The Effect Of Vagus Nerve Stimulation In The Treatment Of Drug Refractory Epilepsy In Children

Objective: Objective to verify the safety and effectiveness of vagus nerve stimulation(VNS)in the treatment of drug-resistant epilepsy(DRE)in young children,explore the best stimulation parameters after VNS,and analyze the influence of VNS on the development of neurological function in young children.Methods: Six DRE children aged 3-6 years who were treated in the Affiliated Hospital of Zunyi Medical University from December 2017 to March 2018 were selected.The epileptic seizures(frequency,duration,type,etc.)in the three months before operation were collected.The average seizure condition of the three months before operation was taken as the baseline level,and the preoperative neurological function of the children was evaluated by Gesell score After the operation,the family members of the children were instructed to record the epileptic seizures through the epilepsy diary.The follow-up time nodes were 3 months,6 months,12 months,18 months and 24 months.Epilepsy diaries were collected and recorded during the follow-up,and adverse events were recorded during the follow-up period.The stimulation parameters were adjusted according to the epilepsy control situation of the children,and the neurological function changes were evaluated at 18 months after operation.The efficacy of VNS was evaluated by mean seizure reduction rate,response rate and McHugh classification.Statistical analysis of data before and after operation was performed by paired t test before and after operation,P <0.05,with significant difference.Results: The effective rates of grade I and grade III were 66.67% and 24.67%respectively at 12 months and 3 months after operation,respectively.During the follow-up,there were 1 case of chest wall incision redness and swelling,1 case of changing VNS device,1 case of transient cough and retching related adverse reactions caused by electrical stimulation.After repeated parameter program-controlled adjustment,the best effect was achieved when the stimulation current was 1.22 ± 0.52 ma,the pulse width was 500 μ s,the stimulation frequency was 10-30 hz,the stimulation parameters were 30 s,and the interval time was 3-30 min.The results of Gesell score at 18 months after operation showed that the adaptability,large movement,fine movement,language and personal social intercourse were significantly improved after operation,and the difference was statistically significant.Conclusion: VNS is safe and effective for children with DRE,and the effect has time accumulation effect.For children with VNS,the effect of high parameter stimulation may be better than that of low parameter stimulation.At the same time,VNS can improve the development of nervous function and the quality of life of children with DRE.