摘要：

目的 探讨迷走神经刺激术治疗药物难治性癫痫的疗效和术后最佳刺激参数。方法 共71 例药物难治性癫痫患者均接受迷走神经刺激术，McHugh 分级评价手术疗效，术后行刺激参数调试以达到最佳疗效。结果 本组患者术后随访3 ~ 56 个月、中位值22 个月，癫痫发作频率较术前减少［18（3，92）次/月对30（5，145）次/月；Z = 826.500，P = 0.000］。发作频率减少< 50%者20 例（28.17%）、≥ 50%者51 例（71.83%），其中27 例（38.03%）发作频率减少≥ 80%，14 例（19.72%）发作停止。本组有8 例（11.27%）使用磁铁后发作严重程度减轻。结论 迷走神经刺激术是一种治疗药物难治性癫痫安全、有效的方法。最佳刺激参数一般为刺激电流1.00 ~ 1.75 mA，0.75 mA 也是有效刺激电流，同时需综合多个参数调试以达到最佳疗效。

关键词: 癫痫,  迷走神经, 电刺激疗法

Abstract:

Objective  To explore the curative effect and parameter settings of vagus nerve stimulation (VNS) therapy in refractory epilepsy. Methods VNS was performed in 71 patients with drug-resistant epilepsy, and McHugh classification was used to evaluate the curative effect of VNS. Programmable pulse parameters included output current, frequency, pulse width, and On/Off times. The optimum settings for each patient should balance the goals of maximizing efficacy, minimizing side effects, and preserving battery life. Results  After operation, all patients were followed up for 3-56 months (median 22 months), and experienced a significantly reduced seizure frequency compared with before operation [18 (3, 92) vs 30 (5, 145) times/month; Z = 826.500, P = 0.000]. In these patients, 20 cases (28.17% ) had < 50% reduction of seizure frequency, and 51 cases (71.83% ) had ≥ 50% reduction of seizure frequency, including 27 cases (38.03%) with ≥ 80% reduction and 14 cases (19.72%) with seizure free. Seizure termination or seizure diminution was reported in 8 patients (11.27% ) after using magnet. Conclusions  VNS is a safe and effective therapy in medically refractory epilepsy. Optimized output current is generally 1.00-1.75 mA, however, 0.75 mA is also an efficient current. Besides, parameter settings should be considered to reach the maximizing efficacy.

Key words: Epilepsy, Vagus nerve, Electric stimulation therapy