The Effect Of Vagus Nerve Stimulation For Drug Refractory Epilepsy Patients Of Surgery And Cognitive

ObjectiveTo investigate the effect of vagus nerve stimulation (VNS) in the treatment of intractable epilepsy and the evaluation of the cognitive function.Methods12 cases of intractable epilepsy patients, preoperative were symptoms, neuroimaging, neurophysiological examination comprehensive evaluation, including video electroencephalogram (EEG), magnetic resonance imaging, PET/SPECT etc. shows for intracranial multiple/widely induced epileptogenic focus or epileptogenic foci in functional areas, not suitable for craniotomy. The situation and cognitive function of preoperative epileptic seizures in patients. To preoperative 1 month epilepsy attack as a comparison baseline, records of patients with seizure frequency, seizure duration, medication, regular follow-up after operation. During the study of serum antiepileptic drug (AED) concentration level detection and maintain patients with stable blood drug concentration, and by patients or their families recorded seizure diary. In 7 days before surgery to cognitive scores as compared to the baseline, postoperative 3 months,6 months,12 months,18 months and thereafter every six month assessment, the Montreal Cognitive Assessment Scale for the evaluation of cognitive function. Patients underwent surgery under general anesthesia and left vagus nerve implant stimulation system.2 weeks after the wound without redness, leakage can boot stimulation. The frequency of seizures, the duration of seizures, and the improvement of the cognitive function were compared before and after the follow-up.ResultsDuring the follow-up of 12 months, the average frequency of attack in 12 patients was reduced by 62.65%(SD=25.01).8 cases (66.7%) patients with reduction in seizure frequency is more than 50%, including 2 cases (16.7%) patients during the follow-up period of seizure.4 patients (33.3%) had a reduction of the frequency of attack by<50%. Patients with Montreal cognitive assessment table scores before surgery 7 days average score of 1908 (SD=4.96. After 3 months the average score of 22.25 SD=4.61. After 6 months the average score of 2.342 SD=3.78, postoperative 12 months scored an average of 25.16 (SD=2.94). The average MoCA score of 12 months after surgery was 6.08 (P=0.01). The improvement of cognitive function was statistically significant. In addition, the improvement of cognitive function in patients with epilepsy was not related to epilepsy improvement.ConclusionsVagus nerve stimulation is a drug in the treatment of refractory epilepsy is a safe and effective method, can reduce the seizure frequency and shortened the seizure duration, and the longer the treatment, seizure control effect is better; epilepsy patients after operation with the extension of treatment time, cognitive function can gradually improve. In addition, the study also found that the degree of improvement of the cognitive function of patients was not related to the seizure control that is the epileptic seizure control is not ideal, the cognitive function of the patients may also improve.