난치성 간질에 대한 미주 신경 자극술의 임상경험
Clinical Experiences with vagus Nerve Stimulation for Medically Intractable Epilepsy
신일영, 임효주, 이정교, 강중구, 이상암, 고태성,
소속 상세정보
신일영 ( Shin Il-Young )
울산대학교 의과대학 서울아산병원 신경외과학교실
임효주 ( Lim Hyo-Joo )
울산대학교 의과대학 신경외과학교실
이정교 ( Lee Jung-Kyo )
울산대학교 의과대학 서울아산병원 신경외과학교실
강중구 ( Kang Joong-Koo )
울산대학교 의과대학 서울아산병원 신경과학교실
이상암 ( Lee Sang-Ahm )
울산대학교 의과대학 서울아산병원 신경과학교실
고태성 ( Ko Tae-Sung )
울산대학교 의과대학 서울아산병원 소아과학교실
KMID : 0877220050090010080
Abstract
Purpose: Recently, Vagus nerve stimulation (VNS) has been reported to show promising results as an adjunctive therapy for medically intractable seizures. We report early experiences with VNS for medically intractable epilepsy in young adults and pediatric patients.
Methods: Eleven patients ages ranging from 7 years to 29 years underwent implantation of vagal nerve stimulators (Cyberonics, Houston, TX) from September 1999 to April 2003. We reviewed clinical findings in 11 patients and recorded changes of seizure frequency, quality of life (QOL), and antiepileptic drug (AED).
Results: The mean age of seizure onset was 4.5 years old (range:3 months-11 years). The seizure duration before VNS was mean 8.7 years (range:1.5-19 years). Seven patients had symptomatic partial epilepsies, and one had cryptogenic partial epilepsy. Unclassified patients had 2 Lennox-Gastaut syndrome and 1 reflex epilepsy. Two patients received total callosotomy for reducing drop attack, but refractory. One patient, who underwent a temporal lobectomy, failed to obtain desirable results. One implantation was performed with total callosotomy, simultaneously. All of implantations were successful, except for one wound revision due to a subcutaneously protruded anchoring device of electrode. About two weeks after the implantation, programming of the stimuli was started and increased the output current to the levels, at which patients was tolerated. The most common adverse effect was hoarseness or voice alteration (44%). Mean reduction of seizure frequency compared with baseline before VNS was 23.6% after 3 months, 33.5% after 6 months, 41.3% after 1 year, and 46.6% at latest follow-up. Three patients had no response to VNS. One patient was added 1 one new AED after VNS. Two patients were reduced 1 or 2 drugs. But there was no correlation between VNS effect and AED change. Six patients had some improvement of QOL. Mean follow-up period, which was 28 months (range:12-48 months).
Conclusions: We concluded that VNS has a role of adjunctive therapy for medically intractable epilepsy and the further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximal efficacy in patients with various backgrounds.
키워드
Medically Intractable Epilepsy;Seizure frequency
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