95% confidence interval (CI) ranging from −1.00 to −0.15. For HF heart rate variability, patients with DRE with VNS had a lower value (-0.45) before surgery than after surgery in the response subgroup, with a 95% CI ranging from −0.74 to −0.17. No differences were found for LF/HF values or the LF and HF values of other subgroups.

Conclusion

VNS has little effect on the balance of sympathetic and parasympathetic nerve activity and would not be expected to cause cardiovascular autonomic dysfunction in patients with DRE. For patients with DRE, VNS can control seizures and has little effect on autonomic nervous function.

中文翻译：

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耐药性癫痫患者术前和术后心率变异性和迷走神经刺激的荟萃分析

客观的

迷走神经刺激（VNS）是治疗耐药性癫痫（DRE）的重要辅助疗法，其对自主神经功能的影响仍存在争议。心率变异性是一种广泛使用的自主神经功能指标。为了阐明 VNS 与心率变异性 (HRV) 之间的关系，我们进行了一项荟萃分析，以系统地评估 VNS 对癫痫患者 HRV 的影响。

方法

我们通过搜索以下在线数据库进行了系统评价：PubMed、Web of Science、EMBASE 和 Cochrane 图书馆。关键搜索词是“迷走神经刺激”、“癫痫”和“心率变异性”。癫痫患者 VNS 的其他特征包括术后低频 (LF)、高频 (HF) 和低频/高频 (LF/HF) 心率变异性的变化，用作评估指标，以及使用纽卡斯尔-渥太华质量评估量表和Stata 14.0统计软件进行文献质量评估和荟萃分析。

结果

获得了 12 篇英文发表的研究，在剔除重复文章和不符合纳入标准的文章后，最终纳入了 229 名接受 VNS 的癫痫患者。关于 LF 心率变异性，在响应亚组中，伴有 VNS 的 DRE 患者在手术前的值 (-0.58) 低于手术后，95% 的置信区间 (CI) 范围为 -1.00 至 -0.15。对于 HF 心率变异性，具有 VNS 的 DRE 患者在手术前的值 (-0.45) 低于响应亚组的手术后，95% CI 的范围为 -0.74 至 -0.17。LF/HF 值或其他亚组的 LF 和 HF 值没有发现差异。

结论

VNS 对交感神经和副交感神经活动的平衡影响不大，预计不会引起 DRE 患者的心血管自主神经功能障碍。对于DRE患者，VNS可以控制癫痫发作，对自主神经功能影响不大。