| Background and ObjectiveCerebral palsy(CP)is primarily a chronic neurological disorder affecting limb movement,postural development,and muscle tone in affected children,caused by brain injury in the developing fetus or infant.Although the disorder itself is non-progressive,the clinical presentation changes over time as the brain matures.Its global prevalence is has progressed to 2-3 cases per 1000 live births.Approximately 25-45%of children with cerebral palsy worldwide currently have seizures.And during the treatment and rehabilitation of children with cerebral palsy,epilepsy is a frequent and difficult problem encountered by clinicians.Seizures in children with cerebral palsy can further exacerbate brain damage,worsen motor and cognitive deficits,and have a significant negative impact on rehabilitation,as well as on mental recovery and improvement of cerebral palsy.The prognosis for epilepsy in children with cerebral palsy is often poor,with half of them developing drug-refractory epilepsy.Cerebral palsy with drug-refractory epilepsy has a high disability rate and has become a serious public health problem that needs to be addressed because of the long duration of the disease,the many complications,the difficulty of care,and the poor prognosis of the child,which places a huge burden on society and the family,especially the mother.Therefore,the ability to provide early and sustained effective seizure control in children with cerebral palsy will directly affect the long-term prognosis of children with cerebral palsy.The use of common carotid sympathetic nerve net stripping for the treatment of children with cerebral palsy not only improves muscle tone and motor function,but also helps to improve their quality of life and cognitive function,and therefore this procedure is widely used in the treatment of cerebral palsy in China.In the case of drug-refractory epilepsy,the most effective treatment is surgery,and the current surgical treatment modalities include epileptic focal resection and palliative surgery.iVNS is considered an effective palliative surgical approach for drug-refractory epilepsy and has been recognized for reducing seizure frequency,alleviating seizures,improving cognitive function,and improving quality of life.However,there are few reports of these two surgical modalities acting together in cerebral palsy with drug-refractory epilepsy.Therefore,in this paper,we conducted an amount evaluation of the factors affecting the efficacy of iVNS in patients with cerebral palsy with drug-refractory epilepsy,and a long-term postoperative follow-up of children with cerebral palsy with drug-refractory epilepsy who underwent combined treatment with common carotid sympathetic nerve net stripping and iVNS,and systematically evaluated the combined procedure on muscle tone,motor ability,seizures,and quality of life in children with cerebral palsy with drug-refractory epilepsy The long-term effects of combined surgery on muscle tone,motor ability,seizures,and quality of life and cognitive function in children with cerebral palsy with medically refractory epilepsy were systematically assessed.This study provides an effective approach to the treatment of children with cerebral palsy with medically refractory epilepsy.Chapter One Multifactorial analysis of factors affecting the efficacy of iVNS in children with cerebral palsy with drug-refractory epilepsyMethodsThe clinical data of 58 children with cerebral palsy with drug-refractory epilepsy admitted to the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to March 2018 were retrospectively included.Registration information included gender,seizure status of children before and after iVNS surgery(AEDs use,seizure frequency,and dominant seizure type),age of onset of epilepsy,age of iVNS implantation,IQ,modified As worth spasticity classification,and whether they received CCASNS.At 1 year follow-up,the seizure control efficiency was counted,and the relationship between influencing factors and outcome was evaluated using univariate and multifactorial analyses.Results.1.The seizure control efficiency of 58 children was 48.3%and 50.0%at 6 months and 1 year after surgery,respectively,and 3 and 2 achieved complete seizure control without seizures,respectively.2.Univariate Analysis Among the responders,more children with cerebral palsy with focal seizures(55.2%)were more likely to be responders(72.4%)who underwent concurrent carotid sympathetic nerve net stripping at the time of iVNS implantation.Gender,age at seizure onset,age at iVNS implantation,use of AEDs,seizure frequency,modified Asworth spasticity classification,and IQ were not associated with iVNS efficacy.The dominant seizure type,seizure frequency and the receipt of common carotid sympathetic net stripping were significant factors influencing the efficacy of iVNS(P<0.05).3.whether or not to receive common carotid sympathetic net stripping were independent influencing factors on the response to iVNS in children with cerebral palsy.Conclusion1.iVNS is a well-tolerated,effective,and safe adjunctive treatment for cerebral palsy with drug-refractory epilepsy.2.Children with cerebral palsy with drug-refractory epilepsy who undergo carotid sympathetic net dissection may respond better to iVNS.The combination of common carotid sympathetic net dissection may allow children with cerebral palsy with medication-refractory epilepsy to benefit more from iVNS treatment.Chapter Two Clinical effect of iVNS combined with CCASNS in the treatment of children with cerebral palsy with drug-refractory epilepsyMethodsSixty-six patients with cerebral palsy with drug-refractory epilepsy at the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to September 2019 in finger love were retrospectively included.Among them,32 patients who received CCASNS+iVNS were the combined group,and 34 patients who received iVNS only were the iVNS group.The time of surgery,bleeding volume,postoperative hospital days,hospital expenses and postoperative complications were counted in both groups,and the follow-up reviews 3 months before surgery,6 months after surgery,1 year after surgery and every year thereafter were selected as the assessment points,which included muscle tone,limb motor function,epilepsy control,IQ,AEDs use,quality of life score,cognitive function score and family burden.Results.There were statistically significant differences between the two groups in terms of operative time and hospitalization cost(P<0.05),whereas there were no statistically significant differences in terms of bleeding,mean postoperative hospitalization time,and postoperative complications(P>0.05).In the combined group,the differences in the postoperative modified Asworth muscle tone evaluation and Fine Motor Function Measure(FMFM)scores were statistically significant(P<0.05)compared with the preoperative and iVNS group,and the differences in the control group were not statistically significant(P>0.05)compared with the preoperative group.The difference between the two groups was statistically significant(P<0.05),and the seizure control was better in the combined group than in the iVNS group.The difference in the Pediatric Quality of Life(PEDSQLTM)questionnaire and the Caregiver Burden Scale(CBS)between the two groups was statistically significant(P<0.05).ConclusionIn patients with cerebral palsy with drug-refractory epilepsy,implantable vagus nerve stimulation combined with common carotid sympathetic nerve net stripping is safe and feasible,has good clinical outcomes,provides better seizure control than implantable vagus nerve stimulation alone,and significantly improves quality of life and cognitive function in children with cerebral palsy with drug-refractory epilepsy. |
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