摘要
目的 探讨迷走神经刺激术治疗顽固性癫痫的治疗效果和机制。方法 2004年4月-2006年12月，11例顽固性癫痫进行了迷走神经刺激治疗，其中3例为脑炎后部分性继发全身发作，3例为Lenonx-CastautSyndrome（LGS），另外5例为原因不明的全身强直阵挛性发作。手术在全麻下进行，在甲状软骨水平左侧胸锁乳突肌前缘作3cm皮肤切口，分离肌肉并显示左侧迷走神经干约3cm，将螺旋型迷走神经刺激电极缠绕于迷走神经干上，在左腋前线作一皮肤切口，将刺激器置入皮下并与刺激电极相连接及固定。术后2周开机，调试参数，刺激电流从0．25mA逐渐调至1．5mA，刺激模式为：刺激时间为30秒，间歇5分钟，脉宽为500～1000μs，频率为30Hz。结果 术后3个月～2年随访，癫痫发作频率平均减少60％，发作程度减轻，全身强直阵挛性发作明显减少，精神状态明显改善。结论 迷走神经刺激手术创伤小，副作用少，术后能减少病人发作的频率，提高病人生活质量，对不适合开颅手术的难治性癫痫是一种有效的治疗方法。
Objective To explore the effectiveness and mechanism of VNS therapy in intractable epilepsy. Methods Vagus Nerve Stimulation were performed in eleven patients from April 2004 to December 2006, three patients with secondarily generalized partial seizures after cephalitis （multi-lesion）, three patients with Lenonx-Gastaut Syndrome （LGS）, others with generalized seizures. All patients have tried more than two antiepilepsy drugs without effect. The operation was conducted under general anaesthesia, 3cm long incision was made in the front of left sternocleidomastoid near thyroid cartilage. Left vagus nerve stem was exposed, gyrate electrode of VNS device was wrapped the cervical vagus nerve stern. The skin incision was made in left side of the chest wall and VNS generator was implanted, electrode was connected with generator and fixed. The generator was turned on 2 weeks after operation. Stimulation parameters were 30seconds ON and 5minutes OFF, the frequency was 30Hz, and the pulse width was from 500μs to 1000μs. The output currents adjusted from 0. 25mA to 1.5mA. Results After 0. 5-2 years of intermittent stimulation of the left vagal nerve, a seizure frequency was reduced by 60% occurred in all patients. Tonicoclonic seizures were significantly controlled and the seizure severity was alleviated significantly. Measures of neuropsychological test showed a moderate improvement in mental functioning, behavior, and mood. Conclusion VNS is a minimal invasive surgery with few side effects. It can obviously reduce seizure frequency, and greatly improve the quality of life in patients with epilepsy. It is also an alternative and better way for patients with refractory epilepsy.
出处
《立体定向和功能性神经外科杂志》
2007年第2期72-76,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
迷走神经
刺激
癫痫
Vagus nerve Stimulation Epilepsy
