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首页> 外文期刊>Seizure: the journal of the British Epilepsy Association >Long-term outcome after callosotomy or vagus nerve stimulation in consecutive prospective cohorts of children with Lennox-Gastaut or Lennox-like syndrome and non-specific MRI findings
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Long-term outcome after callosotomy or vagus nerve stimulation in consecutive prospective cohorts of children with Lennox-Gastaut or Lennox-like syndrome and non-specific MRI findings

机译：Lennox-Gastaut或Lennox样综合征和非特异性MRI表现的儿童的连续预期队列中，在切开血管或迷走神经刺激后的长期结局

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Purpose: There is currently no resective (potentially curative) surgical option that is useful in patients with Lennox-Gastaut syndrome. Palliative procedures such as callosotomy (Cx), vagus nerve stimulation (VNS) or deep brain stimulation have been offered. We compared the outcomes after Cx or VNS in two consecutive prospective cohorts of patients with generalised epilepsy. Methods: Twenty-four patients underwent callosotomy from 2006 to 2007 (Group 1); 20 additional patients were submitted to VNS from 2008 to 2009 (Group 2). They had generalised epilepsy of the Lennox-Gastaut or Lennox-like type. They were submitted to a neurological interview and examination, interictal and ictal video-EEG, high resolution 1.5 T MRI, and cognitive and quality of life evaluations. The two-year post-operative follow-up results were evaluated for each patient. Results: The final mean stimuli intensity was 3.0 mA in the Group 2 patients. Seizure-free patients accounted for 10% in Group 1 and none in Group 2. Ten and sixteen percent of the Group 1 and 2 patients, respectively, were non-responders. Improvements in attention and quality of life were noted in 85% of both Group 1 and 2 patients. Rupture of the secondary bilateral synchrony was noted in 85% of Group 1 patients; there was no EEG modification after VNS in Group 2. Both procedures were effective regarding the control of atypical absences and generalised tonic-clonic seizures. Both procedures were not effective in controlling tonic seizures. Callosotomy was very effective in reducing the frequency of atonic seizures, but VNS was ineffective. In contrast, callosotomy was not effective in reducing myoclonic seizures, whereas VNS was. Discussion: Callosotomy might be preferred as the primary treatment in children with Lennox-Gastaut syndrome, and no specific findings on MRI if atonic seizures prevail in the patient's clinical picture; when myoclonic seizures prevail, the same might hold true in favour of VNS. When atypical absence or generalised tonic-clonic seizures are the main concern, although both procedures carry similar effectiveness, VNS might be considered a good option as an initial approach, taking into account the adverse event profile. Patients should be advised that both procedures are not very effective in the treatment of tonic seizures.
机译：目的：目前尚无对Lennox-Gastaut综合征患者有用的切除术（可能治愈）。已经提供了姑息治疗，如切开血管（Cx），迷走神经刺激（VNS）或深部脑刺激。我们比较了连续性癫痫患者的两个连续前瞻性队列中Cx或VNS后的结局。方法：2006年至2007年，对24例患者进行了剖切术（第1组）。从2008年到2009年，又有20名患者接受了VNS治疗（第2组）。他们患有Lennox-Gastaut或Lennox样类型的全身性癫痫病。他们接受了神经科访谈和检查，发作期和发作期视频EEG，高分辨率1.5 T MRI以及认知和生活质量评估。对每位患者的术后两年随访结果进行评估。结果：第2组患者的最终平均刺激强度为3.0 mA。无癫痫患者在第1组中占10％，在第2组中无一例。第1组和2组患者中分别有10％和16％是无反应者。第1组和第2组患者中有85％的注意力和生活质量得到改善。第1组85％的患者发生继发性双侧同步性破裂;在第2组中，VNS后没有发生脑电图改变。两种方法在控制非典型性失神和全身性强直阵挛性癫痫发作方面均有效。两种方法均不能有效控制强直性癫痫发作。骨切开术在减少无症状性癫痫发作的频率方面非常有效，但VNS无效。相比之下，骨切开术在减少肌阵挛性癫痫发作方面无效，而VNS则有效。讨论：对于Lennox-Gastaut综合征的患儿，应首选切开术作为主要治疗方法，并且如果患者的临床表现中普遍存在失音性癫痫发作，则在MRI上没有特定的发现。当肌阵挛性发作盛行时，支持VNS可能同样适用。当主要关注非典型性缺乏或全身性强直-阵挛性癫痫发作时，尽管两种手术均具有相似的效果，但考虑到不良事件的发生，VNS可能被认为是一种不错的选择。应告知患者，这两种方法对强直性癫痫发作的治疗都不是很有效。

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