The Study Of Efficacy And Quality Of Life Of Vagus Nerve Stimulation In The Treatment Of Refractory Epilepsy In Adolescents

BackgroundVagus nerve stimulation(VNS),as a method of epilepsy surgical treatment of drug refractory epilepsy,has been gradually applied in China,and has achieved good results in decreasing seizures and improving quality of life in children and adults.The number of clinical treatment cases in China is increasing year by year,but there may be differences in the efficacy of VNS at different ages.Adolescents are at an important stage of psychological and physiological function improvement and emotional establishment,Children or adults by age which can not reflect the real postoperative efficacy of the adolescents.There is less study on refractory epilepsy in adolescents.This study will help them get better treatment.ObjectiveThe effect of vagus nerve stimulation adolescents with intractable epilepsy patients of surgery and quality of life.MethodsGeneral clinical data of 13 patients with refractory epilepsy were collected.Before VNS operation,MRI,video dynamic EEG and PET/SPECT were performed to obtain brain structure imaging,electrophysiology and paroxysmal symptomatology data.The frequency,duration,medication and quality of life of the patients were recorded before and after the operation.During the follow-up period,the blood concentration of antiepileptic drugs was monitored regularly to keep it within the effective range.The family members or patients recorded the epilepsy diary.Taking the seizure frequency and quality of life score at 1 month before operation as control evaluate the postoperative efficacy.Evaluation was performed at 3 months,6 months,12 months.QOLIE-AD-48 was used to assess the qualityof life of 11~17 years old patients(including memory / attention,shame,health perception,social support,physical function,school performance,attitude towards epilepsy and epilepsy effect).All patients underwent left VNS surgery and the stimulations were started at 2 weeks postoperation.The change of severity of seizure frequency and the improvement of life quality were recorded.T-test and spearman correlation test statistical method were used to analyze the efficacy.ResultsAfter 12 months follow-up,the overall seizure attack frequency of 13 patients decreased by 60.1% compared with that before operation.The seizure frequency of 8patients(61.5%)decreased by more than 50%,and that of 5 patients(38.5%)decreased by less than 50%.It was significantly improved compared with that before operation(P =0.001).The severity of attack in 10 patients(76.9%)was significantly reduced compared with that before the operation,while that in the remaining 3 patients(23.1%)was not significantly improved.The overall duration of the attack was significantly shorter than that before the operation(P=0.003).the seizure frequency decreased by 33.3%,48.4% and60.1% at 3,6 and 12 months,respectively.The total score of quality of life increased from59.15±13.56 to 66.07±14.02(P = 0.008).The scores of each subscale were higher than those before operation,and epilepsy impact,memory/attention,shame and school performance were statistically significant.The mean over all and eight subjects of QOLIE-AD-48 score did not correlate with changes in seizure frequency.ConclusionsVagus nerve stimulation can reduce seizure frequency and duration and improve quality of life in adolescent.The longer the treatment,the better the seizure control.In addition,the study also found that the degree of improvement of quality of life was not related to the seizure control,in other words,when seizure control is not ideal,the quality of life of patients may also be improved.